Iraji Fariba, Mousavi Azam, Poostiyan Nazila, Saber Mina
Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Cosmet Dermatol. 2022 Dec;21(12):6776-6782. doi: 10.1111/jocd.15385. Epub 2022 Oct 3.
Solar lentigo (SL) is a benign hyperpigmented spot occurring due to ultraviolet exposure, most commonly in the elderly. We aimed to compare the safety and efficacy of trichloroacetic acid (TCA) peeling with Q-switched laser in the treatment of SLs.
This assessor-blind split-hand randomized controlled trial included 45 patients with symmetric SLs on the back of their hands referred to the dermatology clinics from March 1 to June 24, 2021. TCA 35% was applied to the back of one hand, and the contralateral hand received Q-switched laser. The interventions were repeated for a total of three sessions 4 weeks apart. Eight weeks after the last treatment session, lesion lightening was graded from 1 to 4. Patient satisfaction with treatment was assessed using a visual analogue scale (VAS). Adverse events were also noted.
Of the 45 patients included in the current study with a mean age of 52.71 ± 9.73 years, 11 (24.4%) were male. The Fitzpatrick skin type was II in 11 patients (24.4%), III in 23 (51.1%), and IV in 11 (24.4%). Lesion lightening and patient satisfaction were both significantly better with Q-switched laser compared to TCA peeling (standardized mean difference [SMD] = -1.25, 95% confidence interval [CI] -1.69; -0.79, p < 0.001 and SMD = -1.12, 95% CI -1.56; -0.67, p < 0.001, respectively). Overall, post-inflammatory hyperpigmentation (PIH) occurred in one patient in the laser group and for in the TCA group. Also, erythema and pruritus were observed in all patients of both groups after intervention which were treated with topical repair cream.
Q-switched laser was superior to TCA peeling for the treatment of SLs in terms of lesion lightening and patient satisfaction with a large effect.
日光性雀斑样痣（SL）是一种由于紫外线照射引起的良性色素沉着斑，最常见于老年人。我们旨在比较三氯乙酸（TCA）化学剥脱术与Q开关激光治疗SL的安全性和有效性。
这项评估者盲法双手随机对照试验纳入了2021年3月1日至6月24日转诊至皮肤科门诊的45例双手背部有对称性SL的患者。将35%的TCA应用于一只手的背部，对侧手接受Q开关激光治疗。干预共重复3次，每次间隔4周。最后一次治疗后8周，将皮损变淡程度分为1至4级。使用视觉模拟量表（VAS）评估患者对治疗的满意度。同时记录不良事件。
本研究纳入的45例患者平均年龄为52.71±9.73岁，其中11例（24.4%）为男性。11例患者（24.4%）的菲茨帕特里克皮肤分型为II型，23例（51.1%）为III型，11例（24.4%）为IV型。与TCA化学剥脱术相比，Q开关激光治疗在皮损变淡和患者满意度方面均显著更好（标准化均值差[SMD]= -1.25，95%置信区间[CI]-1.69；-0.79，p<0.001；以及SMD= -1.12，95%CI-1.56；-0.67，p<0.001）。总体而言，激光组有1例患者出现炎症后色素沉着（PIH），TCA组有4例。此外，两组所有患者干预后均出现红斑和瘙痒，均使用外用修复乳膏进行了治疗。
在皮损变淡和患者满意度方面，Q开关激光治疗SL优于TCA化学剥脱术，且效果显著。
