Department of Laser and Aesthetic Medicine, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Plastic and Reconstructive Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
Lasers Surg Med. 2022 Oct;54(8):1051-1059. doi: 10.1002/lsm.23594.
Conventional high fluence Q-switched (HFQS) Alexandrite 755-nm are widely used in clinical café-au-lait macules (CALMs) treatment. There have been recent concerns regarding the efficacy and safety of low fluence Q-switched (LFQS) Nd: YAG 1064-nm lasers.
To evaluate the efficacy and safety of the conventional HFQS and LFQS laser in the treatment of CALMs.
Within 3 months, 20 patients underwent prospective self-controlled split-lesion treatments with HFQS once or twice depending on the recovery rate, and with LFQS six times biweekly. Then the more effective laser was selected for continued treatments. Efficacy outcomes were evaluated by a visual analog scale (VAS) biweekly during the comparative trail. Recovery process, side effects and recurrence were recorded during the trial and follow-up visit. Patient and physician preferences for laser selection were also recorded.
The average VAS scores of areas treated with HFQS and LFQS were 2.92 ± 0.86 and 2.93 ± 1.13, respectively (p > 0.05). The most significant efficacy change of LFQS was after the fourth laser treatment (VAS score: 1.82-2.37, p < 0.001). 11 lesions treated with LFQS and 7 with HFQS achieved an optimal treatment response (3.67 ≤ VAS ≤ 4). Three patients relapsed on one side (one on LFQS, two on HFQS) and five on both sides. Adverse effects included temporary hypopigmentation, hyperpigmentation, uneven pigmentation, and mottled hypopigmentation. Doctors thought 80% of patients were suitable for LFQS. 70% of patients preferred LFQS posttreatment.
The efficacy difference between the LFQS 1064-nm laser and HFQS 755-nm laser in treating CALMs in a 3-month comparative trial was statistically insignificant. LFQS is preferred by doctors and patients and is likely to help more patients achieve treatment efficacy than the HFQS within a short time, with fewer temporary adverse reactions, and a more even pigmentation. But it can cause mottled hypopigmentation. The LFQS had obvious lesion clearance after the fourth treatment.
传统的高能量 Q 开关（HFQS）翠绿宝石 755nm 在临床咖啡斑（CALMs）治疗中被广泛应用。最近人们对低能量 Q 开关（LFQS）Nd：YAG 1064nm 激光的疗效和安全性产生了担忧。
评估传统 HFQS 和 LFQS 激光治疗 CALMs 的疗效和安全性。
在 3 个月内，20 名患者接受前瞻性自身对照分皮损治疗，根据恢复情况，HFQS 治疗 1 次或 2 次，LFQS 治疗 6 次，每两周 1 次。然后选择更有效的激光继续治疗。在比较试验中，每两周通过视觉模拟量表（VAS）评估疗效。在试验和随访期间记录恢复过程、不良反应和复发情况。还记录了患者和医生对激光选择的偏好。
HFQS 和 LFQS 治疗区域的平均 VAS 评分分别为 2.92±0.86 和 2.93±1.13（p>0.05）。LFQS 的最大疗效变化发生在第四次激光治疗后（VAS 评分：1.82-2.37，p<0.001）。11 处 LFQS 治疗皮损和 7 处 HFQS 治疗皮损达到最佳治疗反应（3.67≤VAS≤4）。3 处皮损在单侧复发（1 处 LFQS，2 处 HFQS），5 处皮损在双侧复发。不良反应包括暂时性色素减退、色素沉着过度、色素不均匀和斑驳性色素减退。医生认为 80%的患者适合 LFQS。70%的患者在治疗后更喜欢 LFQS。
在 3 个月的比较试验中，LFQS 1064nm 激光与 HFQS 755nm 激光治疗 CALMs 的疗效差异无统计学意义。LFQS 受到医生和患者的青睐，在短时间内更有可能帮助更多患者达到治疗效果，且暂时性不良反应更少，色素更均匀，但可能导致斑驳性色素减退。LFQS 治疗后第四次治疗后明显清除病变。
