脉冲染料激光治疗皮肤盘状红斑狼疮的疗效和安全性。

Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus.

作者信息

Erceg Angelina, Bovenschen H Jorn, van de Kerkhof Peter C M, de Jong Elke M J G, Seyger Marieke M B

机构信息

Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

出版信息

J Am Acad Dermatol. 2009 Apr;60(4):626-32. doi: 10.1016/j.jaad.2008.11.904.

DOI:10.1016/j.jaad.2008.11.904

PMID:19293010

Abstract

BACKGROUND

Treatment of chronic discoid lupus erythematosus (CDLE) with a pulsed dye laser (PDL) has shown promising results, although outcomes in previous studies were not validated and laser parameters were inconsistent.

OBJECTIVE

We conducted an open prospective study to assess the efficacy and safety of PDL for the treatment of recalcitrant CDLE, using a validated scoring method and a fixed treatment schedule.

METHODS

Twelve patients with active CDLE lesions were treated with PDL (585 nm, fluence 5.5 J/cm(2), spot size 7 mm) 3 times with an interval of 6 weeks followed by a 6-week follow-up period. Treatment outcomes were evaluated by 3 observers using the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Cosmetic results and adverse events were recorded.

RESULTS

A significant decline in "active" CLASI was observed after 6 weeks, after 12 weeks, and at follow-up. Baseline active CLASI was 4.4 +/- 0.2 (mean +/- SEM), reaching 1.3 +/- 0.3 after follow-up (P < .0001). Individual scores for erythema and scaling/hypertrophy significantly declined 6 weeks after treatment. The "damage" CLASI (dyspigmentation, scarring, and atrophy) did not show any significant change during or after therapy. The observed clinical improvement was confirmed by two independent observers by clinical assessment of photographs (r = 0.87 and r = 0.89; both P < .05). The treatment was well tolerated, only minimal pain was reported, and the cosmetic result was fair.

LIMITATIONS

Small sample size and short follow-up duration were limitations.

CONCLUSION

PDL treatment is an effective and safe therapy for patients with refractory CDLE.

摘要

背景

尽管以往研究的结果未得到验证且激光参数不一致，但脉冲染料激光（PDL）治疗慢性盘状红斑狼疮（CDLE）已显示出有前景的结果。

目的

我们进行了一项开放性前瞻性研究，使用经过验证的评分方法和固定的治疗方案，评估PDL治疗顽固性CDLE的疗效和安全性。

方法

12例有活动性CDLE皮损的患者接受PDL（585nm，能量密度5.5J/cm²，光斑大小7mm）治疗，共3次，间隔6周，随后有6周的随访期。3名观察者使用经过验证的皮肤红斑狼疮疾病面积和严重程度指数（CLASI）评估治疗结果。记录美容效果和不良事件。

结果

在6周后、12周后及随访时，“活动性”CLASI均显著下降。基线活动性CLASI为4.4±0.2（均值±标准误），随访后降至1.3±0.3（P<0.0001）。治疗6周后，红斑和鳞屑/肥厚的个体评分显著下降。“损伤性”CLASI（色素沉着异常、瘢痕形成和萎缩）在治疗期间或治疗后未显示任何显著变化。两名独立观察者通过对照片的临床评估证实了观察到的临床改善（r=0.87和r=0.89；均P<0.05）。治疗耐受性良好，仅报告有轻微疼痛，美容效果尚可。