Kim Carey, Gao Jia C, Moy Janet, Lee Hyun Soo
Department of Dermatology, Metropolitan Medical Center, New York, New York.
Department of Dermatology, New York Medical College, Valhalla, New York.
JAAD Int. 2022 Jul 20;8:118-123. doi: 10.1016/j.jdin.2022.02.010. eCollection 2022 Sep.
Ablative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized.
To evaluate the safety and outcomes of ablative fractional CO lasers on refractory melasma in patients with skin of color.
A retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO₂ laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session.
Among the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance ( < .05). The CO₂ laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO₂ laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement.
Retrospective study design with short follow-up period and a small sample size.
Ablative CO laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.
长期以来，剥脱性激光一直被认为不是治疗有色人种黄褐斑患者的理想选择，且其应用仍未得到充分利用。
评估剥脱性分数CO₂激光治疗有色人种难治性黄褐斑的安全性和疗效。
对一家单中心皮肤科诊所的12例患者进行回顾性病历审查。该研究纳入了单独接受剥脱性分数CO₂激光治疗或联合激光调肤和/或氨甲环酸（TXA）治疗的难治性黄褐斑患者。使用经过验证的改良黄褐斑面积和严重程度指数（mMASI）评分量表在基线时以及每次治疗后约1个月评估疾病严重程度。
在这12例患者中，41.7%的患者mMASI评分降低超过50%，其中33.3%的患者具有统计学意义（P<0.05）。联合TXA队列的CO₂激光治疗使平均mMASI评分下降幅度最大，而联合激光调肤的CO₂激光治疗评分下降幅度最小。在首次剥脱性激光治疗后更早开始口服TXA的患者临床改善情况更好。
研究设计为回顾性，随访期短且样本量小。
剥脱性CO₂激光治疗可能是有色人种难治性黄褐斑的合理选择，不过仍需进一步研究。
