中华皮肤科杂志 ›› 2018, Vol. 51 ›› Issue (11): 791-796.doi: 10.3760/cma.j.issn.0412-4030.2018.11.003

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优化强脉冲光联合1 565 nm非剥脱点阵激光改善面部光老化随机半脸对照研究

仲少敏 曹雅晶 苑辰 童欣云 谢孟谚 吴艳   

  1. 北京大学第一医院皮肤科
  • 收稿日期:2018-02-27 修回日期:2018-08-22 发布日期:2018-10-31
  • 通讯作者: 吴艳 E-mail:3437477565@qq.com

An optimized intense pulsed light combined with a non-ablative 1 565 nm fractional laser for facial rejuvenation: a randomized, controlled, split-face study

Zhong Shaomin, Yuan Chen, Cao Yajing, Tong Xinyun, Xie Mengyan, Wu Yan   

  1. Department of Dermatology, Peking University First Hospital, Beijing 100034, China
  • Received:2018-02-27 Revised:2018-08-22 Published:2018-10-31
  • Contact: Wu Yan E-mail:3437477565@qq.com

摘要: 目的 评价优化强脉冲光(IPL)联合非剥脱点阵激光(NAFL)改善面部光老化的有效性及安全性。方法 本试验为随机半脸自身对照研究。2017年3 - 6月在北京大学第一医院皮肤科收集年龄35 ~ 55岁、具有面部光老化特征的男女受试者22例,受试者两侧面部按随机数字表分成联合组和NAFL组,NAFL组仅接受1 565 nm铒玻璃点阵光纤激光治疗,联合组接受优化脉冲光技术治疗后,即刻接受1 565 nm铒玻璃点阵光纤激光治疗。每组均治疗3次,每次间隔1个月,治疗前、治疗后第60天(第2次治疗后1个月)及90天(第3次治疗后1个月)对面部治疗区域照相,并进行生理指标(包括皮肤黑素和红斑指数、角质层含水量、经表皮水分丢失量、弹性和光泽度)测试及主观、客观临床评价。于每次治疗后由两名皮肤科医师对患者面部红斑、肿胀结痂、脱屑、色素沉着及疼痛情况进行评估。结果 1例患者因疼痛退出,1例因个人原因退出,20例受试者完成治疗和随访。联合组黑素指数在第60天(152.9 ± 36.9)和90天(155.0 ± 38.1)时与治疗前(168.4 ± 41.3)相比显著下降(F = 5.321,P<0.05),在第60天时联合组与NAFL组(159.4 ± 35.3)组间差异有统计学意义(P<0.05),而NAFL组在第60天及90天时黑素指数(156.7 ± 36.3)与基线(165.9 ± 35.4)相比差异无统计学意义(P>0.05)。两组红斑指数治疗前后均未发生明显变化(P>0.05)。联合组及NAFL组在第60天及90天时与治疗前相比,皮肤角质层含水量均显著升高(联合组:F = 21.795,P<0.001;NAFL组:F = 21.798,P<0.001),经表皮水分丢失量均显著下降(联合组:F = 8.848,P = 0.001;NAFL组:F = 5.833,P<0.05);两组间皮肤角质层含水量和经表皮水分丢失量在第60天及90天时差异均无统计学意义(P>0.05)。联合组及NAFL组在第60天及90天时皮肤弹性(P值分别<0.05、0.001)和光泽度(均P<0.001)与基线相比均显著升高,联合组皮肤光泽度在第90天时优于NAFL组(P<0.05)。短期不良反应主要包括即刻疼痛和持续2 ~ 3 d的红斑、肿胀和轻微脱屑。主要不良反应为局部轻度色素沉着,持续2 ~ 3个月逐渐消退。结论 IPL术后即刻联合1 565 nm NAFL治疗3次对改善面部色斑、光泽度显著优于单独使用NAFL,不良反应一般短暂且轻微。

关键词: 皮肤衰老, 激光疗法, 治疗结果, 非剥脱点阵激光, 强脉冲光, 联合治疗

Abstract: Zhong Shaomin, Yuan Chen, Cao Yajing, Tong Xinyun, Xie Mengyan, Wu Yan Department of Dermatology, Peking University First Hospital, Beijing 100034, China Corresponding author: Wu Yan, Email: 3437477565@qq.com 【Abstract】 Objective To evaluate the safety and efficacy of the combined treatment with an optimized intense pulsed light(IPL)and a non-ablative fractional laser(NAFL)for facial rejuvenation. Methods A prospective, split-face, randomized, controlled study was conducted. A total of 22 testees with facial photoaging, who aged from 35 to 55 years, were enrolled into this study from the Department of Dermatology of Peking University First Hospital between March and June in 2017. By a random number table, the two sides of each testee′s face were randomized to receive combined treatment with optimized IPL immediately followed by non-ablative 1 565 nm Erbium:Glass fractional laser (combined treatment group) or non-ablative 1 565 nm Erbium:Glass fractional laser alone (NAFL group) once every month for 3 sessions. Before the treatment, 60 and 90 days after the treatment (1 month after the second and third treatment respectively), photos of the treatment regions were taken, skin physiology parameters (including skin melanin, erythema indices, water content of the stratum corneum, transepidermal water loss [TEWL], skin flexibility and glossiness) were measured, and subjective and objective clinical evaluation was carried out. After each treatment, adverse reactions were assessed by two dermatologists independently, including facial erythema, swelling and crusting, desquamation, pigmentation and pains. Results During the treatment course, 1 testee dropped out due to pains, another 1 testee dropped out for personal reasons, and 20 testees completed the treatment and follow-up. The combined treatment group showed significantly decreased melanin indices on days 60 and 90 (152.9 ± 36.9 and 155.0 ± 38.1, respectively) compared with that before the treatment (168.4 ± 41.3, F = 5.321, P < 0.05). On day 60, the melanin index was significantly lower in the combined treatment group than in the NAFL group (159.4 ± 35.3, P < 0.05). However, the melanin indices on days 60 and 90 in the NAFL group (159.4 ± 35.3, 156.7 ± 36.3) did not significantly differ from that before the treatment (165.9 ± 35.4, P > 0.05). No significant difference was observed between the pre- and post-treatment erythema indices in either of the two groups (both P > 0.05). The water content of the stratum corneum on days 60 and 90 significantly increased compared with that before the treatment in both the combined treatment group (F = 21.795, P<0.001) and NAFL group (F = 21.798, P<0.001), while the TEWL on days 60 and 90 significantly decreased compared with that before the treatment in both the combined treatment group (F = 8.848, P = 0.001) and NAFL group (F = 5.833, P<0.05). However, there were no significant differences in either of the water content of the stratum corneum or TEWL on days 60 and 90 between the two groups(P>0.05). On days 60 and 90, the combined treatment group and NAFL group both showed significantly increased skin flexibility (P<0.05, 0.001, respectively) and glossiness (both P<0.001) compared with those before the treatment. On day 90, the skin glossiness in the combined treatment group was higher than that in the NAFL group (P<0.05). The short-term adverse reactions included transient pain, erythema and swelling which lasted 2 - 3 days, and slight desquamation. The main adverse reaction was mild local pigmentation, which lasted 2 - 3 months and then subsided gradually. Conclusion The 3 sessions of treatment with an optimized IPL immediately followed by a 1 565 nm NAFL is clinically superior to those with the NAFL alone for improving the facial pigmentation and skin glossiness, and the adverse reactions are usually transient and mild.

Key words: Skin aging, Laser therapy, Treatment outcome, Non?ablative fractional laser, Intense pulsed light, Combination therapy

引用本文

仲少敏 曹雅晶 苑辰 童欣云 谢孟谚 吴艳. 优化强脉冲光联合1 565 nm非剥脱点阵激光改善面部光老化随机半脸对照研究[J]. 中华皮肤科杂志, 2018,51(11):791-796. doi:10.3760/cma.j.issn.0412-4030.2018.11.003

Zhong Shaomin, Yuan Chen, Cao Yajing, Tong Xinyun, Xie Mengyan, Wu Yan. An optimized intense pulsed light combined with a non-ablative 1 565 nm fractional laser for facial rejuvenation: a randomized, controlled, split-face study[J]. Chinese Journal of Dermatology, 2018, 51(11): 791-796.doi:10.3760/cma.j.issn.0412-4030.2018.11.003