Zhang Y Q, Dong J Y, Wang C, Yan M, Yao M
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
Zhonghua Shao Shang Za Zhi. 2018 Sep 20;34(9):608-614. doi: 10.3760/cma.j.issn.1009-2587.2018.09.010.
To observe the effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus in clinic. A prospective randomized controlled study was conducted. A total of 90 patients with hypertrophic scars conforming to the inclusion criteria who were hospitalized in our ward from March to December 2017 were divided into combination treatment group and control group according to the random number table, with 45 patients in each group. For scar pruritus, patients in control group were treated twice by narrow-spectrum intense pulsed light with a one-month interval, while patients in combination treatment group were firstly treated by narrow-spectrum intense pulsed light combined with fractional carbon dioxide laser once, and with narrow-spectrum intense pulsed light once one month later. Before and 3 months after treatment, scar pruritus was evaluated by the Visual Analogue Scale and the Four-item Itch Questionnaire, and the improvement of scar was assessed by photography. Three months after treatment, the treatment satisfaction of scar pruritus was self-rated by patients. Meanwhile, adverse effects were recorded during the procedures and follow-up periods. Data were processed with Chi-square test, paired test, Wilcoxon rank-sum test, and Fisher's exact probability test. Before treatment, there was no statistically significant difference in scar pruritus degree evaluated by the Visual Analogue Scale and score distribution of scar pruritus location, extent, frequency, and sleep effect of the Four-item Itch Questionnaire between patients of two groups (=-1.08, -0.91, -0.03, -0.69, -1.49, >0.05). Three months after treatment, there was reducing degree of scar pruritus of patients evaluated by the Visual Analogue Scale in control group or combination treatment group compared with before treatment within the same group (=-1.98, -4.65, <0.05 or <0.01), while the latter was more obvious than the former (=-2.14, <0.05). There were reducing scores of scar pruritus extent and frequency of patients in control group, along with location, extent, frequency, and sleep effect of patients in combination treatment group compared with those before treatment within the same group (=-2.33, -2.34, -3.53, -4.96, -3.32, -4.84, <0.05 or <0.01). However, scores of scar pruritus location and sleep effect of patients in control group were similar to those before treatment within the same group (=-0.58, -1.34, >0.05). The scores of scar pruritus location, extent, frequency, and sleep effect of patients were obviously lower in combination treatment group compared with control group (=-2.09, -2.69, -1.99, -2.23, <0.05 or <0.01). It was much better of scar improvement of patients in combination treatment group compared with control group (=-4.00, <0.01). The percentages of treatment satisfaction of scar pruritus of patients with 0, 1%-25%, 26%-50%, 51%-75%, 76%-100% were 0, 2.2% (1/45), 17.8% (8/45), 48.9% (22/45), and 31.1% (14/45) respectively in combination treatment group, which were obviously better than 0, 11.1% (5/45), 53.3% (24/45), 28.9% (13/45), and 6.7% (3/45) in control group (=-4.42, <0.01). During the treatment and follow-up periods, the adverse effect ratio of patients in control group was 6.7% (3/45), similar to 2.2% (1/45) of combination treatment group (>0.05). The combination of narrow-spectrum intense pulsed light and fractional carbon dioxide laser can greatly reduce pruritus, improve effect of scar treatment, and bring higher patient satisfaction compared with narrow-spectrum intense pulsed light alone in treating hypertrophic scar pruritus. Chinese Clinical Trial Registry, ChiCTR-ONH-17012350.
观察窄谱强脉冲光联合二氧化碳点阵激光治疗临床肥厚性瘢痕瘙痒的效果。进行一项前瞻性随机对照研究。2017年3月至12月在我科住院的符合纳入标准的90例肥厚性瘢痕患者，按随机数字表法分为联合治疗组和对照组，每组45例。对于瘢痕瘙痒，对照组患者采用窄谱强脉冲光治疗2次，间隔1个月，联合治疗组患者先采用窄谱强脉冲光联合二氧化碳点阵激光治疗1次，1个月后再采用窄谱强脉冲光治疗1次。治疗前及治疗后3个月，采用视觉模拟评分法和四项瘙痒问卷评估瘢痕瘙痒情况，通过拍照评估瘢痕改善情况。治疗后3个月，患者对瘢痕瘙痒的治疗满意度进行自评。同时，记录治疗过程及随访期间的不良反应。数据采用卡方检验、配对检验、Wilcoxon秩和检验及Fisher确切概率法进行处理。治疗前，两组患者视觉模拟评分法评估的瘢痕瘙痒程度及四项瘙痒问卷中瘢痕瘙痒部位、范围、频率及睡眠影响的得分分布差异无统计学意义（=-1.08，-0.91，-0.03，-0.69，-1.49，>0.05）。治疗后3个月，与同组治疗前相比，对照组或联合治疗组患者视觉模拟评分法评估的瘢痕瘙痒程度均降低（=-1.98，-4.65，<0.05或<0.01），但联合治疗组更明显（=-2.14，<0.05）。与同组治疗前相比，对照组患者瘢痕瘙痒范围和频率得分降低，联合治疗组患者瘢痕瘙痒部位、范围、频率及睡眠影响得分均降低（=-2.33，-2.34，-3.53，-4.96，-3.32，-4.84，<0.05或<0.01）。然而，对照组患者瘢痕瘙痒部位和睡眠影响得分与同组治疗前相似（=-0.58，-1.34，>0.05）。联合治疗组患者瘢痕瘙痒部位、范围、频率及睡眠影响得分明显低于对照组（=-2.09，-2.69，-1.99，-2.23，<0.05或<0.01）。联合治疗组患者瘢痕改善情况明显优于对照组（=-4.00，<0.01）。联合治疗组患者瘢痕瘙痒治疗满意度为0、1%-25%、26%-50%、51%-75%、76%-100%的比例分别为0、2.2%（1/45）、17.8%（8/45）、48.9%（22/45）、31.1%（14/45），明显优于对照组的0、11.1%（5/45）、53.3%（24/45）、28.9%（13/45）、6.7%（3/45）（=-4.42，<0.01）。治疗及随访期间，对照组患者不良反应发生率为6.7%（3/45），与联合治疗组的2.2%（1/45）相似（>0.05）。窄谱强脉冲光联合二氧化碳点阵激光治疗肥厚性瘢痕瘙痒较单纯窄谱强脉冲光可显著减轻瘙痒，提高瘢痕治疗效果，患者满意度更高。中国临床试验注册中心，ChiCTR-ONH-17012350。
