丁笑笑,王 永

玫瑰痤疮是一种面部的慢性皮肤疾病，以红斑、短暂性或持续性毛细血管扩张同时包括丘疹、脓疱在内的炎症性病变为特征。其发病机制仍不完全清楚，目前认为遗传、免疫、神经血管失调、紫外线、微生物等均可能参与本病的发生发展。临床表现一般分为四种类型，包括红斑毛细血管扩张型、丘疹脓疱型、鼻赘型、眼型。玫瑰痤疮患者常出现继发性表现，如瘙痒、灼热或刺痛。除了皮肤和眼睛症状外，还会引起焦虑、尴尬和抑郁，并可能对生活质量产生重大影响。随着玫瑰痤疮诊断和分类的更新，玫瑰痤疮患者的治疗方案引起了皮肤科医生的关注，传统的治疗方案包括外用及系统口服药物治疗，然而传统的治疗方案对于红斑毛细血管扩张型玫瑰痤疮治疗效果欠佳，近些年，随着光电技术的发展，更多技术应用于红斑毛细血管扩张型玫瑰痤疮的治疗中，在国内外研究报道中，光电技术用于治疗红斑毛细血管扩张型玫瑰痤疮取得了较好的疗效，但是其有效性和安全性有待于临床进一步验证，本文将结合国内外研究对红斑毛细血管扩张型的光电治疗进展进行综述。

玫瑰痤疮；毛细血管扩张；光电治疗

[1] 中华医学会皮肤性病学分会玫瑰痤疮研究中心,中国医师协会皮肤科医师分会玫瑰痤疮专业委员会.中国玫瑰痤疮诊疗指南(2021版)[J].中华皮肤科杂志,2021,54(04):279-288. [2] Kassir, R.; Kolluru, A.; Kassir, M. Intense pulsed light for the treatment of Rosacea and Telangiectasias. J. Cosmet. Laser Ther. 2011, 13, 216–222. [3] 杨贝,石春蕊.光电技术在红斑毛细血管扩张型玫瑰痤疮治疗中的应用[J].激光生物学报,2022,31(04):303-310. [4] van Zuuren, Esther J et al. “Rosacea: New Concepts in Classification and Treatment.” American journal of clinical dermatology vol. 22,4 (2021): 457-465. doi:10.1007/s40257-021-00595-7. [5] Ash C, Town G, Whittall R, Tooze L, Phillips J. Lasers and intense pulsed light (IPL) association with cancerous lesions. Lasers Med Sci. 2017;32:1927–1933. [6] Shaker G, Shaker A. A Unique Case of Facial Hypervascularity Responding to Pulsed-Dye Laser. Cureus. 2022 Sep 3;14(9):e28726. doi: 10.7759/cureus.28726. PMID: 36105901; PMCID: PMC9447474.10.7759/cureus.28726.PMID:36105901;PMCID:PMC9447474. [7] Five parameters you must understand to master control of your laser/light-based devices. Farkas JP, Hoopman JE, Kenkel JM. Aesthet Surg J. 2013;33:1059–1064. [8] Suggs AK, Macri A, Richmond H, Munavalli G, Friedman PM. Treatment of erythematotelangiectatic rosacea with pulsed-dye laser and oxymetazoline 1.0% cream: a retrospective study. Lasers Surg Med. 2020;52:38–43. [9] Clark SM, Lanigan SW, Marks R. Laser treatment of erythema and telangiectasia associated with rosacea. Lasers Med Sci. 2002;17:26–33. [10] Campos MA, Sousa AC, Varela P, Baptista A, Menezes N. Comparative effectiveness of purpuragenic 595 nm pulsed dye laser versus sequential emission of 595 nm pulsed dye laser and 1,064 nm Nd: YAG laser: a double-blind randomized controlled study. Acta Dermatovenerol Alp Pannonica Adriat. (2019) 28:1–5. 10.15570/actaapa.2019.1. [11] Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol. 2016;9:29–40. doi: 10.2147/ccid.s69106. [12] Goldman MP, Martin DE, Fitzpatrick RE, Ruiz-Esparza J. Pulsed dye laser treatment of telangiectases with and without subtherapeutic sclerotherapy. Clinical and histologic examination in the rabbit ear vein model. J Am Acad Dermatol. 1990 Jul;23(1):23-30. [13] 王昕,李敏,郭紫薇,等.医用强脉冲光治疗仪的基本原理和临床应用[J].中国激光医学杂志,2023,32(05):291-298+300.DOI:10.13480/j.issn1003-9430.2023.0291. [14] Fischer DL, Han H, Gade A, et al. Intense pulsed light for the treatment of pigmented and vascular disorders and lesions:a review[J]. Dermatological Reviews, 2021,2:69-81. [15] Luo Y, Luan X-L, Zhang J-H, Wu L-X, Zhou N. Improved telangiectasia and reduced recurrence rate of rosacea after treatment with 540 nm-wavelength intense pulsed light: a prospective randomized controlled trial with a 2-year follow-up. Exp Ther Med. 2020;19:3543–50. [16] Piccolo D, Fusco I, Zingoni T, Conforti C. Effective Treatment of Rosacea and Other Vascular Lesions Using Intense Pulsed Light System Emitting Vascular Chromophore-Specific Wavelengths: A Clinical and Dermoscopical Analysis. J Clin Med. 2024 Mar 13;13(6):1646. doi: 10.3390/jcm13061646. PMID: 38541871; PMCID: PMC10970793. [17] Kapicioglu Y, Sarac G, Cenk H. Treatment of erythematotelangiectatic rosacea, facial erythema, and facial telangiectasia with a 577-nm pro-yellow laser: a case series. Lasers Med Sci. 2019;34:93–98. [18] Khamaysi, Z et al. “Nd:YAG 1064-nm laser for residual infantile hemangioma after propranolol treatment.” Scientific reports vol. 13,1 7474. 8 May. 2023, doi:10.1038/s41598-023-33870-0. [19] Ruchiatan, Kartika et al. “Hypertrophic Scar Following Excisional Surgery and Full-Thickness Skin Grafting Due to Rhinophyma Treated with 1064 nm Q-Switched Neodymium:Yttrium Aluminum Garnet Laser.” International medical case reports journal vol. 15 15-18. 20 Jan. 2022, doi:10.2147/IMCRJ.S348092. [20] E.M. Say, G. Okan, G. Gökdemir Treatment outcomes of long-pulsed Nd: YAG Laser for two different subtypes of rosacea J Clin Aesthet Dermatol, 8 (2015), pp. 16-20. [21] Piccolo D, Zalaudek I, Genovesi C, et al. Long-pulsed Nd:YAG laser using an "in motion" setting to treat telangiectatic rosacea. Ann Dermatol Venereol. 2023;150(2):121-122. doi:10.1016/j.annder.2022.09.007. [22] Bevin, A.A.; Parlette, E.C.; Domankevitz, Y.; Ross, E.V. Variable-Pulse Nd:YAG Laser in the Treatment of Facial Telangiectasias. Dermatol. Surg. 2008, 32, 7–12. [23] Yepuri, V., Patil, A.D., Fritz, K. et al. Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia. Dermatol Ther (Heidelb) 11, 1879–1887 (2021). [24] Bordera, Gabriel Buendía et al. “Use of high-power diode laser at 1060 nm for the treatment of vascular lesions.” Journal of vascular surgery cases and innovative techniques vol. 5,4 415-418. 26 Sep. 2019, doi:10.1016/j.jvscit.2019.06.015. [25] Karnezis TT, Davidson TM. Efficacy of intranasal bevacizumab (Avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis. Laryngoscope 2011;121:636–8. 10.1002/lary.21415. [26] Nguyen L, Dierckxsens C, Kerscher M, Hartjen A, Schneider SW, Herberger K. Rosacea treatment with 532 nm KTP versus 595 nm pulsed dye laser-A prospective, controlled study. J Cosmet Dermatol. Published online April 10, 2024. doi:10.1111/jocd.16300. [27] A new 532 nm, variable-pulse-structure, dual-wavelength, KTP laser incorporating cryogen spray cooling, effectively treats rosacea. Bernstein EF. Lasers Surg Med. 2023;55:734–740. [28] Almutairi, Rawan et al. “The Long-Pulse Potassium-Titanyl-Phosphate Laser: Promising Treatment for Resistant Port-Wine Stains.” Cureus vol. 16,2 e53994. 11 Feb. 2024, doi:10.7759/cureus.53994.

点击下载PDF