Brauer Jeremy A, McDaniel David H, Bloom Bradley S, Reddy Kavitha K, Bernstein Leonard J, Geronemus Roy G
J Drugs Dermatol. 2014 Nov;13(11):1317-22.
Long-term exposure to sunlight, including ultraviolet A and B, produces signs associated with photoaging and photodamage, including laxity and discoloration of the skin. Initial laser treatment for dyspigmentation included the use of ablative lasers, followed by Q-switched lasers and more recently fractional lasers.
We investigated the safety and efficacy of a fractionated 1927nm non-ablative thulium laser for the treatment of photo-induced pigmentation.
Prospective multi-center study of subjects with clinically identifiable photopigmentation. The study protocol was approved by BioMed Institutional Review Board (San Diego, CA). Subjects received two treatments with a non-ablative 1927nm fractionated thulium laser (Fraxel Dual 1550/1927 Laser System, Solta, Hayward CA), energy level of 10mJ, coverage of 40% and 4-6 passes. Subject pain, erythema and edema were recorded immediately after treatment. Two dimensional photography was obtained before each treatment and at one and three month follow up visits. Independent blinded physician assessment was performed evaluating overall improvement in appearance as well as pigment specific improvement.
Forty men and women, ages 30 to 80 years, Fitzpatrick skin types I-IV, with photo-induced facial pigmentation were enrolled and treated, and 39 completed the three month follow up visit. Mean pain sensation for subjects during laser treatments was reported to be 4.3 on a 10-point scale. Mean scores for erythema, edema, and skin roughness throughout all treatments indicated moderate erythema, mild edema and mild skin roughness. Assessment of overall improvement was graded as moderate to very significant in 82% of subjects at one month and in 69% of subjects at three months after the second treatment. Assessment of lentigines and ephelides demonstrated moderate to very significant improvement in approximately 68% of subjects at the one month and in 51% of subjects at three months after the second treatment. Independent blinded physician assessment of randomized photography also demonstrated a durable response at three month follow up visit. Treatment was well tolerated and no serious adverse events related to treatment were observed or reported. Study limitations included a limited number of male subjects, lack of Fitzpatrick skin types V and VI, and decrease in improvement at 3 months post-treatment.
Two treatments with a 1927nm non-ablative fractionated thulium laser produced moderate to marked improvement in overall appearance and pigmentation with high patient satisfaction. The response to treatment was maintained at one and three months follow up.
长期暴露于阳光（包括紫外线A和B）会产生与光老化和光损伤相关的迹象，包括皮肤松弛和色素沉着。最初用于色素沉着异常的激光治疗包括使用剥脱性激光，随后是调Q激光，最近是分数激光。
我们研究了1927nm非剥脱性铥激光治疗光诱导色素沉着的安全性和有效性。
对临床上可识别的光色素沉着患者进行前瞻性多中心研究。研究方案经生物医学机构审查委员会（加利福尼亚州圣地亚哥）批准。受试者接受两次非剥脱性1927nm分数铥激光治疗（Fraxel Dual 1550/1927激光系统，Solta，加利福尼亚州海沃德），能量水平为10mJ，覆盖率为40%，照射4 - 6遍。治疗后立即记录受试者的疼痛、红斑和水肿情况。在每次治疗前以及治疗后1个月和3个月的随访时拍摄二维照片。由独立的盲法医生进行评估，评估外观的总体改善情况以及色素沉着的具体改善情况。
纳入并治疗了40名年龄在30至80岁之间、Fitzpatrick皮肤类型为I - IV型、有光诱导面部色素沉着的男性和女性，39名完成了3个月的随访。据报告，受试者在激光治疗期间的平均疼痛感觉在10分制中为4.3分。所有治疗过程中红斑、水肿和皮肤粗糙度的平均评分表明有中度红斑、轻度水肿和轻度皮肤粗糙度。在第二次治疗后1个月，82%的受试者总体改善评估为中度至非常显著；在3个月时，69%的受试者评估为中度至非常显著。对雀斑和雀斑样痣的评估显示，在第二次治疗后1个月，约68%的受试者有中度至非常显著的改善；在3个月时，51%的受试者有中度至非常显著的改善。独立的盲法医生对随机拍摄照片的评估也显示在3个月随访时效果持久。治疗耐受性良好，未观察到或报告与治疗相关的严重不良事件。研究局限性包括男性受试者数量有限、缺乏Fitzpatrick皮肤类型V和VI，以及治疗后3个月改善程度下降。
用1927nm非剥脱性分数铥激光进行两次治疗，可使外观和色素沉着得到中度至显著改善，患者满意度高。治疗反应在1个月和3个月随访时得以维持。
