Combined Therapy Using Q‐Switched Ruby Laser and Bleaching Treatment With Tretinoin and Hydroquinone for Acquired Dermal Melanocytosis
Combined Therapy Using Q‐Switched Ruby Laser and Bleaching Treatment With Tretinoin and Hydroquinone for Acquired Dermal Melanocytosis
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DOI：
10.1046/j.1524-4725.2003.29291.x
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发表时间：
2003-10
影响因子：
2.4
通讯作者：
Akira Momosawa;K. Yoshimura;G. Uchida;Katsujiro Sato;E. Aiba;Daisuke Matsumoto;Hisayo Yamaoka;S. Mihara;K. Tsukamoto;K. Harii;T. Aoyama;T. Iga
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文献类型：
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作者：
Akira Momosawa;K. Yoshimura;G. Uchida;Katsujiro Sato;E. Aiba;Daisuke Matsumoto;Hisayo Yamaoka;S. Mihara;K. Tsukamoto;K. Harii;T. Aoyama;T. Iga
背景与目的与太田痣相比，获得性双侧皮肤黑色素细胞增多症（ADM；获得性双侧太田痣样斑痣）以其顽固性而知名，我们认为其原因之一是激光治疗后炎症后色素沉着（PIH）的发生率和程度更高。方法采用0.1%维甲酸水凝胶和含7%乳酸的5%对苯二酚软膏进行局部漂白治疗（4 ~ 6周），以排出表皮黑色素。随后，q -开关红宝石（QSR）激光照射消除皮肤色素沉着。这两个步骤重复两到三次，直到获得患者满意（通常间隔2个月的激光疗程）。在19例adm患者中进行了这种治疗，其中6例在基线、漂白预处理后和治疗结束时进行了皮肤活检。结果所有患者经2 ~ 3次QSR激光治疗后清除率均达到良好至极好。总治疗期3 ~ 13个月，平均8.3个月。10.5%的病例出现PIH。组织学上，所有标本均观察到表皮色素沉着，局部漂白预处理显着改善。结论QSR激光联合局部漂白预处理治疗ADM效果一致，PIH发生率低，减少了激光治疗次数和总治疗时间，也可应用于表皮和真皮色素沉着的其他病变。
BACKGROUND AND OBJECTIVE Acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) is known for its recalcitrance compared with Nevus of Ota, and we assume that one of the reasons is a higher rate and degree of postinflammatory hyperpigmentation (PIH) seen after laser treatments. METHODS Topical bleaching treatment with 0.1% tretinoin aqueous gel and 5% hydroquinone ointment containing 7% lactic acid was initially performed (4 to 6 weeks) to discharge epidermal melanin. Subsequently, Q-switched ruby (QSR) laser was irradiated to eliminate dermal pigmentation. Both steps were repeated two to three times until patient satisfaction was obtained (usually at a 2-month interval for laser sessions). This treatment was performed in 19 patients with ADM. Skin biopsy was performed in six cases at baseline, after the bleaching pretreatment, and at the end of treatment. RESULTS All patients showed good to excellent clearing after two to three sessions of QSR laser treatments. The total treatment period ranged from 3 to 13 (mean of 8.3) months. PIH was observed in 10.5% of the cases. Histologically, epidermal hyperpigmentation was observed in all specimens and was dramatically improved by the topical bleaching pretreatment. CONCLUSION QSR laser combined with the topical bleaching pretreatment appeared to treat ADM consistently with a low occurrence rate of PIH and lessen the number of laser sessions and total treatment period and may also be applied to any other lesions with both epidermal and dermal pigmentation.