强脉冲光联合Q开关1064 nm Nd:YAG激光治疗黄褐斑的临床观察

Clinical observation of intense pulsed light combined with Q-switched 1064nm Nd:YAG laser in the treatment of melasma

目的探究强脉冲光与Q开关1064 nm Nd:YAG激光联合治疗黄褐斑的治疗效果。方法选取2022年8月至2023年8月苏州市吴中人民医院收治的120例黄褐斑患者,依据治疗方式不同分为强脉冲光组(n=38)、Q开关1064 nm Nd:YAG激光组(n=41)与联合治疗组(n=41),参考黄褐斑面积与严重指数评分评估疗效,对比治疗前后激光扫描共聚焦显微镜图像特征及皮肤屏障指标。结果联合治疗组治疗总有效率(97.56%)高于强脉冲光组(84.21%)与Q开关1064 nm Nd:YAG激光组(80.49%),差异有统计学意义(P<0.05);治疗后联合治疗组表皮颗粒层含量、棘层含量、基底层色素颗粒层含量、TEWL显著低于强脉冲光组与Q开关1064 nm Nd:YAG激光组,角质层含水量、皮脂含量高于强脉冲光组与Q开关1064 nm Nd:YAG激光组,上述结果差异均有统计学意义(P<0.05)。结论强脉冲光与Q开关1064 nm Nd:YAG激光联合治疗黄褐斑疗效显著高于单一治疗,可改善皮肤屏障功能,临床应用价值较高,值得借鉴。

Objective To investigate the therapeutic effect of IPL and Q-switched neodymium-doped yttrium aluminum garnet(Nd:YAG)laser in the treatment of melasma.Methods A total of 120 cases of melasma patients admitted to our hospital from August 2022 to August 2023 were selected and divided into the intense pulsed light group(n=38,IPL treatment),the Q-switched Nd:YAG laser group(n=41,Q-switched Nd:YAG laser treatment),and the combined treatment group(n=41,IPL combined with Q-switched Nd:YAG laser treatment)based on the method of randomized numerical table,with reference to Melasma Area and Severity Index Score(MASI)to assess the effificacy of the treatment,and compared the characteristics of laser scanning confocal microscopy images(CLSM)and skin barrier indexes before and after treatment.Results The total effective rate of the combined treatment group(97.56%)was higher than that of the intense pulsed light group(84.21%)and the Q-switched 1064 nm Nd:YAG laser group(80.49%),and the difference was statistically signifificant(P<0.05);After treatment,the content of epidermal granular layer,Acanthous layer,pigment granular layer and TEWL in the combined treatment group were signifificantly lower than those in the intense pulsed light group and Q-switched 1064 nm nd:yag laser group,while the water content and sebum content in the stratum corneum were higher than those in the intense pulsed light group and Q-switched 1064 nm nd:yag laser group,and the differences were statistically signifificant(P<0.05).Conclusions The effificacy of IPL and Q-switched Nd:YAG laser combined treatment for melasma was signifificantly higher than that of single treatment,and it could improve the function of the skin barrier,which is of high value in clinical application and is worthwhile to learn from.