摘要
目的探索激光治疗黄褐斑的合适方法和作用机制。方法采用大光斑低能量的QSNY分别进行临床试验和动物实验,并通过皮肤反应、MCI、CLSM和组织病理学等多种方法评估该方法治疗黄褐斑的有效性和安全性。结果临床试验显示：治疗结束后,基本治愈8例,显效25例,好转12例,无效1例,有效率为73.33%;MCI显著降低,较治疗前有统计学意义（P〈0.05）;CLSM见基底层及棘层中下部黑素显著减少,但是可见MC,且树突长。动物实验显示：治疗结束后豚鼠皮肤色素沉着完全消退,MCI显著降低,较治疗前有统计学意义（P〈0.01）,CLSM和组织病理见毛囊周围及基底层黑素颗粒和MC均显著减少;但是随访4周发现色素沉着复发,肉眼达治疗前的80%~90%,MCI显著增高,但较治疗前有统计学差异（P〈0.05）;CLSM和硫酸亚铁染色见黑素颗粒明显增加,MC的数目、密度明显增多。阳性对照组皮肤治疗前后无明显改变。结论大光斑低能量的QSNY治疗黄褐斑短期内疗效肯定,副作用小,但有复发的高风险。
Objective To explore the appropriate method of laser treatment for melasma.Methods Clinical trials and animal experiments were carried respectively,using a 1064nm Q-switch Nd： YAG laser with large spot and low fluence.The efficacy and safety of this treatment were estimated by visual,melanin content index（MCI）,confocal laser scanning microscopy（CLSM） and histological analyses.Results The results of clinical trials showed： after treatment,eight cases were basically cured,25 cases were markedly effective,12 cases were improved,one case was uneffective,and with an effective rate was 73.33%.MCI decreased significantly compared with that before treatment（P0.05）.The CLSM images showed a drastic decreasing in the reflection from epidermal-basal keratinocytes,but dendritic melanocytes became visible.Animal experiments showed： after treatment,skin pigmentation in guinea pigs was completely cleared,and MCI decreased significantly（P0.01）.CLSM and pathological images showed melanin granules and melanotytes around the hair follicles and basal layer of epidermal were significantly reduced.But through a four-week follow-up,all skins developed rebound hyperpigmentation,and MCI was significantly higher,but lower than that before treatment（P0.05）.CLSM images showed increased epidermal melanin particles and MC,and the staining intensity significantly increased in basal layers.Control group had no significant changes before and after treatment.Conclusion Treatment with lager spot size and low fluence of the 1064nm Q-switch Nd： YAG laser give an effective short-term relief of melasma,but with a high risk of recurrence.
出处
《中国中西医结合皮肤性病学杂志》
CAS
2011年第3期137-140,共4页
Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine
关键词
激光
黄褐斑
激光共聚集显微镜
治疗
laser
melasma
confocal laser scanning micriscopy
treatment
