Alora M B, Anderson R R, Quinn T R, Taylor C R
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
Lasers Surg Med. 1998;22(3):165-70. doi: 10.1002/(sici)1096-9101(1998)22:3<165::aid-lsm4>3.0.co;2-n.
Laser resurfacing can precisely remove epidermis and papillary dermis, sites pivotal to the pathogenesis of psoriasis. Our objective was to determine the efficacy and safety of superficially ablating carbon dioxide (CO2) lasers for treating isolated, recalcitrant psoriatic plaques.
Twelve adult subjects with stable, plaque-type psoriasis were recruited. In six volunteers, the quadrants received different numbers of passes with a 60 microsec pulsed CO2 (Tru-Pulse) laser. In the remaining patients, one quadrant underwent curettage prior to resurfacing, the second resurfacing with a scanned continuous wave (Sharplan Silktouch) CO2 laser and the last curettage alone.
Despite clinical and histological evidence of complete ablation of the epidermis and papillary dermis, most quadrants recurred within 8 weeks. Surprisingly, two patients showed no recurrence after 4 months.
Ablation of the entire epidermis and papillary dermis with either pulsed or scanned CO2 lasers appears generally ineffective in treating recalcitrant psoriatic plaques, although the clearing seen in two patients suggests potentially successful future research directions.
激光换肤可精确去除表皮和乳头真皮，这些部位是银屑病发病机制的关键所在。我们的目的是确定浅表剥脱性二氧化碳（CO2）激光治疗孤立性、顽固性银屑病斑块的疗效和安全性。
招募了12名患有稳定斑块型银屑病的成年受试者。在6名志愿者中，象限接受了不同次数的60微秒脉冲CO2（Tru-Pulse）激光照射。在其余患者中，一个象限在换肤前进行刮除术，第二个象限用扫描连续波（Sharplan Silktouch）CO2激光进行换肤，最后一个象限仅进行刮除术。
尽管有临床和组织学证据表明表皮和乳头真皮已完全消融，但大多数象限在8周内复发。令人惊讶的是，两名患者在4个月后未复发。
用脉冲或扫描CO2激光消融整个表皮和乳头真皮在治疗顽固性银屑病斑块方面似乎总体无效，尽管两名患者的皮损清除表明未来可能有成功的研究方向。
