Tanzi Elizabeth L, Alster Tina S
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA.
Dermatol Surg. 2004 Feb;30(2 Pt 1):152-7. doi: 10.1111/j.1524-4725.2004.30078.x.
Atrophic scar revision techniques, although numerous, have been hampered by inadequate clinical responses and prolonged postoperative recovery periods. Nonablative laser treatment has been shown to effect significant dermal collagen remodeling with minimal posttreatment sequelae. Although many studies have been published regarding the effectiveness of these nonablative lasers on rhytides, there are limited data demonstrating their specific effects on atrophic scars.
To evaluate and compare the efficacy and safety of long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers in the treatment of atrophic facial scarring.
A series of 20 patients (skin phototypes I-V) with mild to moderate atrophic facial acne scars randomly received three successive monthly treatments with a long-pulsed 1320-nm Nd:YAG laser on one facial half and a long-pulsed 1450-nm diode laser on the contralateral facial half. Patients were evaluated using digital photography and three-dimensional in vivo microtopography measurements at each treatment visit and at 1, 3, 6, and 12 months postoperatively. Histologic evaluations of cutaneous biopsies obtained before treatment, immediately after the first treatment, and at 1, 3, 6, and 12 months after the third treatment were performed. Clinical assessment scores were determined at each treatment session and follow-up visit. Patient satisfaction surveys were obtained at the end of the study.
Mild to moderate clinical improvement was observed after the series of three treatments in the majority of patients studied. Patient satisfaction scores and in vivo microtopography measurements paralleled the photographic and histopathologic changes seen. Side effects of treatment were limited to mild transient erythema, edema, and hyperpigmentation. No scarring or adverse textural changes resulted from the use of either laser system.
Nonablative long-pulsed 1320-nm Nd:YAG and 1450-nm diode lasers each offer clinical improvement for patients with atrophic scarring without significant side effects or complications. The 1450-nm diode laser showed greater clinical scar response at the parameters studied. The use of nonablative laser systems is a good treatment alternative for patients with atrophic scarring who are unable or unwilling to endure the prolonged postoperative recovery process associated with ablative laser skin resurfacing procedures.
萎缩性瘢痕修复技术虽然众多，但临床效果欠佳以及术后恢复期延长限制了其应用。非剥脱性激光治疗已被证明可有效重塑真皮胶原蛋白，且治疗后后遗症极少。尽管已有许多关于这些非剥脱性激光治疗皱纹有效性的研究发表，但证明其对萎缩性瘢痕有特定效果的数据有限。
评估并比较长脉冲1320纳米钕：钇铝石榴石激光和1450纳米二极管激光治疗面部萎缩性瘢痕的疗效和安全性。
选取20例（皮肤光型I - V）患有轻至中度面部痤疮萎缩性瘢痕的患者，在面部一侧连续三个月每月接受一次长脉冲1320纳米钕：钇铝石榴石激光治疗，对侧面部接受长脉冲1450纳米二极管激光治疗。在每次治疗时以及术后1、3、6和12个月，使用数码摄影和三维活体微观形貌测量对患者进行评估。在治疗前、首次治疗后即刻以及第三次治疗后1、3、6和12个月，对获取的皮肤活检组织进行组织学评估。在每次治疗和随访时确定临床评估分数。在研究结束时进行患者满意度调查。
在大多数研究患者中，经过一系列三次治疗后观察到轻至中度临床改善。患者满意度评分和活体微观形貌测量结果与所观察到的摄影和组织病理学变化一致。治疗的副作用仅限于轻度短暂性红斑、水肿和色素沉着。两种激光系统的使用均未导致瘢痕形成或不良质地改变。
非剥脱性长脉冲1320纳米钕：钇铝石榴石激光和1450纳米二极管激光均可使萎缩性瘢痕患者获得临床改善，且无明显副作用或并发症。在所研究的参数下，1450纳米二极管激光显示出更大的临床瘢痕反应。对于那些无法或不愿忍受与剥脱性激光皮肤重建手术相关的长时间术后恢复过程的萎缩性瘢痕患者，非剥脱性激光系统的使用是一种良好的治疗选择。
