Chan Henry H, Wong David S Y, Ho W S, Lam L K, Wei W
Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong.
Dermatol Surg. 2004 Jul;30(7):987-94; discussion 994. doi: 10.1111/j.1524-4725.2004.30303.x.
Pulse dye laser has been used with variable degrees of success in the treatment of hypertrophic scars, and although earlier reports suggested a significant degree of improvement, more recent studies have raised concern about its effectiveness. Furthermore, most previous studies examined its use in patients with light skin types, and the use of pulse dye laser in dark-skinned patients for the treatment of hypertrophic scars is not well established.
The objective was to assess the role of pulsed dye laser therapy in the treatment and prevention of hypertrophic scars in Chinese persons.
Twenty-nine patients (35 scars) who had scars for less than 6 months were recruited into the prevention group, and 27 patients (36 scars) who had scars for more than 6 months were recruited into the treatment arm of the study. Each received pulse dye laser treatment (585 nm, 1.5-msec pulse duration, 5-mm spot size, 7-8 J/cm(2)) for three to six treatments at 8-week intervals. Half of the scar was treated with the laser and the other half was used as a control. All patients were assessed for subjective improvement with the use of a structured questionnaire and objectively with ultrasonography for thickness and a cutometer for viscoelasticity. Scars were marked on every patient and mapped with a translucent paper at the first appointment to ensure the consistency of location. At the end of the study, 15 patients from the prevention group (15 scars) and 23 patients from the treatment group (34 scars) agreed to return for spectrophotometer assessment.
Fifty-four percent of patients in the prevention group and 66% of patients in the treatment group considered their scars to be better or much better. For both groups of patients, there was significant improvement in term of pruritics after laser treatment. For objective assessment, although scar thickness reduced significantly compared to baseline in the treatment group, such change was not significant when changes in the control side were taken into consideration. There was insignificant change in viscoelasticity. Spectrophometer assessment indicated a significant degree of lightening in the treatment group.
Our study indicated that although there was significant symptomatic improvement, there was an insignificant degree of objective improvement in terms of scar thickness and viscoelasticity in the prevention group compared to the control group. Our findings are in line with several previous controlled studies and contradict the results of several others. Such differences can be due to differences in assessment methodology, laser settings, skin type, and scar location. Suprapurpuric pulsed dye laser should not be considered as the standard of practice for the treatment and prevention of hypertrophic surgical scars especially in the chest in Asians patients.
脉冲染料激光在治疗增生性瘢痕方面取得了不同程度的成功，尽管早期报告显示有显著改善，但最近的研究对其有效性提出了质疑。此外，以前的大多数研究考察了其在浅肤色患者中的应用，而脉冲染料激光在深肤色患者中治疗增生性瘢痕的应用尚未得到充分证实。
评估脉冲染料激光治疗在中国人群增生性瘢痕治疗和预防中的作用。
招募29例（35处瘢痕）瘢痕形成时间小于6个月的患者进入预防组，27例（36处瘢痕）瘢痕形成时间大于6个月的患者进入研究的治疗组。每组均接受脉冲染料激光治疗（585nm，1.5毫秒脉冲持续时间，5毫米光斑大小，7 - 8J/cm²），每隔8周进行3至6次治疗。瘢痕的一半接受激光治疗，另一半作为对照。所有患者通过结构化问卷进行主观改善评估，并通过超声测量厚度和使用皮肤弹性仪测量粘弹性进行客观评估。在首次就诊时对每位患者的瘢痕进行标记并用半透明纸绘制，以确保位置的一致性。研究结束时，预防组的15例患者（15处瘢痕）和治疗组的23例患者（34处瘢痕）同意返回进行分光光度计评估。
预防组54%的患者和治疗组66%的患者认为其瘢痕有所改善或明显改善。两组患者在激光治疗后瘙痒症状均有显著改善。对于客观评估，尽管治疗组瘢痕厚度与基线相比显著降低，但考虑到对照侧的变化时，这种变化并不显著。粘弹性变化不显著。分光光度计评估显示治疗组有显著的色素沉着减轻。
我们的研究表明，尽管有显著的症状改善，但与对照组相比，预防组在瘢痕厚度和粘弹性方面的客观改善程度不显著。我们的研究结果与之前的几项对照研究一致，与其他一些研究结果相矛盾。这种差异可能是由于评估方法、激光设置、皮肤类型和瘢痕位置的不同。尤其在亚洲患者胸部，超紫癜性脉冲染料激光不应被视为治疗和预防增生性手术瘢痕的标准方法。
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