The Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Am Acad Dermatol. 2011 Mar;64(3):516-23. doi: 10.1016/j.jaad.2010.01.048. Epub 2011 Jan 20.
Various treatments are currently available for melasma. However, results are often disappointing.
We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard).
Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment.
Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling.
Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups.
Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies.
目前有多种治疗黄褐斑的方法。然而，结果往往令人失望。
我们旨在评估非剥脱性 1550nm 点阵激光治疗的疗效和安全性，并与三联外用疗法（金标准）的结果进行比较。
20 名女性中度至重度黄褐斑患者，Fitzpatrick 皮肤类型 II 至 V 型，随机对照、观察者盲法研究中，分别接受非剥脱性点阵激光治疗或三联外用疗法（氢醌 5%、维 A 酸 0.05%和曲安奈德 0.1%乳膏），每天一次，共 8 周。激光治疗每 2 周进行一次，共 4 次。在末次治疗后 3 周、3 个月和 6 个月评估医生总体评估。
两组在 3 周时医生总体评估均有改善（P<0.001）。两组间医生总体评估无差异。在 3 周时，激光组的治疗满意度和推荐率明显更高（P<0.05）。然而，两组患者在 6 个月后均有 5 例黄褐斑复发。激光组的副作用有红斑、烧灼感、面部水肿和疼痛；三联组的副作用有红斑、烧灼感和脱屑。
局限性在于：患者数量少；只有一组激光参数；以及两组间的动机差异。
非剥脱性点阵激光治疗安全，疗效和复发率与三联外用疗法相当。当局部美白无效或不耐受时，它可能是黄褐斑的一种有用的替代治疗选择。未来的研究应测试不同的激光参数和长期维持治疗。
