Q-switched 755 nm alexandrite laser combined with topical tranexamic acid in the treatment of melasma: a hemifacial randomized controlled study
10.3760/cma.j.cn114453-20210707-00290
- VernacularTitle:调Q开关755 nm紫翠宝石激光联合外用氨甲环酸治疗黄褐斑随机半侧面部对照研究
- Author:
Lingling ZHANG
1
;
Xiaoying QIAN
;
Yi JIN
;
Nannan LIU
Author Information
1. 浙江省荣军医院皮肤科，嘉兴 314000
- Keywords:
Laser therapy;
Tranexamic acid;
Melasma;
Q-switch;
755 nm alexandrite laser
- From:
Chinese Journal of Plastic Surgery
2022;38(9):970-977
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of Q-switched 755 nm alexandrite laser combined with tranexamic acid in the treatment of facial melasma.Methods:According to the inclusion and exclusion criteria, the subjects were selected from female patients with melasma who visited the Department of Dermatology of Zhejiang Rongjun Hospital from June to December 2020, the patients were divided into group A, B and C according to the random number table. The study was conducted by half face self contrast method. Group A, lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser with the mode of 5 mm spot, 1.6 J/cm 2 energy, 70 ns pulse width(mode A) with an interval of two weeks for 6 sessions. Meanwhile, tranexamic acid serum was applied topically on the lesions twice a day for six months. Lesions on the right side of the face, as control side, tranexamic acid serum was used in the same way as above described. Group B, lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser for 6 sessions with the mode of 3 mm spot, 5.0 J/cm 2 energy, 150 μs pulse width(mode B) with an interval of two weeks for 6 sessions. Meanwhile, tranexamic acid serum was applied topically on the lesions twice a day for six months. The treatment of right side of face as control side was the same as group A. The treatment method and postoperative treatment of the left face in group C were the same as those in group A left face. The treatment method and postoperative treatment of the right side face were the same as those of the left side face of group B. The treatment effect was evaluated 12 weeks after the end of laser treatment. (1) Assessment of Melasma Area and Severity Index (MASI), the score ranges from 0 to 48, with higher scores indicating more severe lesions. (2) Physician Global Assessment(PGA), the score ranged from 0 to 6, and the higher the score, the more melasma remained. (3) The patient satisfaction rate was the percentage of the total number of patients with very satisfied and satisfied cases. Measurement data to (Mean±SD), the MASI score and PGA score were compared by paired sample t-test, patient satisfaction is using chi-square test, P<0.05 was considered statistically significant. Results:A total of 90 patients were enrolled, and they were divided into A, B and C groups according to the ratio of 1∶1∶1, with 30 patients in each group. The age of patients in group A, B and C were (33.0±5.8) years, (32.3±7.2) years and (32.9±6.5) years, respectively ( P>0.05), the disease duration was (3.5±2.3) years, (3.3±1.9) years, (3.5±1.5) years, respectively ( P>0.05). Assessing the efficacy of 12 weeks after the last laser treatment: (1) MASI. The scores of both sides of the face in group A after treatment were lower than those before treatment ( P< 0.01 or <0.05), and the scores of the left side after treatment (9.67±4.10) were significantly lower than those of the right side (18.13±7.67) ( P<0.01). The scores of both sides of the face in group B after treatment were significantly lower than those before treatment ( P<0.01 or 0.05), and the scores of the left side (9.97±3.74) were significantly lower than those of the right side (18.01±7.17) after treatment ( P<0.01). The scores of both sides of the face in group C after treatment were significantly lower than those before treatment ( P<0.01), and the scores of the left side of the face after treatment (9.92±4.11) were higher than those of the right side (7.95±3.27) ( P<0.05), the effect of laser treatment in mode B was better than that in mode A. (2) PGA. The score of the left side of the face in group A was (1.63±1.32), lower than the right side of the face (2.97±1.50) ( P<0.01). The left side score of group B was (1.27 ± 1.02), which was lower than that of the right side (2.87±1.46) ( P<0.01). The left side score of group C was (1.97±1.16), higher than that of the right side (1.27±1.02) ( P<0.05). It shows that the therapeutic effect of mode B laser is better than that of mode A laser. (3) Patient satisfaction rate. The left side satisfaction rate of group A was 67% (20/30), higher than that of right side 37% (11/30) ( P<0.05). In group B, the satisfaction rate of the left side was 73% (22/30), higher than that of the right side 47% (14/30) ( P<0.05). The satisfaction rate of the left side in group C was 53% (16/30), which was lower than that of the right side 80%(24/30), indicating that the satisfaction rate of the mode B laser treatment side was higher than that of the mode A ( P<0.05). Conclusions:The treatment of Q-switched 755 nm alexandrite laser combined with topical tranexamic acid can significantly improve facial melasma, and the treatment mode with 3 mm spot, 5.0 J/cm 2 energy density, 150 μs pulse width parameters is recommended.
