Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Institute of Dermatology, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
Lasers Med Sci. 2022 Feb;37(1):279-286. doi: 10.1007/s10103-021-03245-w. Epub 2021 Jan 13.
Cafe-au-lait macules (CALMs) affect the appearance of patients and can result in serious psychological problems. Successful treatments without adverse effects remain challenging. We designed a prospective, randomized, controlled, evaluator-blinded trial on 40 pediatric patients to compare the efficacy between a low-fluence 1064-nm Q-switched Nd:YAG laser and a Q-switched Nd:YAG 532-nm laser for the treatment of solitary CALMs in children. We randomly assigned participants into 2 groups. We treated those in the first group with 3 sessions of 532-nm QS laser at 1-month intervals, and those in the second group with 6 sessions of 1064-nm LFQS laser at 2-week intervals. We found no significant differences in treatment efficacy (p = 0.14). The 1064-nm laser group referred significantly less pain than the 532-nm laser group (p = 0.0001). Side effects were detected in 5 patients in the 532-nm laser group. The difference of the side effects was statistically significant (p = 0.04). Two patients in 532-nm laser group were recurred and none in 1064-nm laser group. On a univariate logistic regression analysis, lesions with brown color, small size, and irregular edges were significantly associated with better outcomes (> 50% clearance). Multivariate logistic regression analysis found that brown lesions and lesions with irregular edges had higher odds of getting > 50% clearance (p < 0.05). In conclusion, the 1064-nm LFQS laser produced fewer side effects, less pain, and shorter recovery time than the 532-nm laser. Irregular-bordered, smaller, brown lesions improved better than smooth-bordered, larger, light brown lesions. Moreover, the 1064-nm laser may be a better choice for treating large size CALMs. However, no significant differences were found in terms of the treatment efficacy and recurrence.
咖啡斑（CALMs）影响患者的外观，并可能导致严重的心理问题。寻找一种安全有效的治疗方法仍然具有挑战性。我们设计了一项前瞻性、随机、对照、评估者盲法临床试验，纳入了 40 例儿科患者，旨在比较低能量 1064nm Q-开关 Nd：YAG 激光和 Q-开关 Nd：YAG 532nm 激光治疗儿童单发 CALMs 的疗效。我们将参与者随机分为两组。第一组接受 3 次 532nm QS 激光治疗，间隔 1 个月；第二组接受 6 次 1064nm LFQS 激光治疗，间隔 2 周。我们发现两组之间的治疗效果无显著差异（p = 0.14）。1064nm 激光组的疼痛程度明显低于 532nm 激光组（p = 0.0001）。532nm 激光组有 5 例出现不良反应，差异有统计学意义（p = 0.04）。两组均无复发。单因素逻辑回归分析显示，棕色、小面积、不规则边缘的病变与更好的疗效（> 50%清除率）显著相关。多因素逻辑回归分析发现，棕色病变和边缘不规则的病变获得> 50%清除率的可能性更高（p < 0.05）。总之，与 532nm 激光相比，1064nm LFQS 激光产生的副作用更少，疼痛更轻，恢复时间更短。不规则边缘、较小、棕色的病变比光滑边缘、较大、浅棕色的病变改善更好。此外，1064nm 激光可能是治疗大面积 CALMs 的更好选择。然而，在治疗效果和复发方面，两组之间无显著差异。
