高能量脉冲CO2激光修复面部凹陷性痤疮瘢痕的疗效与汽化深度

目的研究高能量脉冲CO2激光(Coherent UltraPulsed 5000 C)修复面部痤疮瘢痕疗效和汽化深度的关系.方法随访高能量脉冲CO2激光修复面部痤疮瘢痕38例,其中深陷的瘢痕18例,中等深度的瘢痕14例,浅度瘢痕6例,汽化3次以下的19例,汽化4次以上的19例.随访12～48个月.结果总有效率84.2%(32/38).汽化4次以上的,有效率100%;相反,汽化少于3次的,有效率68.4%(13/19).汽化4次以上与汽化3次下的疗效有效率差异有显著性意义(U=4.3625,P=0.0000,P＜0.0001).术后无新的瘢痕产生.结论高能量脉冲CO2激光是修复凹陷性痤疮瘢痕较好的方法,汽化深度在4次以上时,疗效较好.     

Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation

The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the “ECCA Grading Scale” before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75–100 spot/cm² density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.     

非剥脱1550nm铒玻璃点阵激光治疗活动性痤疮及痤疮瘢痕临床疗效观察

目的：观察非剥脱1550nm铒玻璃点阵激光治疗活动性痤疮及痤疮凹陷性瘢痕的临床疗效及安全性。方法：应用非剥脱性1550nm铒玻璃点阵激光治疗中重度痤疮患者25例，其中16例表现为活动性痤疮皮损（粉刺、丘疹、脓疱、结节）合并痤疮后凹陷性瘢痕，3例为痤疮瘢痕不伴活动性皮损，6例为活动性皮损不伴瘢痕形成。治疗1-3次，每次间隔3-4周，于末次治疗1个月后观察疗效。结果：活动性皮损22例，痊愈2例（9．1％）、显效14例（63．6％）、有效6例（27．3％）、无效或恶化0例（O％），总有效率为72．7％；痤疮凹陷性瘢痕19例，痊愈2例（10．5％）、显效10例（52．6％）、有效7例（36．8％）、无效或恶化0例（0％），总有效率为63．2％。且随着治疗次数的增加疗效逐步提高。术后仅出现轻度红肿，平均2-3天消退，均无色素沉着、水疱等不良反应，无1例恶化，患者满意率达840。结论：非剥脱1550nm铒玻璃点阵激光治疗活动性痤疮及痤疮后凹陷性瘢痕均有显著疗效，且安全、不艮反应轻，患者满意率高。     

Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians

Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25–44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium–aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1)?=?<25 %, fair (2)?=?25–50 %, good (3)?=?51–75 %, and excellent (4)?=?>75 %. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P?<?0.001). Complete wound healing occurred between 6 and 9 days. Erythema occurred in all patients and lasted longer than 3 months in two patients (9.1 %). Postinflammatory hyperpigmentation occurred in ten patients (45.5 %) and lasted longer than 3 months in one patient (4.5 %). One patient experienced mild hypopigmentation (4.5 %). Mild to moderate acne flare-up occurred in five patients (22.7 %). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.     

A new modality for fractional CO2 laser resurfacing for acne scars in Asians

Since fractional photothermolysis was first introduced in 2004, it has become a very popular procedure, especially with more and more ablative fractional laser systems and treatments. Fractional ablative laser has been shown to be very effective; however, it does not reach the efficacy of conventional ablative laser treatments in most instances. In an attempt order to make the fractional CO₂ laser treatment more efficacious and safe, we combined both the conventional CO₂ laser and the fractional CO₂ laser to treat acne scars. We report our experience with this new modality. A total of 44 Chinese patients with facial acne scars and skin type IV were included in this study. Each patient received a minimum of two treatment sessions. For each laser session, both the conventional CO₂ laser treatment and the DeepFX laser treatment were focused on treating the scar areas only. Following this technique, the more superficialf ActiveFX fractional CO₂ laser was performed to the entire face. The efficacy of the procedure was evaluated 3 months after the final laser treatment. The improvement in acne scars and the overall skin texture change were assessed by photographic evaluation using the following scales: ≤25 % (mild), 26–50 % (moderate), 51–75 % (marked), and >75 % (excellent). Side effects from this therapy were mild to moderate. Two cases of HSV outbreak were noted; they were treated and resolved without adverse sequelae. Post-laser erythema was resolved within 1 month in one half of the patients. Prolonged erythema (≤3 months) was noted in 12(27 %) cases. Temporary post-inflammatory hyperpigmentation (PIH; ≤1 month) was seen in approximately 50 % of the patients. PIH (≤3 months) was noted in four cases (9 %). Sixty-four percent of the patients (28/44) had an improvement of between 51 and 75 % after more than two sessions of the combination of laser treatments. The average overall improvement was 52.50 % (±12.25 %). Three patients achieved improvement of >75 %. This new modality of ablative conventional CO₂ laser therapy with fractional CO₂ laser resurfacing was shown to be safe and efficacious in the treatment of acne scars in Asian patients. It did not increase the risk of PIH compared to other reports of laser therapy and PIH. It is the hope that future study with combination therapy will further enhance the clinical results and thus lessen potential adverse events.     

2790 nm钇-钪-镓-石榴石点阵激光治疗凹陷性痤疮瘢痕的疗效

目的 观察评估2790 nm钇-钪-镓石榴石(YSGG)点阵激光治疗面部凹陷性痤疮瘢痕的疗效及安全性.方法 将患者随机分成两组,A组使用2790 nm YSGG点阵激光非剥脱模式治疗1次,再以剥脱模式治疗;B组仅使用2790 nm YSGG点阵激光非剥脱模式进行治疗.每组共治疗4次,每间隔6周治疗1次,治疗前后均以VISIA(R)数字皮肤分析系统对面部瘢痕和肤质进行评分和统计比较,并由患者、医师共同评价满意度.结果 38例患者均完成4次治疗,治疗后所有凹陷性瘢痕均有不同程度的改善,A、B组治愈率分别为56.0％和30.8％,总有效率81.6％,无1例严重不良反应,A组优于B组.结论 2790 nm YSGG点阵激光具有效果明显、精确度高、损伤小、操作方便的优点,且治疗后并发症少、色素沉着程度轻,2790 nm YSGG点阵激光是治疗面部浅表瘢痕安全、有效的方法之一.     

Long-pulsed dye laser versus intense pulsed light for photodamaged skin: a randomized split-face trial with blinded response evaluation

OBJECTIVE: In a randomized controlled split-face trial to evaluate efficacy and adverse effects from rejuvenation with long-pulsed dye laser (LPDL) versus intense pulsed light (IPL). MATERIALS AND METHODS: Twenty female volunteers with Fitzpatrick skin types I-III, classes I-II rhytids, and symmetrical split-face photodamage were included in the study. Subjects received a series of three treatments at 3-week intervals with half-face LPDL (V-beam Perfecta, 595 nm, Candela Laser Corporation) and half-face IPL (Ellipse Flex, Danish Dermatologic Development); the interventions being randomly assigned to left and right sides. Primary end-points were telangiectasias, irregular pigmentation and preferred treatment. Secondary end-points were skin texture, rhytids, pain, and adverse effects. Efficacy was evaluated by patient self-assessments and by blinded clinical on-site and photographic evaluations at 1, 3, and 6 months postoperatively. Adverse effects were evaluated by blinded clinical on-site evaluations. RESULTS: Telangiectasia improved from LPDL and IPL treatments with superior vessel clearance from LPDL treatments (postoperative side-to-side evaluations, patient self-assessments, P相似文献   

A new 675-nm laser device in the treatment of acne scars: an observational study

Lasers in Medical Science - Acne scarring represents a common problem that negatively impacts patients’ quality of life. Different types of treatments are currently available for this...     

Treatment of wrinkles with the nonablative 1,320-nm Nd:YAG laser.

Ablative laser resurfacing with the CO2 and Er:YAG lasers has become a well-accepted and well-reported modality for skin rejuvenation of photoaged and photodamaged skin. However, the side effects associated with these lasers, such as exudation and crusting followed by prolonged erythema, are often socially disturbing for the patient. A nonablative 1,320-nm pulsed Nd:YAG system has been developed that controls dermal collagen damage while preserving the epidermis. Thirteen patients are presented on whom periocular wrinkle treatment was carried out during two sessions 1 month apart. Side effects were minimal. Histology showed improvement in the previously typical sun-damaged dermis. However, although physician assessment noted a trend toward macroscopic improvement, almost all patients failed to see any improvement. The authors conclude that further studies of the ideal parameters are required before the 1,320-nm Nd:YAG laser can be indicated successfully in stand-alone, nonablative wrinkle removal. In addition, patients should be selected carefully, and a complementary minimally aggressive technique should be used to restore a youthful appearance to the epidermis.     

Practical evaluation and management of atrophic acne scars: tips for the general dermatologist

Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. General dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. This article reviews a practical, step-by-step approach to evaluating the patient with atrophic acne scars. An algorithm for providing treatment options is presented, along with pitfalls to avoid. A few select procedures that may be incorporated into a general dermatology practice are reviewed in greater detail, including filler injections, skin needling, and the punch excision.