低通量Q开关Nd∶YAG激光联合微针导入氨甲环酸治疗黄褐斑

Low-Fluence Q-switched Nd∶YAG Laser Combined with Microneedle Introduction of Tranexamic Acid for Melasma Treatment

目的评估低通量Q开关Nd∶YAG(QSNY)激光单一治疗与其联合微针导入氨甲环酸治疗黄褐斑的疗效差别,并基于皮肤镜分型分析不同类型黄褐斑的最佳治疗方式。方法收集2022年1月—2023年12月就诊的黄褐斑患者的临床资料,比较QSNY激光单一治疗组(对照组,23例)与QSNY激光联合微针导入氨甲环酸治疗组(联合组,23例)治疗3次后改良黄褐斑面积和严重程度指数(mMASI)评分、皮肤镜检查总评分(TDS)、医生临床评估(PGA)和不良反应的发生率。结果2组患者治疗后mMASI评分均降低,联合组的mMASI评分改善优于对照组(P<0.05);2组患者治疗后TDS均降低,联合组改善程度更佳,差别有统计学意义(P<0.05)。与治疗前比较,联合组治疗后毛细血管扩张明显改善,差别有统计学意义(P<0.001)。2组患者的PGA评分比较,差别无统计学意义(P>0.05)。2组患者治疗后均未发现明显的不良反应。结论QSNY激光联合微针导入氨甲环酸治疗黄褐斑的疗效优于单一激光治疗,前者对血管增生和表皮色素沉着明显的黄褐斑更有利。

Objective To evaluate the therapeutic efficacy of low-fluence Q-switched Nd∶YAG(QSNY)laser monotherapy versus the combined therapy of QSNY laser with microneedle-assisted tranexamic acid for melasma,while employing dermoscopy to discern the most favorable treatment for melasma subtypes.Methods The clinical data of patients diagnosed with chloasma from January 2022 to December 2023 were collected.The modified melasma area and severity index(mMASI)score,total dermoscopy score(TDS),physician clinical assessment(PGA)and the incidence of adverse reactions were compared between the patients in QSNY laser monotreatment group(control group,23 cases)and the combined therapy group of QSNY laser with microneedle-assisted tranexamic acid(combined group,23 cases)after 3 times of treatment.Results The mMASI scores of patients in both groups were reduced after treatments,while the improvement of mMASI scores in the combined group exhibitied a significantly greanter increase(P<0.05).TDS was reduced after treatment in both groups,while the improvement extent of the combined group was better,the difference was statistically significant(P<0.05).Compared with the pre-treatment,capillary dilatation signifcantly decreased in the combined group(P<0.001).The intergroup difference of PGA score between the two groups was not statistically significant(P>0.05),and no significant adverse reactions were found in either groups.Conclusion The efficacy of QSNY laser with microneedle-assisted tranexamic acid combined therapy to melasma is greater than that of QSNY laser monotreatment to melasma.The combined therapy is more favorable to melasma with obvious vascular proliferation and epidermal pigmentation.