摘要目的 探讨大光斑低能量Q开关Nd∶YAG激光治疗黄褐斑的疗效,分析黄褐斑皮损激光治疗前后共聚焦激光扫描显微镜(CLSM)特征.方法 收集45例黄褐斑患者,使用大光斑低能量调Q开关Nd∶YAG 1064 nm激光治疗,并在治疗前后对其行CLSM检查.结果 45例患者,治疗结束后基本治愈8例(17.78％),显效25例(55.56％),好转11例(24.44％),无效1例(2.22％),有效率为73.33％.CLSM下可见黄褐斑皮损处较周围正常皮损处表皮全层黑素颗粒增多,激光治疗后表皮处黑素颗粒显著减少.结论 大光斑低能量调Q 1064 nm激光治疗黄褐斑疗效确切,安全性高,CLSM可用于判断激光治疗疗效.

abstractsObjective To evaluate the effect of large-spot and low-energy Q switched Nd:YAG laser on melasma,and to observe the changes of melasma lesions with confocal laser scanning microscopy (CLSM) before and after the laser treatment.Methods Totally,45 patients aged from 24 to 48 years and diagnosed with facial melasma were included in this study,and treated with large-spot and low-energy Q switched Nd:YAG once a week for 10 or more sessions.CLSM was used to estimate the melanin content in melasma lesions before each irradiation and after the last irradiation.Results Among the 45 patients,8 ( 17.78％ ) were nearly cured,25 (55.56％) markedly improved,11 (24.44％) improved,and only 1 (2.22％) unimproved after the laser irradiation.The total response rate was 73.33％.As CLSM showed,there was an increment in melanin granules in melasma lesions compared with the normal skin surrounding melasma lesions,but a reduction in melanin granules was induced by the laser treatment in melasma lesions.Conclusions Large-spot and lowenergy Q switched Nd∶YAG laser is substantially effective and highly safe for the treatment of melasma,and CLSM can be used to evaluate the therapeutic effect of laser on melasma.