目的:黄褐斑是一种难治性皮肤病,需要积极探讨。几十年来,壬二酸一直被用作通过多种机制改善黄褐斑的外用剂,然而,缺乏与激光治疗相结合的研究。这项研究评估了局部使用20%壬二酸及其与755nm皮秒激光联合治疗面部黄褐斑的有效性。
方法:随机,评估者致盲,从2021年10月至2022年4月,在一个中心对30名面部黄褐斑受试者进行了对照研究。所有受试者接受局部20%壬二酸乳膏(AA)24周,4周后,患者随机分配接受755nm皮秒(PS)激光治疗,每4周1次,共3次.通过mMASI评分评估确定治疗效果,皮肤镜评估,反射共聚焦显微镜(RCM)评估和患者满意度评估(PSA)。
结果:用20%壬二酸处理,有或没有皮秒激光治疗,显著降低hemi-mMASI评分(P<0.0001),患者满意度较高.随着时间的推移,在面部两侧观察到皮肤镜和RCM评估的改善,双方没有区别。RCM在联合治疗侧表现出更好的树突状细胞改善。治疗结束时或随访期间无患者出现严重不良反应。
结论:除了通过RCM评估发现的细微差异外,额外使用皮秒激光治疗没有临床差异。该研究在中国临床试验注册中心(ChiCTR2100051294;2021年9月18日)注册。
OBJECTIVE: Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This
study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients.
METHODS: A randomized, evaluator-blinded, controlled
study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient\'s satisfaction assessments (PSA).
RESULTS: Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period.
CONCLUSIONS: The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.The
study was registered in the Chinese Clinical
Trial Registry (ChiCTR2100051294; 18 September 2021).