方慧 陈滨

[摘要]目的：探究調Q脉冲激光和两种波段强脉冲光治疗面部痤疮后红斑及色素沉着的临床疗效和安全性。方法：选取2018年3月-2020年3月笔者医院门诊收治的面部痤疮后红斑及色素沉着患者80例，根据治疗方式的不同分为调Q脉冲激光组（接受调Q脉冲激光治疗，n=33）和强脉冲光组（接受两种波段的强脉冲光治疗，n=47）。对两种治疗方式的安全性进行评估，比较两组患者的临床疗效、治疗前后的红斑及色素沉着情况及皮肤生理指标变化水平。结果：调Q脉冲激光组的治疗总有效率为93.94%，强脉冲光组的治疗总有效率为82.98%，两组治疗总有效率比较无明显差异（P>0.05）;治疗后，两组患者的红斑及色素沉着程度较治疗前明显下降（P<0.05），且调Q脉冲激光组的色素沉着程度低于强脉冲光组（P<0.05）;两组患者的红斑程度无明显差异（P>0.05）;治疗后，两组患者的皮肤pH值、TEWL均明显下降，角质层含水量明显上升（P<0.05），且调Q脉冲激光组的皮肤pH值低于强脉冲光组，角质层含水量高于强脉冲光组（P<0.05），两组患者的经皮水分丢失（TEWL）水平无明显差异（P>0.05）;治疗期间，两组患者出现紧绷感、轻度毛细血管扩张、紫癜等不良反应，未使用任何药物，症状均于术后1～7d内消失。治疗第2、3次，调Q脉冲激光组患者的VAS评分明显低于强脉冲光组（P<0.05），治疗第1、4次，两组患者的VAS评分无明显差异（P>0.05）。结论：调Q脉冲激光与多波段联合强脉冲光在治疗面部痤疮后红斑及色素沉着方面疗效相当，安全性较高，均可明显改善患者的红斑及色素沉着情况，且无明显不良反应，但调Q脉冲激光在改善患者红斑程度和皮肤屏障功能方面优于多波段联合强脉冲光。

[关键词]寻常痤疮;红斑;色素沉着;调Q脉冲激光;强脉冲光

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2021）05-0090-04

Curative Effect of Q-switched Pulse Laser and Intensive Pulsed Light on Facial Acne Erythema ond Pigmentation

FANG Hui1， CHEN Bin2

（1.Department of Dermatology，Huangshan People's Hospital，Huangshan 251000， Anhui， China;2.Department of Dermatology， Lujiang County People's Hospital， Anhui Province， Hefei 231500， Anhui， China）

Abstract：Objective  To explore the clinical effects and safety of Q-switched pulse laser and intensive pulsed light in the treatment of facial acne erythema and pigmentation. Methods  A total of 80 patients with facial acne erythema and pigmentation who were treated at the hospital between March 2018 and March 2020 were divided into Q-switched pulse laser group （33 cases treated with Q-switched pulsed laser） and intensive pulsed light group （47 cases treated with intensive pulsed light） according to the treatment method. Safety of the two treatment methods was evaluated. Clinical effects， erythema and pigmentation before and after treatment， and changes in skin physiological indicators were compared between the two groups. Results The total response rates of Q-switched pulse laser group and the intensive pulsed light group were 93.94% and 82.98%， respectively （P>0.05）. After treatment， erythema and pigmentation in both groups were significantly relieved （P<0.05）， and pigmentation in the Q-switched pulse laser group was milder than that in the intensive pulsed light group （P<0.05）. However， there was no significant difference in the degree of erythema between the two groups （P>0.05）. After treatment， skin pH values and TEWL of both groups decreased significantly， and the water content of stratum corneum increased significantly （P<0.05）. Besides， the skin pH value of Q-switched pulse laser group was lower than that of the intensive pulsed light group， and the water content of stratum corneum was higher than that of the intensive pulsed light group （P<0.05）. However， there was no significant difference in transepidermal water loss （TEWL） between the two groups （P>0.05）. During treatment， there were adverse reactions such as taut feeling， mild capillary telangiectasia and purpura which disappeared within 1-7 days after surgery without drug treatment. In the second and third treatments， VAS scores of the Q-switched pulse laser group were significantly lower than those of the intensive pulsed light group （P<0.05）. In the first and fourth treatments， there was no significant difference in VAS score between the two groups （P>0.05）. Conclusion  Q-switched pulse laser and intensive pulsed light are effective in the treatment of facial acne erythema and pigmentation， with safety. Both can significantly alleviate erythema and pigmentation without obvious adverse reactions. However，treatment with Q-switched pulse laser is superior to ntensive pulsed light in relieving erythema and improving skin barrier function.

Key words： acne vulgaris; erythema; pigmentation; Q-switched pulse laser; intensive pulsed light

痤疮是一种以粉刺、丘疹及脓疱等为临床特征的毛囊皮脂腺慢性炎症性疾病，若治疗不当会出现红斑及色素沉着等后遗症，影响患者面部美观[1]。当前……