From the Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
Plast Reconstr Surg. 2018 Sep;142(3):342e-350e. doi: 10.1097/PRS.0000000000004688.
BACKGROUND: Fractional carbon dioxide laser treatment in postburn scars is safe and effective, but high rates of hypochromia (35 percent) have been described in patients with skin phototypes V and VI after 2 months. The authors evaluated the efficacy and safety of fractional carbon dioxide laser treatment of burn scars in skin phototypes III to VI after 1 year, focusing on the incidence of hypochromia. METHODS: A case series of 20 patients had skin phototypes III to VI with facial burn sequelae. They underwent three sessions of fractional laser. Laser fluence was increased in patients with no hypochromia and reepithelialization time of less than 15 days. Scars were evaluated after 2 months and 1 year by a five-item scale: color, hydration, surface irregularities, volume, and distensibility. RESULTS: The mean time for reepithelialization was 13.3 days (range, 2 to 40 days). The average final score of the scale increased from 4.4 before treatment to 7.33 after 1 year for physicians, and from 5.35 to 7.5 for patients. There was also an increase in the subjective score, which patients used to assess their skin. Two months after treatment, 60 percent of patients presented with punctate hypochromia. After 1 year, only 15 percent of patients still had mild hypochromia; all of them had skin phototypes V and VI. Nevertheless, they were satisfied with overall bleaching of the skin. CONCLUSIONS: Fractional carbon dioxide laser improved skin quality. Late punctate hypopigmentation should be considered a possible complication in patients with skin phototypes V and VI. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景:在烧伤后瘢痕中应用分束二氧化碳激光治疗是安全且有效的,但有报道称,在皮肤类型为 V 和 VI 的患者中,治疗后 2 个月色素减退率高达 35%。作者评估了分束二氧化碳激光治疗皮肤类型为 III 至 VI 的烧伤后瘢痕的疗效和安全性,重点关注色素减退的发生率。
方法:一项病例系列研究纳入了 20 例面部烧伤后遗症患者,其皮肤类型为 III 至 VI。这些患者共接受了 3 次分束激光治疗。对于没有色素减退且上皮化时间少于 15 天的患者,增加激光能量。治疗后 2 个月和 1 年,采用 5 分制量表评估瘢痕:颜色、水分、表面不规则、体积和可扩展性。
结果:上皮化的平均时间为 13.3 天(范围为 2 至 40 天)。治疗后 1 年,医生评估的平均最终评分从治疗前的 4.4 分增加到 7.33 分,患者的平均最终评分从 5.35 分增加到 7.5 分。患者用于评估皮肤的主观评分也有所增加。治疗后 2 个月,60%的患者出现点状色素减退。治疗后 1 年,仅有 15%的患者仍存在轻度色素减退,且均为皮肤类型为 V 和 VI 的患者。然而,他们对皮肤整体美白效果均表示满意。
结论:分束二氧化碳激光改善了皮肤质量。对于皮肤类型为 V 和 VI 的患者,迟发性点状色素减退可能被视为一种潜在并发症。
临床问题/证据水平:治疗,IV。
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