Fractional CO2 laser and adjunctive therapies in skin of color melasma patients.
Fractional CO2 laser and adjunctive therapies in skin of color melasma patients.
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DOI：
10.1016/j.jdin.2022.02.010
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发表时间：
2022-09
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长期以来，烧蚀激光一直被认为是治疗有色皮肤黄褐斑的不利选择，并且仍然没有得到充分利用。评估消融点阵 CO2 激光治疗有色皮肤患者难治性黄褐斑的安全性和结果。对单中心皮肤科诊所 12 名患者的回顾性图表审查。该研究纳入了仅接受消融点阵 CO2 激光治疗或联合激光调色和/或氨甲环酸 (TXA) 治疗的难治性黄褐斑患者。使用经过验证的改良黄褐斑面积和严重程度指数 (mMASI) 评分量表来评估基线和每次治疗后约 1 个月的疾病严重程度。在 12 名患者中，41.7% 的患者 mMASI 评分下降 > 50%，其中 33.3% 的患者显示统计显着性 (P < .05)。 TXA 队列的 CO2 激光治疗的平均 mMASI 评分下降幅度最大，而激光调色的 CO2 激光治疗的平均 mMASI 评分下降幅度最小。在初次消融激光治疗后较早开始口服 TXA 的患者表现出更好的临床改善。回顾性研究设计，随访期短，样本量小。烧蚀性 CO2 激光治疗可能是有色皮肤患者难治性黄褐斑的合理选择，但还需要进一步的研究。
Ablative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized. To evaluate the safety and outcomes of ablative fractional CO2 lasers on refractory melasma in patients with skin of color. A retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO₂ laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session. Among the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance (P < .05). The CO₂ laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO₂ laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement. Retrospective study design with short follow-up period and a small sample size. Ablative CO2 laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.