微等离子束和铒激光治疗痤疮凹陷性瘢痕的对比研究

目的观察微等离子束和铒激光治疗痤疮凹陷性瘢痕三亚型间的疗效和安全性。方法回顾性分析2015年12月至2017年12月,痤疮凹陷性瘢痕患者256例的临床资料,分为两组,微等离子束组(plasma组)患者120例,其中冰锥型瘢痕64例、箱车型瘢痕43例、滚动型瘢痕13例,采用微等离子束治疗,治疗功率60～80W,能量15～30 KJ,每次治疗3～4遍;激光组(Laser组)患者136例,冰锥型瘢痕62例、箱车型瘢痕43例、滚动型瘢痕31例,采用波长2940nm Er:YAG治疗,能量1500mJ/脉冲,光斑直径7mm×7mm。两组患者均接受3次治疗,每次治疗间隔1个月。治疗后随访1个月,每次治疗前及3次治疗后与治疗前照片对比,并采用痤疮瘢痕权重(Echelle d'Evaluation Clinique des Cicatrices d'acne,ECCA)评分、VISIA皮肤图像分析进行疗效评估,同时记录术后不良反应发生情况包括治疗即刻疼痛度、红斑水肿、渗血、治疗后脱痂时间、红斑持续时间、有无瘢痕增生及皮肤感染等。结果 (1)临床疗效:两种方式治疗后所有患者均有不同程度改善,有效率达90%以上。(2)ECCA评分:3次治疗后,两种治疗方式下三种亚型组间比较,ECCA评分均有下降,差异具有统计学意义(P <0.05)。冰锥型痤疮凹陷瘢痕ECCA评分比较,plasma组较激光组下降明显(P <0.05);箱车型、滚动型痤疮凹陷瘢痕ECCA评分比较,激光组较plasma组下降明显(P <0.05)。(3) VISIA皮肤图像分析:两组患者3次治疗后与治疗前比较;毛孔绝对值均明显缩小(P<0.05);两组间比较差异具有统计学意义(P<0.05)。紫质绝对值,激光组高于plasma组(P<0.05);棕色斑绝对值两组患者均无明显改变。(4)不良反应:plasma组5例患者出现轻微红斑,2例患者首次治疗后3 d出现水肿、渗液。激光组4例患者首次治疗后2周出现色素沉着。结论两种方式治疗痤疮凹陷性瘢痕均安全有效,疗效无明显差异。2940 nm铒激光在治疗滚动型与浅箱车型瘢痕时优于微等离子束,微等离子束治疗冰锥型癌疮凹陷性瘢痕时优于2940 nm铒激光。微等离子束治疗痤疮凹陷性瘢痕后产生色素沉着的风险较低,但疼痛程度大,患者均能耐受。2940 nm铒激光无明显不良反应,但更易产生色素沉着。

Comparison between Micro-plasma and Erbium Laser in Treating Atrophic Acne Scars

Objective To observe the efficacy and safety of micro plasma and 2940 nm erbium laser in treating acne atrophic scars.Methods A retrospective summary was made on the clinical data of 256 patients diagnosed with acne atrophic scars from Dec.2015 to Dec.2017.They were divided into two groups:the micro plasma group(plasma group)with 120 patients,including 64 cases of icepick scars,43 cases of boxcar scars and 13 cases of rolling scars,and the 2940 nm Er:YAG group(laser group)with 136 patients,including 62 cases of icepick scars,43 cases of boxcar scars and 31 cases of rolling scars.For both groups,the patients were given 3 treatments at monthly intervals and followed up for a month.Photo comparison was made before and after each treatment,the curative effect was evaluated with ECCA scores and the VISIA skin image analysis,and the data on adverse reactions were recorded,including but not limited to immediate postoperative pain degree and occurrence of erythema,edema,bleeding,erythema duration,scar hyperplasia and skin infection.Statistical analysis was performed on related data.Results All the patients were improved with an effective rate of over 90%.After 3 treatments,the ECCA scores in both groups decreased significantly(P<0.05).For icepick scars,the decrease,rate of ECCA was greater in the plasma group than in the laser group(P<0.05).For boxcar scars and rolling scars,compared with the plasma group,the laser group has a greater reduction of ECCA scores(P<0.05).As to VISIA skin image analysis,after 3 treatments,the absolute values of pore size in both groups were significantly reduced(P<0.05),the absolute value of purple of the laser group increased(P<0.05),but the brown spot in both groups did not change remarkably.For adverse reactions,5 patients in the plasma group showed slight erythema during the treatment,which disappeared 7 days later,2 patients in the plasma group had edema and seepage after 3 days of the first treatment,and 4 patients in the Er:YAG group suffered pigmentation after the first treatment for 2 weeks.Conclusions Both methods were safe and effective in treating acne scars,and there was no significant difference in efficacy.2940 nm erbium laser is superior to micro plasma in the treatment of boxcar and rolling scars,but micro plasma is better than 2940 nm erbium laser in the treatment of icepick scars.The rise of pigmentation in micro plasma was lower than that of 2940 nm erbium laser,but the pain was greater.2940 nm erbium laser has no obvious adverse reaction,but is more likely to induce pigmentation.