点阵激光的临床应用进展

由于点阵激光具有疗效肯定,安全性高和停工期短等优点,已成功用于治疗痤疮瘢痕和光老化等.与传统的剥脱性和非剥脱性激光不同,点阵激光仅作用部分皮肤,保留周围正常皮肤,从而有利于快速愈合和减少停工期.点阵激光通过微治疗孔传递高能量到达真皮层,从而保证疗效,而避免传统剥脱性激光容易出现的风险为持续性色素减退和瘢痕.概述近几年剥脱性和非剥脱性点阵激光在瘢痕、光老化、萎缩纹、色素性疾病、脱发和点阵激光经皮给药等的临床应用、机制和疗效.     

Affirm非剥脱性点阵激光治疗激光术后色素减退临床疗效观察

目的观察Affirm非剥脱性点阵激光治疗激光术后色素减退的临床疗效和安全性。方法选取18例激光术后色素减退的患者,采用Affirm非剥脱性点阵激光治疗,光斑14mm,1320nm波长能量6.0～8.0J/cm^2,1440nm波长能量1～2J/cm^2。每部位扫描3～4次,共治疗10次,每4周1次,术后严格防晒。每次由2名固定医师同时对每例患者色素减退恢复情况按5级分类进行评分并摄相。结果 18例患者经过10次治疗,16.7%患者色素恢复等级达到5级,27.8%患者色素恢复等级达到4级,33.3%患者色素恢复等级达到3级,16.7%患者色素恢复等级达到2级,5%患者色素恢复等级达到1级。每次治疗对色素恢复等级评分的平均值进行t检验,差异具有统计学意义（P〈0.05）。结论 Affirm非剥脱性点阵激光治疗激光术后色素减退疗效确切,安全性高,无明显不良反应,为临床治疗色素减退提供一种新的治疗手段。     

激光治疗脱发的研究进展

激光不仅可以单独治疗脱发,而且能够通过激光辅助给药增强局部抗脱发药物的生物利用度。本文从低能量激光、点阵激光、准分子激光以及激光辅助给药等四个方面分别阐述脱发治疗的最新研究进展。     

1 565nm非剥脱点阵激光联合超分子水杨酸治疗面部轻中度痤疮的疗效观察

目的 探究1 565nm非剥脱点阵激光联合超分子水杨酸治疗面部轻中度痤疮的临床疗效.方法 收集2018年3月-2019年6月就诊的99例面部轻中度痤疮患者,随机分为超分子水杨酸组(33例)、1 565nm非剥脱点阵激光组(33例)和联合治疗组(33例).其中超分子水杨酸组予以超分子水杨酸治疗,1 565nm非剥脱点阵激...     

1540nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑的临床观察

目的评价1 540 nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑的疗效性和安全性。方法将入选的105例黄褐斑患者随机分为3组,各35例,联合治疗组接受1 540 nm非剥脱点阵激光联合氨甲环酸治疗,激光组仅接受1 540 nm非剥脱点阵激光治疗,药物组仅接受氨甲环酸治疗。1 540 nm非剥脱点阵激光治疗1次/月,6次为1个疗程,氨甲环酸片口服,250 mg/次,2次/d,疗程6个月。疗程结束后比较3组患者的临床疗效及安全性。结果联合治疗组、激光组和药物组有效率分别为80.00%,47.06%,51.52%,联合治疗组与对照组间疗效差异有统计学意义(P0.05)。结论 1 540 nm非剥脱点阵激光联合氨甲环酸治疗黄褐斑可获得较好的疗效性和安全性,疗效优于单用1 540 nm非剥脱点阵激光或单用氨甲环酸治疗。     

点阵激光在皮肤科的临床应用及进展

点阵激光第一次报道于2004年,是为得到明显美容效果和最低风险美容技术而引进市场的。与传统的剥脱和非剥脱激光不同的是,剥脱点阵激光和非剥脱点阵激光治疗的仅仅是皮肤的一小部分,最多可有约95%的皮肤不受累,未受损害的周围组织包绕受损组织可使表皮迅速修复。2006年FDA批准非剥脱性点阵激光可用于治疗色素损害、眶周皱纹、皮肤重塑、黄褐斑、软组织凝结、痤疮瘢痕、外科瘢痕和光化性角化症。2007年这个概念被进一步发展到剥脱性点阵激光(Er:YAG或CO2激光),这些设备由FDA明确指出用于治疗各种皱纹、组织结构不平整、色素损伤和血管皮肤变色。本文就剥脱和非剥脱点阵激光这两个概念及其技术细节和临床指征进行了综述。     

1565 nm非剥脱点阵激光联合糖皮质激素治疗增生性瘢痕疗效评价

目的：评价1565 nm非剥脱点阵激光联合糖皮质激素治疗增生性瘢痕患者的疗效。方法：将增生性瘢痕患者随机分成对照组和观察组，观察组给予醋酸曲安奈德注射和1565 nm非剥脱点阵激光治疗(能量10～70 mJ，能量密度50～500 J/cm2),对照组仅给予醋酸曲安奈德注射,利用温哥华瘢痕评分量表(Vancouwer scar scale，VSS)对瘢痕的色泽、质地、厚度等进行评分。结果：共收集患者60例，对照组和观察组各30例，观察组和对照组总体有效率为93.4%和70%，差异具有统计学意义(P<0.05)。观察组VSS评分平均值为2.18低于对照组的3.68，差异具有统计学意义(P<0.05)。两个组均未见明显不良反应。结论：1565 nm非剥脱点阵激光联合糖皮质激素注射治疗增生性瘢痕的疗效优于单用糖皮质激素注射。     

点阵激光治疗黄褐斑进展

点阵激光是皮肤激光美容领域的一种新技术,近年来在黄褐斑的治疗中显示出良好的前景.点阵激光的作用原理是局灶性光热作用,是选择性光热作用的一个重要拓展和延伸.点阵激光可分为非剥脱性点阵激光和剥脱性点阵激光,对黄褐斑有一定的疗效,改善程度不一,有的甚至加重,其疗效与治疗参数的选择、皮肤类型、术后护理、黄褐斑类型等有关.不良反应主要为短暂性红斑、水肿、灼热和疼痛感等,患者可耐受,但炎症后色素沉着发生率相对较高.     

激光治疗痤疮瘢痕的研究进展

痤疮是常见病之一,多数人曾患有不同程度的痤疮,少数患者可遗留痤疮瘢痕,目前尽管有很多方法,包括手术、激光和化学剥脱等可治疗痤疮瘢痕,但其治疗仍是棘手难题.近年来点阵激光的开展给痤疮瘢痕治疗带来一定的突破.从痤疮瘢痕的流行病学、病因、临床特征和各种激光器(包括剥脱性激光、非剥脱性激光和点阵激光)在痤疮瘢痕的临床应用、优缺点和不良反应等方面进行阐述.     

激光辅助透皮给药技术应用于皮肤科的进展

激光具备精准、可控性高和技术成熟的优点广泛应用于临床,在辅助透皮给药技术时激光能通过改变皮肤屏障来提高药物的渗透量和作用深度,其中剥脱性点阵激光因创伤小、不良反应少,能有效增加渗透率而作为首选.影响疗效的主要因素可分为点阵激光的覆盖率、能量及药物的封包时间和相对分子质量.在皮肤科临床,剥脱性点阵激光辅助透皮给药技术能有效提高皮肤基底细胞癌、光线性角化病和增生性瘢痕的疗效,降低甲氨蝶呤治疗银屑病的药物浓度,不论是动物实验还是临床试验均证明其应用于一些皮肤病治疗的可行性.     

Fractional non-ablative laser-assisted drug delivery leads to improvement in male and female pattern hair loss

Androgenetic alopecia, also known as male and female pattern hair loss, is a very prevalent condition; however, approved therapeutic options are limited. Fractionated laser has been proposed to assist in penetration of topical medications to the cutaneous tissue. We present four cases of androgenetic alopecia that underwent treatment with a non-ablative erbium glass fractional laser followed by the application of topical finasteride 0,05% and growth factors including basic fibroblast growth factor, insulin-like growth factor, vascular endothelial growth factor, and copper peptide 1%. During all laser treatment sessions, eight passes were performed, at 7 mJ, 3–9% of coverage and density of 120 mzt/cm². A positive response was observed in all of the four patients. Photographs taken 2 weeks after the last session showed improvement in hair regrowth and density. No significant side effects were observed.     

The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars

Fractional ablative carbon dioxide laser resurfacing is a frontline treatment for acne scars. It creates multiple microscopic treatment zones to accelerate the collagen formation and the healing process of reepithelialization, according the principle of fractional photothermolysis. At present, the fractional CO₂ laser with a wavelength of 10,600 nm is commonly used in the field of cosmetology and clinical therapies for various skin diseases, and it can effectively improve skin regeneration and scar formation. To obtain satisfactory results for patients with scars, repetitive fractional laser therapy is always required; however, this treatment could easily lead to complications such as erythema, edema, infection, and post‐inflammatory hyperpigmentation. In addition, different types of acne scars may have different responses to laser, further limiting its widespread use. In recent studies both home and abroad, a new pattern of fractional laser combined with other therapies to improve acne scar has been recommended to guarantee the safety and effective of treatment. This article reviews the recent pertinent literatures and summarized the progression of ablative fractional CO₂ laser combined with other therapies on acne scar.     

Combined fractional resurfacing (10600 nm/1540 nm): Tridimensional imaging evaluation of a new device for skin rejuvenation

In this study were described the results, by tridimensional imaging evaluation, of the new “Combined Fractional Resurfacing” technique with the first fractional laser that overtakes the limits of traditional ablative, nonablative fractional resurfacing by combining CO₂ ablative and GaAs nonablative lasers. These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients. In this study, it is demonstrated that the simultaneous combination of the CO₂ wavelength (10600 nm) and GaAs wavelength (1540 nm) reduced the downtime, reduced pain during the treatment, and produced better results on fine wrinkles reduction and almost the same results on pigmentation as seen with 3D analysis by Antera (Miravex).     

光疗法在斑秃中的应用

近年来,光疗治疗斑秃取得较好疗效。本文对PUVA疗法、长波紫外线A1、308nm单频准分子光和准分子激光、红外线,低能量激光疗法及点阵二氧化碳激光在斑秃治疗中的应用进行综述。     

5%米诺地尔酊联合670nm+830nm激光治疗雄激素性脱发的疗效评价

目的：评价670nm+830nm激光联合5%米诺地尔酊对雄激素性秃发的疗效。方法：将60例雄激素性秃发患者随机分为治疗组与对照组：对照组单纯外用5%米诺地尔酊治疗,治疗组在对照组基础上加用670nm+830nm激光照射治疗,每周治疗2次,30分钟/次,6个月后进行疗效评定。结果：实际完成治疗及观察人数58例（实验组2例失访),治疗组总有效率为85.7％,对照组为53.3％,差异显著（χ2=10.02 ,P<0.01）,两组不良反应发生率无显著差异(χ2=0 ,P>0.05）。结论：670nm+830nm激光联合5%米诺地尔酊治疗雄激素性秃发安全、有效,可推广应用。     

Alopecia: a review of laser and light therapies

Since the 1980s, laser technology has become increasingly popular to treat a variety of cutaneous conditions. Its successful use as an epilator comes with the rare but interesting side effect of paradoxical hypertrichosis. In this review, we summarize cases describing hair growth after photoepilation, as well as studies testing laser and light sources as treatment for alopecia, particularly androgenetic alopecia and alopecia areata. We also discuss the possible biologic mechanisms by which phototherapy induces hair regeneration.     

Association of androgenetic alopecia and hypertension

Androgenetic alopecia is considered to be associated with coronary heart disease but the explanation of this association remains unknown. Hypertension is highly prevalent in patients with coronary heart disease. Essential hypertension is linked to hyperaldosteronism and spironolactone, an antihypertensive drug which is a mineralocorticoid receptor antagonist, has been used for a long time in the treatment of androgenic alopecia. We recently observed in a double transgenic mouse model that overexpression of a mineralocorticoid receptor targeted to the skin induced the development of alopecia.We prospectively studied the association of hypertension and androgenetic alopecia in Caucasian men. Two hundred and fifty Caucasian men aged 35-65 years were consecutively recruited by 5 general practitioners (50 per practitioner). Data collected included age, androgenetic alopecia score with a simplified Norwood's score (0-4), blood pressure or history of hypertension, smoking, history of diabetes mellitus or hyperlipidemia, familial history of androgenetic alopecia, and treatment. Chi-square, Fisher exact tests and linear regression model were used for statistical analysis.Hypertension was strongly associated to androgenetic alopecia (p < 0.001). Linear regression tests confirmed that this association was independent of age : odds ratio was 2.195 (95% CI : 1.1-4.3). Familial history of androgenetic alopecia was also strongly associated with androgenetic alopecia : odds ratio was 10.870 (95% CI : 4.3-27.1). Other variables (diabetes mellitus, hyperlipidemia, smoking, treatment) were not associated with androgenetic alopecia.We were limited by a relatively small study sample but in this study androgenetic alopecia was strongly associated with hypertension. Association of androgenetic alopecia and hyperaldosteronism warrants additional studies. The use of specific mineralocorticoid receptor antagonists could be of interest in the treatment of androgenetic alopecia.     

CO2点阵激光联合308 nm准分子激光治疗白癜风疗效和安全性meta分析

目的：评价CO₂点阵激光联合308 nm准分子激光治疗白癜风的临床疗效和安全性。方法：通过检索Cochrane Library、PubMed、Embase、万方、中国知网、维普数据库,收集CO₂点阵激光与308 nm准分子激光联合治疗白癜风相关的文献,运用软件（Revman 5.3）进行Meta分析。结果：13篇临床随机对照实验被纳入,其中1014处皮损给予CO₂点阵激光与308 nm准分子激光联合治疗,1005处皮损给予308 nm准分子激光单独治疗。结果显示：联合疗法总有效率和显效率优于单用308 nm准分子激光;两组不良反应发生率无明显差异。结论： CO₂点阵激光+308 nm准分子激光联合治疗白癜风的疗效优于单独使用308 nm准分子激光,且两种疗法的不良反应没有明显差异。     

益肾活血汤治疗雄激素依赖性脱发的临床观察

目的　观察益肾活血汤治疗雄激素依赖性脱发的临床疗效及对患者血液流变学的影响。方法　采用益肾活血汤治疗 86例雄激素依赖性脱发患者 ,观察治疗效果及对血液流变学的影响。结果　临床治疗有效率 61.6%。血液黏度、血浆黏度、红细胞压积比、红细胞聚集指数、红细胞刚性指数、纤维蛋白原等血液流变学指标治疗后与治疗前比较均有显著性下降 (P均 <0 .0 5 )。结论　益肾活血汤能降低雄激素依赖性脱发患者的血液黏度 ,治疗雄激素依赖性脱发有较好的临床效果。