程芳 郭勇 彭健

[摘要]目的：對比非剥脱性点阵CO2激光联合氢醌乳膏与氢醌乳膏单用治疗黄褐斑的临床疗效及安全性。方法：收集笔者医院2017年1月-2019年1月诊治的60例女性黄褐斑患者，采用自体对照策略，左面颊为对照组，右面颊为观察组。对照组：仅给予氢醌乳膏外用;观察组：给予氢醌乳膏联用非剥脱性点阵CO2激光。治疗6周，随访至第18周。评估并记录各时间点皮损黑暗度、均匀性、皮损改善程度、治疗满意度及治疗相关不良事件等。对所有数据进行统计学分析。结果：对照组自第6周起黑暗度及均匀性评分均明显较治疗前降低（P<0.05），观察组自第3周起黑暗度及均匀性评分均明显较治疗前降低（P<0.05）。观察组第3、6、10、18周黑暗度及均匀性评分均低于对照组，差异均具有统计学意义（均P<0.05）。对照组治疗后皮损改善程度以轻度改善及中度改善为主，观察组治疗后皮损改善程度以中度改善及明显改善为主，两组治疗后皮损改善程度比较有显著性差异（P<0.05）。观察组治疗满意度评分高于对照组，差异具有统计学意义（P<0.05）。两组间红斑、水疱、瘙痒、疼痛、脱屑、色素减退及色素沉着等治疗相关不良事件发生率比较均无统计学差异（均P<0.05）。结论：相比于氢醌乳膏单用，非剥脱性点阵CO2激光联用氢醌乳膏可更有效改善黄褐斑皮损，患者满意度更高，但治疗相关不良事件发生率并未增加。

[关键词]非剥脱性点阵CO2激光;氢醌;黄褐斑;疗效;安全性

[中图分类号]R758.4+2    [文献标志码]A    [文章编号]1008-6455（2021）04-0045-04

Clinical Efficacy and Safety Analysis of Non-ablative Fractional CO2 Laser Combined with Hydroquinone Cream in the Treatment of Melasma

CHENG Fang1， GUO Yong1， PENG Jian2

（1.Department of Dermatology and Venereal;2.Department of Disease Statistics，Huangshi Second Hospital，Huangshi 435002，Hubei，China）

Abstract：Objective To compare the clinical efficacy and safety of non-ablative fractional CO2 laser combined with hydroquinone cream and hydroquinone cream in the treatment of melasma. Methods 60 melasma patients， treated in our hospital from January 2017 to January 2019， were collected. The self-control strategy was adopted. The left cheek was taken as control group， while the right cheek was taken as observation group. Control group： hydroquinone cream was applied. Observation group： hydroquinone cream combined with non-ablative fractional CO2 laser were applied. All treatment was given for 6 weeks， and follow-up was performed to the 18th weeks. The darkness， uniformity， improvement of skin lesions， treatment satisfaction and treatment-related adverse events were evaluated and recorded. Statistical analysis was performed. Results Since the 6th week， the darkness and uniformity scores were lower than that before treatment in control group （P<0.05）. Since the 3rd week， the darkness and uniformity scores were lower than that before treatment in observation group （P<0.05）. The darkness and uniformity scores of the observation group at the 3rd， 6th， 10th， and 18th were significantly lower than those of control group （P<0.05）. The degree of skin lesion improvement was mainly mild and moderate in control group， while it was mainly moderate and obvious in the observation group， and there was a significant difference in the degree of skin lesion improvement between two groups （P<0.05）. The treatment satisfaction score of observation group was higher than that of control group （P<0.05）. There were no significant differences in the incidence of treatment-related adverse events （erythema， blistering， itching， pain， desquamation， hypopigmentation and pigmentation） between two groups （P<0.05）. Conclusion Compared with hydroquinone cream， the combination strategy of non-ablative fractional CO2 laser and hydroquinone cream can more effectively improve melasma lesion， achieving high treatment satisfaction without increasing the incidence of treatment-related adverse events.

Key words：non-ablative fractional CO2 laser;hydroquinone cream; melasma; efficacy; safety

黄褐斑是一种以皮肤黑素过多为主要特征的慢性良性疾病，育龄期妇女多见，主要累及面中部、颧部、下颌[1-2]。依据Wood灯判断黑素浸润深度可分为表皮型、真皮型及混合型[1]。其发病机制不明，但遗传、日光暴晒、妊娠、激素替代疗法及光敏药物等因素均属发病危险因素[3]。一线治疗包括氢醌、壬二酸、曲酸及维A酸等局部外用药。果酸换肤属二线选择，主要用于深肤色患者。激光治疗是三线治疗选择，主要用于难治性或复发性病例[2]。2%～4%氢醌乳膏联合维A酸乳膏比氢醌单用更有效[4]。外用三联标准方案包括氢醌、维A酸及皮脂类固醇，但因该方案无法实现长期缓解，使得尝试不同类型激光成为必要[5]。激光治療可有效促进角质层更新并促进经皮药物吸收而可有效改善黄褐斑病情，但因其可造成面部红斑、水肿、烧灼及疼痛等不良反应而多不建议单用激光疗法[6-8]。……