| Backgrounds:Acquired bilateral nevus of Ota-like macules is also known as nevus fusco-caeruleus zygomaticus(NFZ), or the "Hori’s nevus." The main clinical manifestations are symmetrical bilateral zygomatic brown spots, which may be round, oval or irregularly shaped, and are mucosa uninvolved. Histopathology shows that on the upper dermis, the collagen fibers, with their long axis parallel to the skin surface, scattered in a small number of tiny spindle melanocytes. With the proposal of selective photothermolysis theory and the broad application of short-pulse laser in dermatology for nevus, the treatment for NFZ has made tremendous progress. However, in terms of the three commonly used laser treatments—the Q-switched Nd:YAG laser, Q-switched alexandrite laser, and Q-switched ruby laser, studies of the evaluation of their treatment efficacy and the analysis of the factors that influence the efficacy are limited.Objective:To analyze the clinical features of NFZ and explore the clinical efficacy and factors that affect the efficacy in the treatment of the Q-switched Nd:YAG laser, Q-switched alexandrite laser, and Q-switched ruby laser.Methods:A retrospective analysis is adopted to look into685cases of NFZ including8males and677females cases. Clinical characteristics were analyzed such as age, the color of the skin lesions, affected areas, and so on. The number of patients who received a single treatment is respectively as followed:Q-switched Nd:YAG (1064nm) laser,465cases; Q-switched alexandrite (755nm) laser,149cases, and Q-switched ruby (694nm) laser-treated patients,71cases. A physician who was not involved in the study evaluated the efficacy of each treatment, based on the photos taken after each treatment. The efficacy of three different laser treatments was compared through statistical analysis and the efficacy factors were analyzed through univariate and multivariate logistic regression.Results:Among the685cases of NFZ patients,98.8%were female. The mean age of the patients was23.29±8.69years old and mean age of first treatment,31.34±8.99. Patients aged14years or less accounted forl.9%,15to25,27.9%,26to35years old, 36.4%,36to40,14.9%,40to49,16.4%, and50years of age or more accounted for2.6%of the patients. Predilection site of involvement were:malar area(84.4%), root of the nose(14.5%), lateral sites of the forehead(8.9%), upper eyelids (4.5%), and alae of the nose(3.8%). The overall efficiency of the Q-switched1064nm laser group, Q-switched755nm laser group, Q-switched694nm laser was respectively52.5%,51.9%,39.5%. After average five times of treatment of the Q-switched755nm laser and Q-switched694nm laser, significant effect was observed among75%of the patients, while it took the Q-switched1064nm laser average seven times to achieve the same effect. The effect of the three laser treatments shows no difference in treating NFZ complicated with melasma. The lower the age of first treatment and the more times of treatment, the better the results will be. Whether melasma involved was a contributing factor of the treatment effect (P <0.05). The treatment efficacy in cases without melasma was47times higher than those with melasma (OR=47.522). Adverse reaction rate in the Q switch1064nm,755nm,694nm laser group was respectively30.5%,27.5%,43.7%. The presence of hyperpigmentation is correlated to treatment efficacy (P<0.001). The treatment efficacy in cases without hyperpigmentation was5.4times better than those with hyperpigmentation (OR=5.448). In the Q-switched694nm group, a case involving punctate pigment loss was found. In the Q-switched1064nmlasergroup,age,frequency of treatment and complication with melasma are correlated to hyperpigmentation, while in the Q-switched755nm laser group, complication with melasma are correlated to hyperpigmentation.Conclusion:NFZ mainly is found in women aged from15to35, primarily with malar involved.Q-switched Nd:YAG laser, Q-switched alexandrite laser, Q-switched ruby laser were effective and safe treatment for NFZ. Considering the overall efficacy and durationof treatment, Q-switched alexandrite laser is a better choice. Frequency of treatment is an important contributing factor for treatment efficacy. That is, the more times of treatment, the better efficacy. In Q-switched1064nm and694nm laser group, the presence of hyperpigmentation is correlated to treatment efficacy. In Q-switched laser1064nm treatment for NFZ, the efficacy is also under the influence of age, frequency of treatment, and whether melasma is involved. |
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