强脉冲光联合长脉冲Nd:YAG激光治疗面部激素依赖性皮炎的临床疗效分析

Analysis on Clinical Effect of Joint Application of Intense Pulsed Light and Long Pulsed Nd:YAG Laser of Optimized Parameters on Facial Hormone-Dependent Dermatitis

目的 分析强脉冲光联合优化参数的长脉冲Nd∶YAG激光治疗面部激素依赖性皮炎的临床疗效和不良反应。方法 面部激素依赖性皮炎炎症期消退后患者34例,随机分为A、B两组,每组患者各17例。A组单独应用强脉冲光治疗,根据患者皮肤fitzpatrick分型选择波长、能量、脉宽及延迟时间等参数,Ⅲ型皮肤选择波长560 nm;Ⅳ~Ⅴ型皮肤,选择波长590/640 nm,双脉冲、三脉冲模式,能量密度13~20 J/cm^2,双脉冲脉宽为2. 4~5 ms,延迟时间20~40 ms;三脉冲脉宽3~5 ms,延迟时间分别为20~40 ms。B组采用强脉冲光联合长脉冲Nd∶YAG激光治疗,先采用IPL逐个光斑治疗,治疗参数同A组,再根据血管扩张程度对粗大血管应用长脉冲Nd∶YAG激光局部照射。激光治疗参数选择小光斑直径3 mm、短脉宽10~15 ms、中等能量密度130~140 J/cm2的优化原则。两组患者每3~4周治疗1次,第3次治疗后1个月随访进行疗效评价分析,随访6个月至1年。结果 A组痊愈1例(5. 9%),显效9例(52. 9%);B组痊愈6例(35. 3%),显效10例(58. 8%),两组间总有效率比较差异有统计学意义(P<0. 05)。总体不良反应发生率20. 6%,均未影响正常工作和生活,其中A组不良反应发生率17. 6%,B组不良反应发生率23. 5%,两组不良反应发生率比较,差异无统计学意义(P>0. 05)。结论 依据'小光斑、短脉宽、中等能量'原则优化长脉冲Nd∶YAG激光参数,联合强脉冲光,用于治疗面部激素依赖性皮炎,疗效显著且安全。

Objective To analyze the clinical efficacy and adverse reactions of joint application of intense pulsed light and long pulsed Nd∶YAG laser of optimized parameters to treat facial hormone-dependent dermatitis.MethodsTotally 34 patients with hormone-dependent facial dermatitis subsided after inflammation were randomly divided into two groups,each group of 17 cases.Group A treated with simple application of intense pulsed light therapy,according to the patients with skin type fitzpatrick points selecting wavelength,energy,pulse width and the parameters such as delay time,typeⅢskin with wavelength of 560 nm;Type IV-V skin,with 590/640 nm;Double and triple-pulse mode.The energy density was 13-20 J/cm2,the double pulse width was 2.4-5 ms,and the delay time was 20-40 ms.The pulse width of the three pulses was 3-5 ms,and the delay time was 20-40 ms,respectively.Group B with intense pulsed light joint long pulse Nd∶YAG laser treatment.IPL spot therapy was performed one by one with the same treatment parameters as group A,and then local Nd∶YAG laser irradiation was applied to large vessels according to the degree of vascular dilatation.Treatment parameters were selected based on the optimal principle of small light with diameter of 3 mm,short pulse width 10-15 ms,medium energy 130-140 J/cm2,every 3 to 4 weeks for a period of treatment,we did curative effect evaluation analysis 1 month at the end of the third treatment,follow-up of 0.5-1 year.ResultsOne patient was healed(5.9%)and 9 patients markedly improved(52.9%)in Group A,and 6 patients healed(35.3%),10 patients(58.8%)markedly improved in Group B.The difference between the two groups in total efficiency was statistically significant(P<0.05).The overall incidence of adverse reactions was 20.6%.The normal work and life of all these patients was not affected by the treatment.The incidence of adverse reaction was 17.6%in Group A and 23.5%in Group B,and the difference was not statistically significant(P>0.05).ConclusionsUnder the condition to adopt the principle of'small light spot,short pulse width and medium energy',the combination of strong pulsed light and long pulsed Nd∶YAG laser of optimized parameters is effective and safe in treating hormone-dependent facial dermatitis.