Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China.
Department of Dermatology, MEIYAN Aesthetic Plastic Medical Clinic, Beijing, China.
Lasers Med Sci. 2022 Jun;37(4):2099-2110. doi: 10.1007/s10103-022-03514-2. Epub 2022 Feb 5.
Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials have tried to prove the effectiveness of the combination therapy involving laser therapy, but the results have been indeterminate. This study aimed to evaluate the effectiveness of laser treatment for melasma via a systematic review and meta-analysis. We respectively searched 4 databases and clinicaltrials.gov as of June 8, 2021. Two researchers independently searched for literature and extracted data. Study outcomes were computed by weighted mean differences (WMD). All statistical analyses were performed by the Review Manager version 5.3, STATA version 14 software at 95% confidence interval. We obtained 22 eligible studies which involved a total of 694 patients. After the heterogeneity test and sensitivity analysis, we took a subgroup meta-analysis on the before and after treatment of different laser types. We found that most lasers and laser-based combinations were associated with reduced melasma area and severity index (MASI), such as low-fluence Q-switch 1,064-nm Nd: YAG laser (QSNYL) (WMD: - 2.76; 95% CI: - 3.53 to - 1.99), fractional ablative CO2 laser (WMD: - 9.36; 95% CI: - 12.51 to - 6.21), and fractional ablative 2940-nm Er: YAG laser (WMD: - 2,72; 95% CI: - 3.94 to - 1.49). Significant decrease was seen in neither MASI score of non-ablative 1550-nm fractional laser (WMD: - 1.29; 95% CI: - 2.80 to 0.21) and picosecond laser (WMD: - 0.58; 95% CI: - 1.43 to 0.27), nor melanin index (MI) of low-fluence QSNYL treatment (WMD: 10.17; 95% CI: - 4.11 to 24.46). When using laser to treat melasma, various adverse reactions may occur, most of which will resolve quickly without subsequent treatment, such as edema, erythema, scaling, and burning sensation after treatment. However, for patients with darker skin, there are risks of postinflammatory hyperpigmentation and hypopigmentation. The laser and laser-based combination treatment for melasma could significantly reduce the MASI score, which was showed by our systematic review and meta-analysis.
黄褐斑是一种高度普遍且影响美容的色素沉着性皮肤病。治疗后的结果往往不尽如人意。大量的临床试验试图证明激光治疗联合疗法的有效性，但结果并不确定。本研究旨在通过系统评价和荟萃分析评估激光治疗黄褐斑的效果。截至 2021 年 6 月 8 日，我们分别在 4 个数据库和 clinicaltrials.gov 进行了搜索。两位研究人员独立搜索文献并提取数据。研究结果通过加权均数差（WMD）计算。所有统计分析均使用 Review Manager 版本 5.3 和 STATA 版本 14 在 95%置信区间进行。我们获得了 22 项符合条件的研究，共涉及 694 名患者。经过异质性检验和敏感性分析，我们对不同激光类型治疗前后的结果进行了亚组荟萃分析。我们发现，大多数激光和基于激光的联合治疗与黄褐斑面积和严重程度指数（MASI）的降低有关，例如低能量 Q-开关 1,064nmNd:YAG 激光（WMD：-2.76；95%CI：-3.53 至-1.99）、分 割性 CO2 激光（WMD：-9.36；95%CI：-12.51 至-6.21）和分 割性 2940nmEr:YAG 激光（WMD：-2.72；95%CI：-3.94 至-1.49）。非分 割性 1550nm 分 割性激光（WMD：-1.29；95%CI：-2.80 至 0.21）和皮秒激光（WMD：-0.58；95%CI：-1.43 至 0.27）的 MASI 评分和低能量 QSNYL 治疗的黑色素指数（MI）（WMD：10.17；95%CI：-4.11 至 24.46）均未见明显降低。当使用激光治疗黄褐斑时，可能会出现各种不良反应，大多数不良反应无需后续治疗即可迅速缓解，如治疗后出现的水肿、红斑、脱屑和烧灼感。然而，对于肤色较深的患者，存在炎症后色素沉着过度和色素减退的风险。本系统评价和荟萃分析表明，激光和基于激光的联合疗法可显著降低 MASI 评分。
