黄褐斑的治疗进展

黄褐斑是一种获得性色素增加性皮肤病，病因复杂，治疗困难。外用药是黄褐斑治疗的首选，单用4%氢醌乳膏和三联疗法（4%氢醌乳膏+0.01%氟轻松+0.05%维A酸乳膏）为一线治疗方案，目前外用氨甲环酸治疗黄褐斑被证实安全有效，苯丙氨酸、丁雷锁辛也有一定疗效。外用木质素过氧化物酶、锌、西酸模精华、二乙酰伯尔定碱及转化生长因子β1仿生寡肽68、氟他胺等是近年的新方法。联合口服氨甲环酸能增加疗效。Q开关激光治疗黄褐斑疗效明显，但易复发和色素沉着。强脉冲光、点阵激光尚缺乏大样本研究，CO2激光和铒激光疗效显著，但极易造成亚洲患者的炎症后色素沉着，故不适于亚洲人群。顽固性黄褐斑患者可考虑化学或物理剥脱治疗，皮肤磨削术使97%患者的黄褐斑获得了永久性清除。

Treatments of melasma

Melasma is an acquired hyperpigmented skin disorder with complex etiology, and is hard to treat. External application drugs are the first?choice treatment of melasma, mainly including hydroquinone 4% cream alone or in combination with fluocinolone acetonide 0.01% cream and tretinoin 0.05% cream. At present, the efficacy and safety of topical tranexamic acid have been proved, and phenylalanine and 4?n?butylresorcinol have also shown efficacy in the treatment of melasma. In recent years, many new external application drugs have emerged gradually, including lignin peroxidase, zinc, rumex occidentalis extracts, diacetyl boldine, transforming growth factor? β1 (TFG?β1) biomimetic oligopeptide?68 and flutamide. Oral tranexamic acid can increase efficacy of the above drugs. Q?switched laser is effective for the treatment of melasma, but there is a high risk of recurrence and hyperpigmentation. Large sample size?based studies are needed to evaluate the efficacy of intense pulsed light and fractional laser. CO2 laser and erbium:YAG laser are not recommended for Asian patients because of high risks of postinflammatory hyperpigmentation. Refractory melasma can be treated with chemical peeling or dermabrasion, and dermabrasion may result in persistent clearance of melasma in 97%of patients.