Belkin Daniel A, Neckman Julia P, Jeon Hana, Friedman Paul, Geronemus Roy G
Laser & Skin Surgery Center of New York, New York.
Dermatology & Laser Surgery Center, Houston, Texas.
JAMA Dermatol. 2017 Nov 1;153(11):1158-1161. doi: 10.1001/jamadermatol.2017.2807.
Response to laser treatment for café au lait macules (CALMs) is inconsistent and difficult to predict.
To test the hypothesis that irregularly bordered CALMs of the "coast of Maine" subtype respond better to treatment than those of the smooth-bordered "coast of California" subtype.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series included patients from 2 multiple-clinician US practices treated from 2005 through 2016. All patients had a clinical diagnosis of CALM and were treated with a Q-switched or picosecond laser. A total of 51 consecutive patients were eligible, 6 of whom were excluded owing to ambiguous lesion subtype. Observers were blinded to final patient groupings.
Treatment with 755-nm alexandrite picosecond laser, Q-switched ruby laser, Q-switched alexandrite laser, or Q-switched 1064-nm Nd:YAG laser.
Main outcome was grade in a visual analog scale (VAS) consisting of 4 levels of treatment response: poor (grade 1, 0%-25% improvement), fair (grade 2, 26%-50% improvement), good (grade 3, 51%-75% improvement), and excellent (grade 4, 76%-100% improvement).
Forty-five patients were included in the series, 19 with smooth-bordered lesions and 26 with irregularly bordered lesions. Thirty-four (76%) of the participants were female; 33 (73%) were white; and the mean age at the time of laser treatment was 14.5 years (range, 0-44 years). Smooth-bordered lesions received a mean VAS score of 1.76, corresponding to a fair response on average (26%-50% pigmentary clearance). Irregularly bordered lesions received a mean VAS score of 3.67, corresponding to an excellent response on average (76%-100% clearance) (P < .001).
CALMs with jagged or ill-defined borders of the coast of Maine subtype tend to respond well to laser treatment, whereas those with smooth and well-defined borders of the coast of California subtype tend to have poor response. Clinicians using Q-switched or picosecond lasers to treat CALMs can use morphologic characteristics to help predict response and more effectively manage patient expectations.
咖啡斑（CALMs）对激光治疗的反应不一致且难以预测。
检验“缅因州海岸”亚型边界不规则的咖啡斑比边界光滑的“加利福尼亚州海岸”亚型对治疗反应更好这一假设。
设计、地点和参与者：这项回顾性病例系列研究纳入了2005年至2016年在美国两家多临床医生诊所接受治疗的患者。所有患者均有咖啡斑的临床诊断，并接受了调Q或皮秒激光治疗。共有51例连续患者符合条件，其中6例因病变亚型不明确而被排除。观察者对最终患者分组不知情。
使用755纳米翠绿宝石皮秒激光、调Q红宝石激光、调Q翠绿宝石激光或调Q 1064纳米钕：钇铝石榴石激光进行治疗。
主要结局是视觉模拟量表（VAS）中的分级，该量表由4个治疗反应水平组成：差（1级，改善0%-25%）、中等（2级，改善26%-50%）、好（3级，改善51%-75%）和优秀（4级，改善76%-100%）。
该系列研究纳入了45例患者，其中19例病变边界光滑，26例病变边界不规则。参与者中34例（76%）为女性；33例（73%）为白人；激光治疗时的平均年龄为14.5岁（范围为0-44岁）。边界光滑的病变平均VAS评分为1.76，平均对应中等反应（色素清除率26%-50%）。边界不规则的病变平均VAS评分为3.67，平均对应优秀反应（清除率76%-100%）（P<0.001）。
边界呈锯齿状或不清晰的“缅因州海岸”亚型咖啡斑对激光治疗往往反应良好，而边界光滑且清晰的“加利福尼亚州海岸”亚型咖啡斑往往反应较差。使用调Q或皮秒激光治疗咖啡斑的临床医生可以利用形态学特征来帮助预测反应，并更有效地管理患者预期。
