Hwang Chian-Yaw, Lin Chrang-Shi, Tseng Ming-Li, Liu Han-Nan
Department of Dermatology, Taipei General Veterans Hospital, Taipei, Taiwan, Republic of China.
J Cosmet Laser Ther. 2010 Feb;12(1):47-50. doi: 10.3109/14764170903352886.
The development of skin hyperpigmentation in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been well documented. However, the cosmetic concern was neither valued seriously nor treated effectively in the past. We report a female case who suffered from facial hyperpigmentation (FH). She was treated by large-spot sized, 1064-nm Q-switched Nd:YAG laser (QSNYL). A significant improvement was found after three treatment sessions at a fluence of 3.9 J/cm(2) with 8-day intervals, but spotted leucoderma developed at the fourth visit. Neither residual FH nor spotted leucoderma subsequently improved following two additional sessions of 1064-nm QSNYL at a lower fluence with topical hydroquinone and HeNe laser, and it persisted at the 1-year follow-up. This clinically specific round-shaped leucoderma suggested laser-induced damage to melanocytes due to unsuitable application. The 1064-nm QSNYL with a large spot size and an appropriate parameter may become an effective therapeutic modality if properly utilized.
血液透析（HD）的终末期肾病（ESRD）患者皮肤色素沉着过度的发展已有充分记录。然而，过去对其美容问题既未给予足够重视，也未得到有效治疗。我们报告一例患有面部色素沉着过度（FH）的女性病例。她接受了大光斑尺寸的1064纳米调Q钕：钇铝石榴石激光（QSNYL）治疗。在以3.9 J/cm(2)的能量密度、间隔8天进行三次治疗后，发现有显著改善，但在第四次就诊时出现了点状白斑。在随后两次以较低能量密度进行的1064纳米QSNYL治疗并联合外用氢醌和氦氖激光治疗后，残余的FH和点状白斑均未改善，且在1年随访时仍持续存在。这种临床上特定的圆形白斑提示由于应用不当导致激光对黑素细胞造成损伤。如果合理使用，大光斑尺寸且参数合适的1064纳米QSNYL可能成为一种有效的治疗方式。
