低能量密度1064nm QS Nd:YAG激光治疗黄褐斑疗效观察

目的观察低能量密度Q开关Nd:YAG激光治疗面部黄褐斑的疗效和安全性。方法应用波长为1064nm的Q开关Nd:YAG激光低能量密度治疗17例面部黄褐斑患者,1次/w,10次为一疗程,治疗结束后随访12周。根据患者MASI评分降低值和患者满意度对疗效进行评价。结果 17例患者中,9例(52.9%)患者达到显著改善及痊愈。平均皮损改善级别为2.53级,起效平均次数3.18次,MASI评分平均降低了6.55分,患者满意率82.3%。部分患者在术中轻微灼痛、术后数十分钟有轻至中度红斑。结论低能量密度Q开关Nd:YAG激光治疗面部黄褐斑疗效确切,不良反应轻。     

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.     

A prospective,randomized, double-blinded,split-face pilot study comparing Q-switched 1064-nm Nd:YAG versus 532-nm Nd:YAG laser for the treatment of solar lentigines

Treating photoaging with laser technologies has increased in popularity due to their efficacy, minimal downtime, and side effects. New Q-Switched (QS) Nd:YAG lasers’ frequency doubled with 532 nm wavelength can both target epidermal chromophores as well as stimulate collagen production. The objective of this study was to compare single-pulsed 1064-nm Nd:YAG with dual-pulsed 532-nm/1064-nm QS laser for reducing solar lentigines. Ten subjects with solar lentigines were enrolled in this prospective, randomized, double-blind, split-face study. Subjects received six laser treatments (half-face dual, half single) at 2-week intervals. Blinded investigator and subject assessments were conducted 1 month posttreatment to evaluate global skin improvement, safety, and patient satisfaction. Blinded investigator assessments showed statistically significant improvement in the dual-treated side. Patient satisfaction was also statistically significantly increased in the dual-treated side. In conclusion, dual laser treatment can result in superior and safe global improvement of photoaging.     

Salicylic acid peeling combined with vitamin C mesotherapy versus salicylic acid peeling alone in the treatment of mixed type melasma: A comparative study

Introduction: Melasma is a distressing condition for both dermatologists and patients. We evaluated the effectiveness of salicylic acid (SA) peel and vitamin C mesotherapy in the treatment of melasma. Materials and methods: Fifty female patients were divided into two groups. All patients were treated with 30% SA peel every two weeks for two months. In addition, after SA peeling Group A was intradermally administered 10 vitamin C on the melasma lesion at 1-cm intervals. All patients were followed up for 6 months, during which the recurrence rates were evaluated. Digital photographs of the melasma site were taken and patients’ Melasma Area and Severity Index (MASI) scores were assessed. After the treatment, the patients were asked to complete the melasma quality of life questionnaire (MelasQoL) to evaluate their satisfaction with the treatment. All the adverse effects were noted. Results: The MelasQoL and MASI scores of patients in both groups significantly decreased after the treatment. Apart from a burning sensation, no adverse event was observed and all patients tolerated the treatment well. Discussion: SA peel combined with vitamin C mesotherapy is a safe and effective alternative for the treatment of melasma with no significant side effects and minimal downtime.     

Microneedling with glutathione versus microneedling alone in treatment of facial melasma: Split-face comparative study

Background

Melasma is a distressing disfiguring acquired pigmentary disorder especially affecting females and it is of high tendency of recurrence. Up till now, treatment of melasma is a challenging problem.

Objectives

We evaluated the effectiveness of microneedling with glutathione versus microneedling alone in treatment of melasma.

Patients and Methods

In this study, 29 adult females with epidermal type of melasma (confirmed with Wood's light examination) were enrolled. The affected area was subjected to microneedling using dermapen followed by application of glutathione solution on the right side only. This session was performed every 2 weeks for 3 months (six sessions for every patient). The response to therapy was measured using modified melasma area and severity index (m MASI) that were calculated on each side of the face (Hemi- m MASI) before treatment sessions.

Results

There was statistically significant reduction in the mean of Hemi- m MASI score over the sessions on both sides of the face but the right side (microneedling with glutathione) showed more reduction and earlier response to therapy than the left side (microneedling alone). On the left side, mean of Hemi- m MASI score before and after sessions was (4.06 ± 1.91, 2.31 ± 1.450) and on the right side, it was (4.21 ± 2.08, 1.96 ± 1.30), respectively and this was statistically significant. Percentage of improvement on the left side was 46.92 ± 16.30 (%) while on the right side was 55.17 ± 15.50 (%) and this was statistically significant.

Conclusions

Microneedling is an effective promising tool in treatment of melasma and its combination with glutathione as a whitening agent, increases and accelerates its efficacy. So, combined therapy is more preferred than monotherapy in treatment of facial melasma.     

Efficacy of topical vitamin D combined with microneedling in the treatment of vitiligo: A comparative study

Background

Vitiligo is a depigmenting disorder caused by the destruction of melanocytes by various mechanisms which affect melanocyte function and survival. Different therapeutic approaches for vitiligo include nonsurgical and surgical methods but effective therapy is still challenging. There are few studies that suggest the role of vitamin D analogs in the repigmentation process with encouraging results. To our knowledge, this is the first study to evaluate the effect of topical vitamin D (cholecalciferol) combined with microneedling in the treatment of depigmented patches of vitiligo.

Aim of the Work

Evaluate the effect of microneedling alone versus microneedling with topical vitamin D in the treatment of vitiligo.

Patients and Methods

A prospective comparative clinical trial was carried out on 25 patients with stable vitiligo; every patient had at least two patches; the first patch was treated with microneedling alone. The other patch was treated with microneedling combined with topical cholecalciferol.

Results

Good-to-excellent response was detected in 52% of the patches treated with microneedling topical cholecalciferol, while only in 40% of the patches treated with microneedling alone. The improvement was higher in combined treatment with no significant difference between both groups.

Conclusion

Topical cholecalciferol is a relatively effective and safe alternative in the treatment of stable vitiligo and its combination with microneedling increases its efficacy.     

Combined microneedling with topical vitamin D3 or bimatoprost versus microneedling alone in the treatment of alopecia areata: A comparative randomized trial

Introduction

Alopecia areata (AA) is a challenging disease with variable treatment outcomes. Hair follicles express vitamin D receptors. Therefore, vitamin D3 may be promising for AA treatment through immunomodulatory mechanisms. The efficacy of bimatoprost in scalp AA treatment was reported by few studies.

Objective

To evaluate the efficacy and safety of microneedling (MN) with topical vitamin D3 versus MN with bimatoprost in comparison with MN alone in the treatment of localized AA.

Patients and Methods

Seventy-five patients with localized AA were divided into three groups. The first group: 25 patients were treated with MN alone. The second group: 25 patients treated with MN combined with topical vitamin D3. The third group: 25 patients treated with MN combined with bimatoprost solution. The response was evaluated clinically and dermoscopically.

Results

At the end of the study, all groups showed a statistically significant decrease in the SALT score compared to the baseline. The clinical response (regrowth scale): vitamin D and bimatoprost groups showed a statistically significant higher regrowth scale compared to MN alone group (p-value = 0.000). After treatment, hair regrowth was significantly higher in MN combined with bimatoprost than in MN combined with topical vitamin D3. However, after 3 months of follow-up, there was no statistically significant difference between both groups. Side effects were mild and transient in all groups.

Conclusion

Topical vitamin D3 and bimatoprost combined with MN are safe and effective therapeutic options for localized AA.     

Q开关Nd:YAG激光联合谷胱甘肽、维生素C治疗黄褐斑疗效分析

目的探讨大光斑、小功率Q开关Nd∶YAG激光联合谷胱甘肽、维生素C治疗黄褐斑的疗效和安全性.方法12例女性黄褐斑患者接受Medlite C6 Q开关Nd∶YAG激光,波长1064 nm,光斑6 mm,能量2.5～3.0 J/cm2,共治疗8次,间隔1周,第9次后治疗间隔改为1个月,共治疗6次.同时联合还原谷胱甘肽900 mg和维生素C2g静脉滴注,每天一次,共14 d为1个疗程,疗程间隔3个月.治疗前后均拍照,并算出治疗前后黄褐斑面积和严重指数(MASI).结果12例患者中治愈1例,显效5例,好转6例,无效0例.所有患者的平均MASI值由治疗前的13.8±4.3降到7.1±2.4(P＜ 0.05),差异有统计学意义.所有患者均无色素沉着和色素脱失等不良反应,治疗后患者毛孔缩小,皮肤更细腻.结论大光斑、小功率Q开关Nd∶YAG激光联合谷胱甘肽、维生素C治疗黄褐斑疗效好,安全性高,无需停工期,不良反应小,可作为治疗黄褐斑的一种选择.     

A split-face,evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Abstract

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.     

A prospective,split-face,double-blinded,randomized study of the efficacy and safety of a fractional 1064-nm Q-switched Nd:YAG laser for photoaging-associated mottled pigmentation in Asian skin

Background: Laser toning using low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum laser (QSNY) has gained popularity in the treatment of photoaging-associated mottled pigmentation (PMP). However, hypopigmentation or lack of efficacy has been reported depending on the fluences used. Objective: To compare a novel fractional 1064-nm QSNY with conventional 1064-nm QSNY for the treatment of photoaging-associated mottled pigmentary lesions except epidermal lesions of lentigines and freckles through a randomized, split-face, double-blind study. Materials and methods: Thirteen Asian women were treated every week for 6 weeks with fractional 1064-nm QSNY on one side of the face and conventional 1064-nm QSNY on the other side. We evaluated the pigmentation area and severity index (PSI), melanin index, erythema index, and the patient's global assessment of improvement. Results: At three months post-treatment, the PSI score improved compared with baseline, by 14.48% on the conventional 1064-nm QSNY side and 21.81% on the fractional 1064-nm QSNY side. Both groups showed improvements in the melanin index. Conclusion: Both fractional 1064-nm QSNY and strictly low-fluence conventional 1064-nm QSNY are moderately effective against PMP and other photoaging signs. Fractional laser toning shows better subjective outcomes than conventional toning.     

大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效分析

目的 探讨大光斑低能量Q开关Nd∶YAG激光治疗黄褐斑的疗效,分析黄褐斑皮损激光治疗前后共聚焦激光扫描显微镜(CLSM)特征.方法 收集45例黄褐斑患者,使用大光斑低能量调Q开关Nd∶YAG 1064 nm激光治疗,并在治疗前后对其行CLSM检查.结果 45例患者,治疗结束后基本治愈8例(17.78％),显效25例(55.56％),好转11例(24.44％),无效1例(2.22％),有效率为73.33％.CLSM下可见黄褐斑皮损处较周围正常皮损处表皮全层黑素颗粒增多,激光治疗后表皮处黑素颗粒显著减少.结论 大光斑低能量调Q 1064 nm激光治疗黄褐斑疗效确切,安全性高,CLSM可用于判断激光治疗疗效.     

Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q-switched Nd:YAG laser monotherapy

Background: Despite the effectiveness of low-fluence Q-switched Nd:YAG laser (QSNY) treatment in melasma, adverse events, including mottled hypopigmentation (MH) and rebound hyperpigmentation (RH) have been reported. Objective: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and long-pulse Nd:YAG laser (LPNY) (Dual toning), with low-fluence QSNY monotherapy (QS toning), in Asian melasma patients. Materials and methods: Patients were treated for 10 sessions at 1-week intervals with QSNY (6 mm spot); 2.5–3.0 J/cm² for QS toning (n = 177) or 2.1–2.5 J/cm² for dual toning (n = 183). The dual toning group was immediately treated with LPNY (7 mm spot, 15–17 J/cm²). The results were evaluated using the modified Melasma Area and Severity Index (mMASI) score and the physician's global assessment. Results: MH or RH were significantly lower (1.1% vs. 14.1%) and the treatment efficacy was improved (median decrease of mMASI, 3.6 vs. 3.0) in the dual toning group compared with the QS toning group. Periorbital melasma showed distinctively high rates of adverse events in the QS toning group (23.9% vs. 5.7%), which were significantly reduced in the dual toning group (2.9%). Conclusion: Dual toning could represent a safe and effective treatment for Asian melasma patients, as it is associated with minimal adverse events and improved treatment efficacy compared with QS toning monotherapy.     

Q开关1064 nm Nd:YAG激光治疗黄褐斑所致点状色素减退:2年随访研究

目的:了解大光斑低能量模式Q开关1064 nm激光治疗黄褐斑后所致点状色素减退恢复情况。方法:对大光斑低能量模式Q开关1064 nm Nd:YAG激光治疗5次以上的180例黄褐斑患者随访2年。结果:15例出现点状色素减退(8.33%),2年后1例痊愈,2例有改善,13例无变化。结论:大光斑低能量Q开关1064 nm激光治疗黄褐斑所致的点状色素减退斑可持续2年以上。     

Q-switched Nd:YAG laser versus itraconazole pulse therapy in treatment of onychomycosis: A clinical dermoscopic and mycologic study

Background

Onychomycosis (OM) represents about 50% of nail disorders. Oral antifungals have proven efficacy in the treatment of onychomycosis but their associated side effects limit their use. Accordingly, there is an increased need for a safe and effective therapy to induce clearance and improve the esthetic appearance of diseased nails.

Objective

The current study is an attempt to evaluate and compare the efficacy of Q-Switched Nd:YAG (1064 nm) laser as monotherapy versus pulse itraconazole in the clearance of onychomycosis.

Methods

In this prospective study, 40 onychomycosis patients were equally divided into two groups: Groups I (laser group) and II (Itraconazole group). Patients of Group I are treated with six biweekly sessions of Q-Switched Nd:YAG (1064 nm) laser. Patients of Group II are treated with itraconazole pulse therapy. The assessment of clearance was rated using the “Onychomycosis Severity Index (OSI)”, photographs, dermoscopy, and mycology. All 40 patients were followed up for 3 months after the end of treatment.

Results

Group I's clinical improvement response was a marked improvement in 19 cases and moderate improvement in one case (OSI before treatment was 24.5 and after was 0). A dermoscopic cure occurred in 19 cases. Mycological cure was obtained in 19 cases. Group II's clinical improvement response was marked in 15 and moderate in 5 (OSI before treatment was 24 and after was 0). Dermoscopic cure occurred in 15 cases. Mycological cure was obtained in 15 cases. There were no adverse effects. The clinical response, the dermoscopic cure, and the mycological cure were equal in both groups, with no significant difference found between them.

Conclusion

Q-Switched Nd:YAG (1064 nm) laser can be used as an effective and safe modality in the clearance of nail onychomycosis, particularly in patients who have a contraindication to or refuse the use of oral antifungals.     

Efficacy of 577 nm pro-yellow laser in the treatment of melasma: a prospective split-face study

ABSTRACT

We aimed to study the effectiveness of 577 nm pro-yellow laser in the treatment of melasma. A total of 82 patients with melasma were included in this comparative study. A detailed medical history, examination, and calculation of Melasma Area and Severity Index were done for all patients. All participants were treated with topical sunscreen and hydroquinone 4% cream on both sides of the face. In addition, the left side of the face was subjected to a single pass of 577-nm pro-yellow laser at a monthly interval for three sessions. Follow up was done by comparing the Melasma area and severity index at 0, 3 and 6 months. At baseline, there is no significant difference in the Melasma area and severity index score between both sides of the face. At 3 months, MASI score was statistically significantly decreased on both sides of the face compared to pretreatment (P < .05). At 6 months, the mean MASI score at the laser-treated side was statistically significantly decreased compared to the non-laser-treated side (P < .05). we concluded that the addition of 577 nm pro-yellow laser in the treatment of melasma leads to maintain the improvement and reduction of the recurrence rate.     

Topical 3% tranexamic acid enhances the efficacy of 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of melasma

Background: A QS-NdYAG laser (QSNYL) and topical tranexamic acid (TA) have been widely used. However, no study has yet reported the efficacy of using both QSNYL and TA as a combined treatment for melasma. Objectives: To evaluate the efficacy and adverse effects of topical 3% TA combined with 1064-nm QSNYL as a treatment for melasma. Methods: A randomized, prospective, split-face, controlled trial was conducted. A 1064-nm QSNYL was performed on the entire face at baseline and 4 weeks later. The participants were randomly selected for application of topical 3% TA on one side of the face and the vehicle treatment on the other side of the face for 8 weeks. Clinical responses were determined by mMASI scores, Mexameter?, and participants’ evaluation. Results: Twenty-five participants completed the study. At the end of the study, the mMASI score significantly decreased in the combination treatment (p < 0.05), while no significant changes were observed in the laser-alone treatment. More than 80% of the participants noticed a >50% improvement on the side with combination therapy at every follow-up visit. No serious adverse events were reported. Conclusion: Topical TA as an adjuvant demonstrated trends of better outcomes than QSNYL alone for the treatment of melasma.     

Comparative study of dual-pulsed 1064 nm Q-switched Nd:YAG laser and single-pulsed 1064 nm Q-switched Nd:YAG laser by using zebrafish model and prospective split-face analysis of facial melasma

Background: Recently dual-pulsed low-fluence 1064-nm Q-switched Nd:YAG (QSNY) laser has been developed for reducing complication during melasma treatment. Objective: Comparison of the efficacy and safety between dual-pulsed mode and single-pulsed mode for the treatment of melasma. Materials and methods: In preclinical study, adult zebrafish were irradiated with dual-pulsed and single-pulsed mode. Changes of melanophore and cell death were assessed. In split-face clinical study, dual-pulsed and single-pulsed mode were irradiated on the left and right side of the face, respectively. L* value, clinical digital photos, modified Melasma Area and Severity Index (MASI) scores, and side effects were measured. Results: As compared to single-pulsed mode and dual-pulsed mode with longer intervals, zebrafish melanophore was cleared quickly at dual-pulsed mode with 80-μsec interval and 0.3 J/cm² fluence. Dual-pulsed mode showed the least regeneration of melanophore at 4 weeks after irradiation and no cell death was observed with 80-μsec interval. Both pulse modes improved melasma significantly but modified MASI score and L* value were not significantly different between each other. Lesser pain and shorter duration of post-laser erythema were observed with dual-pulsed mode. Conclusion: Dual-pulsed mode was as effective as single-pulsed mode for the treatment of melasma and revealed less side effects.