Jordan R, Cummins C, Burls A
Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K.
Br J Dermatol. 2000 Mar;142(3):413-23. doi: 10.1046/j.1365-2133.2000.03350.x.
This review presents and evaluates the evidence of the effectiveness of laser resurfacing for facial acne scars. Primary studies of all types of design in any language were identified from MEDLINE, EMBASE, the Cochrane database, Science Citation Index and various internet sites. Studies were accepted if they included patients treated by any laser for atrophic or ice-pick acne scars. The quality of the studies was assessed and data extracted by two independent researchers. There were no controlled trials but 14 case series were found which reported the effects of either the carbon dioxide or erbium:YAG laser. All of the studies were of poor quality. The types and severity of scarring were poorly described and there was no standard scale used to measure scar improvement. There was no reliable or validated measure of patient satisfaction; most improvement was based on visual clinical judgement, in many cases without blinded assessment. The inaccurate use of ordinal scales meant that any improvement was impossible to quantify with any validity, although the evidence suggested that laser treatment had some efficacy (a range in individual patients of 25-90% for both the carbon dioxide laser and the erbium:YAG laser). Changes in pigmentation as a side-effect were common (in up to 44% of patients), although lasting only a few weeks. Laser resurfacing technology is increasingly used in clinical practice to treat acne scars. Despite the poor quality evidence, it is plausible that there is some improvement of acne scarring; there is insufficient information, however, for patients to make informed decisions on whether to opt for treatment and there is not enough evidence to compare the two types of laser. There is a particular lack of information about the psychological effects of acne scar improvement. Good quality randomized controlled trials are needed with standardized scarring scales and validated patient outcome measures in order to assess the effectiveness of laser resurfacing in this group of patients.
本综述展示并评估了激光换肤治疗面部痤疮疤痕有效性的证据。从医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、考克兰数据库、科学引文索引以及各类网站中，检索出了所有语言的各种设计类型的初步研究。若研究纳入了接受过任何激光治疗萎缩性或冰锥样痤疮疤痕的患者，则该研究可被纳入。由两名独立研究人员评估研究质量并提取数据。虽未找到对照试验，但发现了14个病例系列，这些系列报告了二氧化碳激光或铒：钇铝石榴石激光的治疗效果。所有研究质量均较差。疤痕的类型和严重程度描述欠佳，且未使用标准量表来衡量疤痕改善情况。没有可靠或经过验证的患者满意度衡量指标；大多数改善基于视觉临床判断，在许多情况下没有进行盲法评估。序数量表的不准确使用意味着任何改善都无法有效量化，尽管证据表明激光治疗有一定疗效（二氧化碳激光和铒：钇铝石榴石激光在个体患者中的改善范围为25% - 90%）。色素沉着作为副作用很常见（高达44%的患者出现），不过仅持续几周。激光换肤技术在临床实践中越来越多地用于治疗痤疮疤痕。尽管证据质量较差，但痤疮疤痕有一定改善似乎是合理的；然而，信息不足，患者无法做出是否选择治疗的明智决定，且没有足够证据比较这两种激光。尤其缺乏关于痤疮疤痕改善的心理影响方面的信息。需要进行高质量的随机对照试验，采用标准化的疤痕量表和经过验证的患者结局指标，以评估激光换肤对这类患者的有效性。
