Choice Dermatology Clinic, Pyeongchon, Korea.
Department of Dermatology, Gachon University, College of Medicine, Incheon, Korea.
J Dermatolog Treat. 2024 Dec;35(1):2390081. doi: 10.1080/09546634.2024.2390081. Epub 2024 Aug 12.
Infantile café au lait spot is a brown macule with various sizes (diameter: 0.5 cm-30 cm). Infantile giant café au lait spot (IGCALS) is a huge (diameter >20cm) irregular-shaped benign hyperpigmented skin disorder that arises in infants. There has been no clearly established laser treatment consensus for the treatment of IGCALS because infants are too fragile to receive laser treatment with long hours and broad areas along with the possibility of undesirable cosmetic results.
This study investigated the safety and efficacy of Golden Parameter Therapy (GPT) using a high fluence 1064-nm Q-switched Nd:YAG laser (QSNL) for IGCALS treatment.
This study included 24 Korean patients with IGCALS. Twenty-one patients who were treated with a 1064-nm QSNL weekly for 30-50 treatment sessions with GPT. The parameters included a spot size of 7 mm, a fluence of 2.2 J/cm and a pulse rate of 10 Hz with one pass using a sliding-stacking technique over the IGCALS. In control group, three patients were treated with a 532-nm picosecond laser monthly for three treatment sessions with a spot size of 3 mm, a fluence of 1 J/cm and a pulse rate of 2 Hz.
After the last treatment, 21 patients with IGCALS reached the complete removal of pigmented lesions, which can be considered optimal cosmetic results without any side effects such as purpura, crust, post-inflammatory hyperpigmentation, iatrogenic punctate leukoderma, and scarring. There are no recurrences in any patients after 6-21 months' follow-up, but treatment failure occurred in three patients who were treated with 532 nm picosecond laser.
Convincingly, we argue that early intervention before 12 months of age with GPT using a high fluence 1064 nm QSNL is a safe, applicable and effective treatment for IGCALS, minimizing side effects without any recurrences.
婴儿咖啡斑牛奶斑是一种大小不一的棕色斑点（直径：0.5-30 厘米）。婴儿巨大咖啡斑牛奶斑（IGCALS）是一种巨大的（直径>20 厘米）不规则形状的良性色素沉着性皮肤疾病，发生在婴儿中。由于婴儿太脆弱，无法接受长时间、大面积的激光治疗，并且可能会产生不理想的美容效果，因此对于 IGCALS 的激光治疗尚未形成明确的共识。
本研究探讨了使用高能量 1064nm Q-开关 Nd:YAG 激光（QSNL）进行 Golden Parameter Therapy（GPT）治疗 IGCALS 的安全性和有效性。
本研究纳入了 24 名患有 IGCALS 的韩国患者。21 名患者每周接受 1064nm QSNL 治疗一次，共 30-50 次治疗，同时采用 GPT。参数包括 7mm 的光斑大小、2.2J/cm 的能量密度和 10Hz 的脉冲率，采用滑动叠加技术对 IGCALS 进行单次治疗。在对照组中，3 名患者每月接受 532nm 皮秒激光治疗一次，共三次治疗，光斑大小为 3mm，能量密度为 1J/cm，脉冲率为 2Hz。
在最后一次治疗后，21 名 IGCALS 患者的色素沉着病变完全去除，可视为最佳美容效果，无任何副作用，如瘀斑、结痂、炎症后色素沉着、医源性点状白瘢、瘢痕等。在 6-21 个月的随访中，没有任何患者复发，但接受 532nm 皮秒激光治疗的 3 名患者治疗失败。
令人信服的是，我们认为在 12 个月龄之前使用高能量 1064nm QSNL 进行 GPT 早期干预是一种安全、适用且有效的 IGCALS 治疗方法，可以最大限度地减少副作用，且无复发。
