Alam Murad, Hsu Te-Shao, Dover Jeffrey S, Wrone David A, Arndt Kenneth A
Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Lasers Surg Med. 2003;33(1):30-9. doi: 10.1002/lsm.10195.
Nonablative laser and light treatments have largely replaced ablative laser therapy in clinical use for the improvement of the visible signs of cutaneous photoaging, including rhytides, vascular lesions, and pigmentation. However, the mechanisms underlying the reported clinical efficacy of nonablative treatments are not well-understood. The purpose of this analysis is to critically evaluate what is known about histologic and tissue effects of nonablative laser therapy and suggest future directions for research.
STUDY DESIGN/MATERIALS AND METHODS: This is a review of the English language literature pertaining to nonablative laser and light treatments available through MEDline (1995-2002), and unpublished reports presented at major national meetings. Only studies that included harvesting and analysis of tissue samples are included.
(a) Thermal injury to the dermis in association with epidermal cooling most likely affects the dermal vasculature, which initiates a cascade of inflammatory events that includes fibroblastic proliferation and apparent up-regulation of collagen expression; (b) There is no indication that nonablative treatments are harmful or able to induce skin cancer; (c) It is possible that the horizontally distributed collagen reported after nonablative treatments is a "microscar," an enlarged Grenz sone associated with repetitive photo-induced trauma; (d) Further research is needed to elucidate the biophysical mechanisms underlying nonablative treatment, as well as to distinguish the utility of different wavelengths on epidermal and dermal improvement.
非剥脱性激光和光治疗在临床上已基本取代剥脱性激光治疗，用于改善皮肤光老化的可见征象，包括皱纹、血管病变和色素沉着。然而，非剥脱性治疗所报道的临床疗效背后的机制尚未完全明确。本分析的目的是严格评估关于非剥脱性激光治疗的组织学和组织效应的已知情况，并提出未来的研究方向。
研究设计/材料与方法：这是一篇对通过MEDline（1995 - 2002年）可获取的关于非剥脱性激光和光治疗的英文文献以及在主要全国性会议上发表的未发表报告的综述。仅纳入了包括组织样本采集和分析的研究。
（a）与表皮冷却相关的真皮热损伤很可能影响真皮血管系统，引发一系列炎症事件，包括成纤维细胞增殖和胶原蛋白表达明显上调；（b）没有迹象表明非剥脱性治疗有害或能够诱发皮肤癌；（c）非剥脱性治疗后报道的水平分布的胶原蛋白可能是一种“微瘢痕”，即与重复性光诱导创伤相关的增厚的无细胞层；（d）需要进一步研究以阐明非剥脱性治疗背后的生物物理机制，以及区分不同波长在改善表皮和真皮方面的效用。
