Evaluation of the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in Asians
Evaluation of the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in Asians
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DOI：
10.1002/lsm.23028
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发表时间：
2019-01-01
影响因子：
2.4
通讯作者：
Chan, Henry H-L
中科院分区：
文献类型：
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作者：
Kung, Ka-yee;Shek, Samantha Y-N;Chan, Henry H-L
背景和目的皮肤色素性疾病在皮肤颜色的患者中更为常见，并且由于表皮中的黑色素含量较高而更难治疗。虽然Q开关激光被广泛认为是表皮和真皮色素沉着病的标准治疗方法，但在有色皮肤患者中，炎症后色素沉着过度（PIH）的风险高达25%。最近，具有在亚纳秒域操作的脉冲持续时间的新型皮秒激光器已被证明在纹身去除和痤疮疤痕的治疗中是有效的。本研究的目的是检查双波长皮秒激光治疗亚洲患者良性色素性皮肤病变的安全性和有效性。方法12例良性色素性皮肤病患者，菲茨帕特里克皮肤类型为III ~ IV型，采用前瞻性临床研究，观察双波长皮秒激光治疗的安全性和有效性。根据病变类型，患者以约2-6周的间隔接受治疗。主要疗效终点是总体清除率百分比，由设盲观察者使用治疗后照片与基线照片进行比较评价。在每次激光治疗前后评估安全性，并要求患者在每次治疗后根据视觉模拟量表对疼痛水平进行评分。患者满意度在治疗结束时进行问卷调查。所有患者在末次治疗后4、8和12周进行随访。结果治疗的色素沉着包括黄褐斑、雀斑、雀斑样痣、咖啡Au lait斑、Hori斑。治疗后3个月，53.8%的色素获得了极好的反应（75-94%增亮），30.8%的色素获得了良好的反应（50-74%增亮），7.7%的色素分别获得了一般的反应（25-49%增亮）和差的反应（0-24%增亮）。达到至少50%清除率所需的平均治疗次数为：黄褐斑4.5次，雀斑1次，雀斑样痣1.5次，咖啡Au lait 1次。患有Hori斑的患者在总共六次治疗后仍未达到50%的清除率。63%的患者在主观评估中表示满意，27.3%的患者表示中立，9.1%的患者表示非常不满意。炎症后色素沉着过度率为4.8%，6.5%的受试者出现水疱作为治疗的副作用。结论双波长皮秒激光治疗色素沉着症安全、有效。特别是，证明了治疗雀斑和雀斑样痣的上级临床疗效，PIH风险低。激光外科医学51：14-22，2019。(c)2018 Wiley Periodicals，Inc.
Background and Objectives Cutaneous pigmentary disorders are both more common and more difficult to treat in patients with skin color given the higher melanin content in the epidermis. Although Q-switched lasers are widely considered to be the standard treatment for both epidermal and dermal pigmentary conditions, a very high risk of post-inflammatory hyperpigmentation (PIH) of up to 25% is seen in patients with skin of color. Recently, the novel picosecond laser with pulse durations operating at sub-nanosecond domains has been shown to be effective in tattoo removal and in the treatment of acne scars. The objective of this study is to examine the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented skin lesions in Asian patients. Methods Twelve subjects with benign pigmentary disorders and Fitzpatrick skin types III to IV were recruited in a prospective clinical study to examine the safety and efficacy of the dual wavelength picosecond laser. Patients were treated at approximately 2-6 week intervals depending of the type of lesion. The primary efficacy endpoint is the global percent of clearance which was evaluated by blinded observers using post treatment photographs compared to baseline photographs. Safety was evaluated before and after each laser treatment and patients were asked to rate the level of pain according to the Visual Analog Scale after each treatment session. Patient satisfaction was assessed at the completion of treatment with questionnaires. All patients were followed up at 4, 8, and 12 weeks after the last treatment session. Results The pigmentary conditions treated included melasma, freckles, lentiginies, cafe au lait macules, and Hori's macules. Three months after treatment, 53.8% of all pigments achieved excellent response (75-94% lightening,) 30.8% of pigments achieved good response (50-74% lightening,) and 7.7% of pigments achieved both fair (25-49% lightening) and poor responses (0-24% lightening), respectively. The average number of treatment sessions required to reach at least 50% clearance was 4.5 for melasma, 1 for freckles, 1.5 for lentigines and 1 for cafe au lait. The patient with Hori's macules did not reach 50% clearance after a total of six treatments. Sixty three percent of patients reported satisfaction in the subjective assessment, while 27.3% were neutral and 9.1% were very dissatisfied. The post inflammatory hyperpigmentation rate was 4.8% and 6.5% of subjects developed blistering as a side effect of treatment. Conclusion The dual wavelength picosecond laser is a safe and effective treatment of benign pigmentary conditions in patients with skin of color. In particular, superior clinical efficacy is demonstrated for treatment of freckles and lentigines with a low risk of PIH. Lasers Surg. Med. 51:14-22, 2019. (c) 2018 Wiley Periodicals, Inc.