CO_(2)点阵激光联合复方倍他米松注射液封包治疗稳定期顽固性白癜风疗效观察

Clinical efficacy of combined treatment with CO_(2) dot matrix laser and compound Betamethasone in refractory stable vitiligo

目的探究CO_(2)点阵激光联合复方倍他米松封包治疗稳定期顽固性白癜风的临床疗效和安全性。方法采用单中心、随机、自身对照的研究方法,纳入2019年10月至2023年10月首都医科大学附属北京朝阳医院皮肤科经传统药物治疗和(或)光疗无效的白癜风患者48例,每例患者选取2处皮损。采用掷硬币法将96处皮损分为观察组和对照组。对照组48处皮损予0.1%他克莫司软膏涂抹,每日2次;观察组48处皮损予CO_(2)点阵激光联合复方倍他米松注射液局部封包24 h,随后涂抹0.1%他克莫司软膏,每日2次,共治疗3个月。比较2组皮损处皮损面积、复色率、临床疗效、患者满意度及生活质量以及不良反应发生情况。结果观察组有效率为91.67%,对照组有效率为70.83%,观察组有效率高于对照组(P<0.05)。治疗后2组皮损面积均缩小(P<0.05),且观察组小于对照组(P<0.05)。观察组复色率为60%(48%,70%),对照组复色率为18%(9%,24%),观察组复色率高于对照组(P<0.05)。观察组满意度评分高于对照组(P<0.05)。所有患者均能耐受治疗,观察组48处皮损中,5处(10.42%)出现持续性红斑,3处(6.25%)毛囊炎,2处(4.17%)毛细血管扩张,6处(12.5%)色素沉着,未出现皮肤瘢痕或萎缩。随访3个月后,红斑和色素沉着均已恢复正常,毛细血管扩张和毛囊炎部分恢复。对照组48处皮损中,2处(4.17%)出现毛囊炎,未出现其他不良反应,随访3个月后均已恢复正常。不良反应发生率观察组高于对照组。结论CO_(2)点阵激光联合复方倍他米松封包治疗稳定期顽固性白癜风,疗效肯定,安全性良好。

Objective To explore the efficacy and safety of CO_(2) dot matrix laser combined with compound betamethasone in the treatment of refractory stable vitiligo.Methods A single-center,randomized,self-controlled study was conducted,and a total of 48 patients with vitiligo who had failed to respond to traditional drug therapy and/or phototherapy at the Department of Dermatology,Beijing Chaoyang Hospital,Capital Medical University,between October 2019 and October 2023 were included in the study.Two lesions were selected for each patient,and subsequently,a total of 96 lesions were randomly assigned into two groups using a coin toss.In the control group,48 lesions were treated with 0.1%tacrolimus ointment applied twice daily.In the experimental group,48 lesions were treated with the combined treatment with CO_(2) dot matrix laser and encapsulation therapy of compound betamethasone injection,followed by the application of 0.1%tacrolimus ointment twice daily.A total of 3 months of treatment was given in both groups.The two groups were compared in terms of lesion area,repigmentation rate,clinical efficacy,patient satisfaction,quality of life,and the incidence of adverse reactions.Results The effectiveness rate in the experimental group(91.67%)was significantly higher than that in the control group(70.83%)(P<0.05).After treatment,the lesion areas in both groups decreased(P<0.05),and the lesion area in the experimental group was smaller than that in the control group(P<0.05).The experimental group achieved a repigmentation rate of 60%(ranging from 48%to 70%),significantly higher than the control group’s rate of 18%(ranging from 9%to 24%)(P<0.05).The patient satisfaction score was also higher in the experimental group compared to the control group(P<0.05).All patients tolerated the treatment well.In the experimental group,among the 48lesions,5(10.42%)developed persistent erythema,3(6.25%)had folliculitis,2(4.17%)had telangiectasia,and 6(12.5%)developed hyperpigmentation.No scarring or atrophy was observed.After a3-month follow-up,erythema and hyperpigmentation had returned to normal,while telangiectasia and folliculitis showed partial recovery.In the control group,among the 48 lesions,2(4.17%)developed folliculitis,with no other adverse reactions reported.After a 3-month followup,all adverse effects had resolved.The incidence of adverse reactions was higher in the observation group compared to the control group.Conclusion The combination of CO_(2) dot matrix laser and encapsulation therapy with compound betamethasone demonstrates efficacy and safety in the treatment of refractory stable vitiligo.