Abstract:

Objective　To study the efficacy and safety of ultra picosecond dual wavelength (1 064 nm combined with 532 nm) fractional laser in the treatment of melasma. Methods　A retrospective analysis was conducted on 45 patients with melasma, all female, aged (40.6±2.4) years, in the Laser Department of Guangzhou Institute of Dermatology from January 2019 to December 2022. They received treatment with ultra picosecond dual wavelength (1 064 nm combined with 532 nm) fractional laser every 4 weeks, a total of 3 times. The Melasma Area and Severity Index (MASI) was scored, and the VISIA was used to detect the positive UV spot, brown spot, spot, and erythema counts. The efficacy was observed by the Physician Global Assessment (PGA), and the adverse reactions were evaluated. Analysis of variance for repeated data and paired t test were used. Results　After 3 treatments, the PGA score showed that it was complete clearance in 2 cases (4.4%), basic clearance in 2 cases (4.4%), significant improvement in 5 cases (11.1%), moderate improvement in 19 cases (42.2%), mild improvement in 15 cases (33.3%), no improvement in 1 case (2.2%), and aggravation in 1 case (2.2%), with an improvement rate of 95.6%. There was a statistically significant difference in the MASI score before treatment and after 1, 2, and 3 treatments (F=7.287 0, P=0.000 2); compared with the baseline value [(19.32±10.36) points], the MASI score decreased significantly after 2 treatments [(12.13±7.27) points, t=2.919 0, P=0.004 9] and after 3 treatments [(9.49±6.65) points, t=4.372 0, P<0.000 1]. There was a statistically significant difference in the VISIA brown spot count before and after treatment (F=5.361 0, P=0.000 5); after 3 treatments, there was a decrease compared to the baseline value [(22.24±7.84) points vs. (29.06±8.72) points] (t=3.579 0, P=0.000 7). There was a statistically significant difference in the erythema count before and after treatment (F=5.072 0, P=0.000 7); compared with the baseline value [(18.80±9.51) points], the erythema count was significantly decreased after 2 treatments [(14.09±7.18) points, t=3.164 0, P= 0.0022] and after 3 treatments [(13.26±8.49) points, t=3.229 0, P=0.001 9]. The patients experienced mild pain during the surgery, followed by mild erythema, edema, and pigmentation, all of which subsided within 2-7 days, without any blister scar. Conclusion　The treatment of melasma with ultra picosecond dual wavelength fractional laser is effective and safe.

Key words:

Melasma, Ultra picosecond laser, Dual wavelength, 1 064 nm, 532 nm, Adverse reactions

摘要：

目的　研究超皮秒双波长1 064 nm联合532 nm点阵激光治疗黄褐斑的疗效与安全性。方法　回顾性分析于2019年1月至2022年12月来广州市皮肤病防治所激光科就诊的黄褐斑患者45例，均为女性，年龄（40.6±2.4）岁，采用超皮秒双波长1 064 nm联合532 nm点阵激光治疗，每4周治疗1次，共治疗3次，采用黄褐斑面积和严重指数（Melasma Area and Severity Index，MASI）评分，VISIA检测正面紫外线斑、棕色斑、斑点、红斑计数分值，医生整体评价法（Physician Global Assessment，PGA）观察疗效，评估不良反应。采用重复测量设计的方差分析、配对t检验。结果　治疗3次后PGA评分显示完全清除2例（4.4%），基本清除2例（4.4%），明显改善5例（11.1%），中度改善19例（42.2%），轻度改善15例（33.3%），无改善1例（2.2%），较治疗前加重1例（2.2%），改善率达95.6%。治疗前及治疗1次、2次、3次后MASI评分差异有统计学意义（F=7.287 0，P=0.000 2）；与基线值［（19.32±10.36）分］相比，治疗2次后［（12.13±7.27）分，t=2.919 0，P=0.004 9］、治疗3次后MASI评分［（9.49±6.65）分，t=4.372 0，P<0.000 1］均明显下降。VISIA棕色斑分值治疗前后差异有统计学意义（F=5.361 0，P=0.000 5）；在3次治疗后［（22.24±7.84）分］较基线值［（29.06±8.72）分］出现下降（t=3.579 0，P=0.000 7）；红色斑分值治疗前后差异有统计学意义（F=5.072 0，P=0.000 7），与基线值［（18.80±9.51）分］比较，在治疗2次［（14.09±7.18）分，t=3.164 0，P=0.002 2］、3次后［（13.26±8.49）分，t=3.229 0，P=0.001 9］均明显下降。患者术中出现轻度疼痛，术后出现轻度红斑、水肿、色素沉着，均在2～7 d内消退，无水疱疤痕。结论　超皮秒双波长点阵激光治疗黄褐斑疗效确切，安全性好。

关键词:

黄褐斑, 超皮秒激光, 双波长, 1 064 nm, 532 nm, 不良反应