Esmat Samia M, Fawzi Marwa M, Gawdat Heba I, Ali Heba S, Sayed Safinaz S
Department of Dermatology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
Department of Histology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
Lasers Surg Med. 2015 Jul;47(5):388-95. doi: 10.1002/lsm.22361. Epub 2015 May 6.
Primary cutaneous amyloidosis (PCA) comprises three main forms: macular, lichen, and nodular amyloidosis. The current available treatments are quite disappointing.
Assess and compare the clinical and histological changes induced by different modes of Fractional CO2 laser in treatment of PCA.
Twenty five patients with PCA (16 macular and 9 lichen amyloidosis) were treated by fractional CO2 using; superficial ablation (area A) and deep rejuvenation (area B). Each patient received 4 sessions with 4 weeks intervals. Skin biopsies were obtained from all patients at baseline and one month after the last session. Patients were assessed clinically and histologically (Congo red staining, polarized light). Patients were followed-up for 3 months after treatment.
Both modes yielded significant reduction of pigmentation, thickness, itching, and amyloid deposits (P-value < 0.001). However, the percentage of reduction of pigmentation was significantly higher in area A (P-value = 0.003). Pain was significantly higher in area B. Significant reduction in dermal amyloid deposits denotes their trans-epidermal elimination induced by fractional photothermolysis.
Both superficial and deep modes of fractional CO2 laser showed comparable efficacy in treatment of PCA. Superficial mode being better tolerated by patients, is recommended as a valid therapeutic option.
原发性皮肤淀粉样变（PCA）主要包括三种形式：斑状、苔藓状和结节状淀粉样变。目前可用的治疗方法相当令人失望。
评估和比较不同模式的二氧化碳点阵激光治疗PCA所引起的临床和组织学变化。
25例PCA患者（16例斑状和9例苔藓状淀粉样变）接受了二氧化碳点阵激光治疗，采用浅表消融（A区）和深层嫩肤（B区）。每位患者接受4次治疗，间隔4周。在基线时和最后一次治疗后1个月对所有患者进行皮肤活检。对患者进行临床和组织学评估（刚果红染色、偏振光）。治疗后对患者随访3个月。
两种模式均使色素沉着、厚度、瘙痒和淀粉样蛋白沉积显著减少（P值<0.001）。然而，A区色素沉着减少的百分比显著更高（P值=0.003）。B区疼痛明显更严重。真皮淀粉样蛋白沉积的显著减少表明其通过点阵光热分解诱导经表皮清除。
二氧化碳点阵激光的浅表和深层模式在治疗PCA方面显示出相当的疗效。浅表模式患者耐受性更好，推荐作为一种有效的治疗选择。
