点阵式Er：YAG激光治疗痤疮瘢痕及毛孔粗大的疗效观察

目的 探讨点阵式掺铒钇铝石榴石（Er:YAG）激光对于面部凹陷性痤疮瘢痕及毛孔粗大的疗效。方法 轻至中度凹陷性痤疮瘢痕41例,予中长脉宽、能量800 ～ 1200 mJ、定点连续发射4 ～ 8个脉冲。毛孔粗大23例,予中脉宽、能量800 ～ 1000 mJ、定点连续发射2 ～ 4个脉冲。疗程为3 ～ 5次,每次间隔1个月。由医生对治疗后皮损改善程度进行评价,由患者对疗效进行满意度评价。应用三维皮肤成像仪获取皮肤立体图像,评价治疗对皮肤粗糙度的影响。结果 医生评估痤疮瘢痕患者皮损改善程度为82.93%,毛孔粗大患者皮损改善程度为86.96%;两种皮损患者满意率分别为88.80%和91.30%;与治疗前相比,治疗后表示粗糙度的Ra值及Rz值分别下降18.74%和21.01%（P < 0.001）。结论 点阵式Er:YAG激光可有效改善面部轻中度凹陷性痤疮瘢痕及毛孔粗大。     

皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性比较

【摘要】 目的 通过前瞻性、半脸对照研究,比较皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性。方法 2015年10月至2017年10月在中国医学科学院皮肤病医院激光科收集面部对称性萎缩性痤疮瘢痕患者,左侧面部痤疮瘢痕采用超脉冲CO2点阵激光治疗,右侧采用皮秒翠绿宝石激光点阵模式治疗,治疗间隔为2个月,共治疗3次。治疗前后由皮肤科医生根据ECCA评价表对瘢痕进行评分,患者根据四分法自评临床疗效。记录治疗时疼痛程度和不良反应。两侧间、治疗前后ECCA评分及疼痛程度评分比较采用配对t检验,组间四分法评分比较采用 Wilcoxon 秩和检验。结果 治疗前皮秒激光侧和点阵激光侧间ECCA评分差异无统计学意义（t = 1.06,P = 0.300）,治疗3次后差异有统计学意义［（70.98 ± 21.48）分比（58.04 ± 17.63）分,t = 3.76,P = 0.001］。与治疗前相比,皮秒激光侧瘢痕改善评分（2.21 ± 1.09）分,CO2点阵激光侧（2.83 ± 1.11）分,两组差异有统计学意义（z = 2.70,P = 0.007）。与CO2点阵激光侧相比,皮秒激光侧不良反应更少,表现为一过性红斑、水肿,治疗疼痛评分亦明显降低［（3.71 ± 0.62）分比（6.23 ± 1.06）分,t = 11.93,P < 0.001］。结论 皮秒翠绿宝石激光与超脉冲CO2点阵激光均能有效改善萎缩性痤疮瘢痕,CO2点阵激光疗效更显著,而皮秒激光不良反应更少。     

The pinhole method using an erbium: YAG laser for the treatment of papular acne scars

Papular acne scars are skin‐colored or hypopigmented, soft and elevated lesions of the chin and trunk. Papular scars are one of the most difficult acne scars to treat. Herein, we reported two patients with papular acne scars on the chin that were successfully treated by the pinhole method using an Erbium (ER):YAG laser. Good cosmetic results were achieved in both patients. The side effects included mild, intra‐, and post‐procedural pain and erythema that resolved spontaneously within 2 weeks. The pinhole method with an Er:YAG laser could potentially be used as a safe and effective treatment for papular acne scars.     

Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars

Ablative laser resurfacing is an effective treatment for atrophic acne scars. However, it often induces complications such as edema, prolonged erythema, scarring and hyperpigmentation. Therefore, a new concept of laser treatment called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation treatment of atrophic acne scars. This study was designed to prospectively evaluate the use of a technique similar to fractional photothermolysis using only the standard CO₂ laser without the fractional laser device in the treatment of atrophic scars and demonstrates it as a safe, effective and economical treatment option. Clinical improvement was achieved in all 35 patients with minimal adverse effects.     

CO_2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕的临床分析

目的:评价CO2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕的临床疗效和安全性。方法:对纳入的20例萎缩性痤疮瘢痕患者进行病例对照研究,每例患者治疗2个疗程,治疗后3个月进行疗效和安全性评价,对治疗前后萎缩性痤疮瘢痕严重程度评分,评估临床疗效和不良反应,同时统计患者主观评价。结果:所有患者瘢痕严重程度评分由治疗前(64.3±19.8)分下降至(39.8±14.3)分,改善百分比达(37.6±9.6)%,其中17例患者认为皮损明显或显著改善,无严重不良反应。结论:CO2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕,是一种安全有效的新型治疗方法。     

Successful treatment of acne keloidalis nuchae with erbium:YAG laser: a comparative study

Background: Acne keloidalis nuchae (AKN) is a chronic inflammatory disease involving hair follicles of the neck. It is a form of keloidal scarring alopecia that is often refractory to medical or surgical management.

Objective: To evaluate the efficacy of Er:YAG laser in the treatment of AKN as compared to long pulsed Nd:YAG laser. Patients and

Methods: This study was conducted on 30 male patients with AKN. Their ages ranged from 19 to 47 years with a mean age of 36.87 ± 7.8 years. Patients were divided randomly into two groups of 15 patients, each receiving six sessions of either Er:YAG or long-pulsed Nd:YAG laser therapy.

Results: A statistically significant decrease in the number of papules was detected at the end of therapy in both groups, with a mean of 91.8% improvement in the Er:YAG group versus 88% in the Nd:YAG group. A significant decrease in plaques count was detected only in the Er: YAG group while a significant decrease in plaques size and consistency was recorded in both groups.

Conclusion: The Er: YAG laser proved to be a potentially effective and safe modality both in the early and late AKN lesions.     

Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: A comparative randomized split-scar trial

Introduction: Keloids and hypertrophic scars are benign fibrous growths that occur after trauma or wounding of the skin and present a major therapeutic problem. Objective: The purpose of this study is to evaluate and compare the effectiveness of pulsed dye laser (PDL) versus Nd:YAG laser in hypertrophic scar and keloid. Methods: Twenty patients with hypertrophic scars and keloid were included in this prospective, randomized, split-scar study. Half of each scar was randomized to treatment with a 595-nm PDL and the contralateral half with the 1064-nm Nd:YAG. Each patient received 6 laser treatment sessions at 1-month intervals. The scars were evaluated at baseline and one month after the last laser session using the Vancouver scar scale (VSS). Results: One month after the last laser treatment, final total VSS analysis of treated sites by PDL and long-pulsed Nd:YAG laser revealed significant improvements (p < 0.001), whereas the average percentage of improvement in the total VSS was 55.14% for PDL and 65.44% for Nd:YAG laser. However, there were no statistically significant differences between PDL- and long-pulsed Nd:YAG laser-treated sites for total VSS (p = 0.074). Limitations: This was a single-center non-controlled trial, which included a small number of patients and subjective outcome measures. Conclusion: PDL and long-pulsed Nd:YAG laser treatments for keloid and hypertrophic scar provide significant improvement with insignificant difference between both modalities.     

Treatment of atrophic facial acne scars with fractional Er:Yag laser

Background: Acne scars are often a permanent disfiguring sequel of acne vulgaris. Although many treatment modalities are available, they are often non satisfactory for all patients. Objective: To determine the effectiveness and safety of fractional 1540 nm erbium_glass laser treatment of facial acne scars in Iraqi patients. Patients and methods: Twenty one patients were enrolled in this prospective clinical study. Three sessions of the 1540 nm erbium glass laser were applied at 2-week intervals. The patients were assessed at 1, 3, and 6 months after the last session. The effect of treatment was assessed by objective (Sharquie scoring system for grading acne scarring and visual analog scale) and subjective (patient satisfaction) methods. Results: Two patients were defaulted. Eleven patients (57.9%) showed improvement from moderate to mild grade, and no grade changes were detected in eight patients (42.1%). The mean score of the visual analog scale prior to treatment was 8.61 ± 0.86 and decreased to 6.15 ± 1.28 (P = 0.037). Ten patients were satisfied to varying degrees. No significant side effects were noted. Conclusion: Non-ablative fractional 1540 nm erbium glass laser is an effective and safe method to treat acne scars and represent good alternative for patients who cannot use the ablative methods because of its longer downtime.     

Safety and efficacy of hybrid energy and trifractional technologies in the treatment of acne scars: An open-label clinical trial

Introduction: This study determines the safety and efficacy of a novel device—Surgen that utilizes hybrid energy (HE) technology and trifractional (TF) technology in the treatment of acne scars in Filipino patients. Methods: Open-label clinical trial on eight subjects who underwent 4 weekly HE treatments followed by 2 TF treatments spaced 3 weeks apart. Efficacy was evaluated by dermatologists’ (investigator and two blinded dermatologists) and patients’ assessment and grading of post-treatment digital photographs. Subjects also reported level of satisfaction and comfort. Adverse events were recorded. Results: Dermatologists’ grading of acne scars improvement—58.3% of subjects showed slight to moderate improvement, 8.3% showed marked improvement, and 33.3% was graded as unchanged after HE treatments. After 2 additional TF treatments grades improved further, with 37.5% showing mild to moderate improvement, 37.5% showing marked improvement, and 25% graded as unchanged. Dermatologist's scoring using the global acne scoring system resulted in improvement of 75% of patients after 4 HE sessions and 100% after TF treatments. Subjects’ grading showed a similar trend: 75% of subjects reported that they were satisfied and 25% slightly satisfied after the complete protocol. Conclusion: A treatment protocol combining HE and TF technology is safe, effective, and comfortable in the treatment of acne scars.     

Fractional picosecond laser for atrophic acne scars: A meta-analysis

Background

Conventional fractional lasers (FLs) are well-established treatments for acne scars with some inevitable adverse events. Fractional picosecond laser (FPL) is increasingly used for acne scars.

Aims

To compare the efficacy and safety of FPL with non-picosecond FLs for acne scars.

Methods

PubMed, Embase, Ovid, Cochrane Library, and Web of Science databases were searched. We also searched ClinicalTrials, WHO ICTRP, and ISRCTN websites. A meta-analysis was conducted to assess the clinical improvement and adverse events after FPL compared with other FLs.

Results

Overall, seven eligible studies were included. Three physician evaluation systems showed no difference between FPL and other FLs in clinical improvement of atrophic acne scars (MD = 0.64, 95% CI:−9.67 to 10.94; MD = −0.14, 95% CI:-0.71 to 0.43; RR = 0.81, 95% CI:0.32 to 2.01). Patient-assessed effectiveness was also not significantly different between FPL and other FLs (RR = 1.00, 95% CI:0.69 to 1.46). Although temporary pinpoint bleeding was more common after FPL (RR = 30.33, 95% CI:6.14 to 149.8), the incidence of post-inflammatory hyperpigmentation (PIH) and pain level were lower for FPL (RR = 0.16, 95% CI:0.06 to 0.45; MD = −1.99, 95% CI:−3.36 to −0.62). Additionally, edema severity after treatment did not differ between the two groups (MD = −0.35, 95% CI:−0.72 to 0.02). As for the duration of erythema, no difference between FPL and nonablative FL groups (MD = −1.88, 95% CI:−6.28 to 2.51).

Conclusions

FPL seems similar to other FLs regarding clinical improvement of atrophic acne scars. With lower PIH risk and pain scores, FPL is more suitable for acne scar patients prone to PIH or sensitive to pain.     

Fractional CO2 laser for the treatment of acne scars

Background Numerous reports have been published on skin rejuvenation by the so‐called fractional laser device that delivers a laser beam in a dot form over a grid pattern. Aims In this study, we characterized the effects of a fractional CO₂ laser on atrophic acne scars at the clinical and ultrastructural levels. Methods Seven healthy adult Japanese volunteers (aged 32–46 years, mean 37.6, five men and two women of Fitzpatrick skin type III) were recruited for this study. A fractional CO₂ laser device, SmartXide DOT (DEKA, Florence, Italy), was used with irradiation parameters set as follows: output power 10 W, pulse width 600 μs, dot spacing 800 μm, and stack 2 (irradiation output power 0.91 J/cm²). A clinical examination and punch biopsy of each subject was performed before and just after the irradiation, and also at week 3 after three irradiation sessions. The biopsy specimens were stained with toluidine blue and were examined ultrastructurally. Results Clinical improvement of the atrophic acne scars was observed at week 3 after the third irradiation session in all cases compared with the condition before treatment. Histologically, outgrowths of many degenerated elastic fibers were observed as irregular rod‐shaped masses in the superficial dermis prior to the treatment in the region of the acne scars. At week 3 after the third irradiation, the degenerated elastic fibers were no longer observed, and the elastic fibers were elaunin‐like. Conclusions The fractional CO₂ laser is considered to be very effective for treating atrophic acne scars.     

A randomized,split-face clinical trial of Q-switched alexandrite laser versus Q-switched Nd:YAG laser in the treatment of bilateral nevus of Ota

Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.     

Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: A split-face comparative study

Objective: To evaluate the efficacy and side effects of 1550-nm fractional Er:Glass laser in treating atrophic acne scar. Materials and methods: Thirty Chinese patients aged 18–65 with atrophic acne scars on both cheeks received a split-face treatment, one side with four sessions of treatment with fractional 1550-nm Er:Glass laser at 20-day interval and the other with topical asiaticoside cream application three times daily as control. Clinical response and side effects were evaluated by a dermatologist three weeks after each treatment and again 12 weeks after the last laser treatment. In addition, self-evaluation of satisfaction by the patients was done at the end of treatment. Results: The study found that mean scores decrease after treatment was 5.65 ± 4.34 for the treated side and 1.23 ± 3.41 for the control side. The improvement in acne scars after the fractional Er:Glass laser 1550-nm treatment was more significant than the control side (p = 0.0001). The side effects were mainly local skin irritation and erythema, which disappeared within one week. Conclusion: The research results show that the fractional 1550-nm Er:Glass laser is an effective and safe treatment device for atrophic acne scars.     

Clinical trial of a laser device called fractional photothermolysis system for acne scars

Ablative laser resurfacing is an effective treatment for acne scars. However, edema and prolonged erythema are common. Additionally, scarring and hyperpigmentation are often induced. A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. We treated 10 patients with acne scars using this laser system (Reliant Fraxel SR Laser). All the patients were successfully treated with minimal adverse effects. The fractional photothermolysis system represents an optional method for the treatment of acne scars.     

Atrophic acne scar treatment using triple combination therapy: Dot peeling,subcision and fractional laser

Abstract

Atrophic scars are a common complication of acne. Many modalities are proposed but each does not yield satisfactory clinical outcomes. Thus, a new combination therapy is suggested that incorporates (i) dot peeling, the focal application and tattooing of higher trichloroacetic acid concentrations; (ii) subcision, the process by which there is separation of the acne scar from the underlying skin; and (iii) fractional laser irradiation. In this pilot study, the efficacy and safety of this method was investigated for the treatment of acne scars. Ten patients received this therapy for a year. Dot peeling and subcision were performed twice 2–3 months apart and fractional laser irradiation was performed every 3–4 weeks. Outcomes were assessed using scar severity scores and patients’ subjective ratings. Acne scarring improved in all of the patients completing this study. Acne scar severity scores decreased by a mean of 55.3%. Eighty percent of the patients felt significant or marked improvement. There were no significant complications at the treatment sites. It would appear that triple combination therapy is a safe and very effective combination treatment modality for a variety of atrophic acne scars.