非剥脱性点阵CO_(2)激光联合氢醌乳膏治疗黄褐斑的临床疗效及安全性分析

Clinical Efficacy and Safety Analysis of Non-ablative Fractional CO_(2) Laser Combined with Hydroquinone Cream in the Treatment of Melasma

目的:对比非剥脱性点阵CO_(2)激光联合氢醌乳膏与氢醌乳膏单用治疗黄褐斑的临床疗效及安全性。方法:收集笔者医院2017年1月-2019年1月诊治的60例女性黄褐斑患者,采用自体对照策略,左面颊为对照组,右面颊为观察组。对照组:仅给予氢醌乳膏外用;观察组:给予氢醌乳膏联用非剥脱性点阵CO_(2)激光。治疗6周,随访至第18周。评估并记录各时间点皮损黑暗度、均匀性、皮损改善程度、治疗满意度及治疗相关不良事件等。对所有数据进行统计学分析。结果:对照组自第6周起黑暗度及均匀性评分均明显较治疗前降低(P<0.05),观察组自第3周起黑暗度及均匀性评分均明显较治疗前降低(P<0.05)。观察组第3、6、10、18周黑暗度及均匀性评分均低于对照组,差异均具有统计学意义(均P<0.05)。对照组治疗后皮损改善程度以轻度改善及中度改善为主,观察组治疗后皮损改善程度以中度改善及明显改善为主,两组治疗后皮损改善程度比较有显著性差异(P<0.05)。观察组治疗满意度评分高于对照组,差异具有统计学意义(P<0.05)。两组间红斑、水疱、瘙痒、疼痛、脱屑、色素减退及色素沉着等治疗相关不良事件发生率比较均无统计学差异(均P<0.05)。结论:相比于氢醌乳膏单用,非剥脱性点阵CO_(2)激光联用氢醌乳膏可更有效改善黄褐斑皮损,患者满意度更高,但治疗相关不良事件发生率并未增加。

Objective To compare the clinical efficacy and safety of non-ablative fractional CO_(2) laser combined with hydroquinone cream and hydroquinone cream in the treatment of melasma.Methods 60 melasma patients,treated in our hospital from January 2017 to January 2019,were collected.The self-control strategy was adopted.The left cheek was taken as control group,while the right cheek was taken as observation group.Control group:hydroquinone cream was applied.Observation group:hydroquinone cream combined with non-ablative fractional CO_(2) laser were applied.All treatment was given for 6 weeks,and follow-up was performed to the 18th weeks.The darkness,uniformity,improvement of skin lesions,treatment satisfaction and treatment-related adverse events were evaluated and recorded.Statistical analysis was performed.Results Since the 6th week,the darkness and uniformity scores were lower than that before treatment in control group(P<0.05).Since the 3rd week,the darkness and uniformity scores were lower than that before treatment in observation group(P<0.05).The darkness and uniformity scores of the observation group at the 3rd,6th,10th,and 18th were significantly lower than those of control group(P<0.05).The degree of skin lesion improvement was mainly mild and moderate in control group,while it was mainly moderate and obvious in the observation group,and there was a significant difference in the degree of skin lesion improvement between two groups(P<0.05).The treatment satisfaction score of observation group was higher than that of control group(P<0.05).There were no significant differences in the incidence of treatment-related adverse events(erythema,blistering,itching,pain,desquamation,hypopigmentation and pigmentation)between two groups(P<0.05).Conclusion Compared with hydroquinone cream,the combination strategy of non-ablative fractional CO_(2) laser and hydroquinone cream can more effectively improve melasma lesion,achieving high treatment satisfaction without increasing the incidence of treatmentrelated adverse events.