| Objective:To evaluate the clinical efficacy and safety of dual-wavelength dual-mode Nd:YAG picosecond laser combined with tranexamic acid cataplasm in the treatment of stable melasma.Method:Sixty-three patients with stable melasma were selected from the Department of Dermatology,Henan people’s Hospital,all of them were female.The patients were randomly divided into three groups:group A,group B and group C.Group A:only treated with dual-wavelength dual-mode Nd:YAG picosecond laser,a total of 3 times,each interval of 4 weeks,12 weeks as a course of treatment.Group B:only external application of tranexamic acid cataplasm,once a day,1 hour each time,for 12 weeks;Group C:dual-wavelength dual-mode Nd:YAG picosecond laser combined with tranexamic acid cataplasm,the method is the same as above,the course of treatment is 12 weeks.The patients in the three groups were followed up at the 12th and 20th weeks.Facial VISIA image collection,melanin index(MI)and erythema index(EI)were measured before treatment and during follow-up.,and the modified melasma area and severity index(m MASI)score was performed by two fixed dermatologists based on VISIA images.The improvement rate of m MASI score and patient satisfaction were evaluated at the 12th week,the clinical recurrence was evaluated at the 20th week,and the related adverse reactions during the treatment were recorded.Results:A total of 63 patients with stable melasma were included,including 2 cases of,detachment 61 cases completed treatment and follow-up,20 cases in group A,21cases in group B and 20 cases in group C.1.mMASI score and MI value:Intra-group comparisons of groups A,B,and C at different time points show that the overall m MASI scores are statistically different(F=15.048,P<0.001;F=8.986,P<0.001;F=59.080,P<0.001),and the overall MI values are statistically different(F=9.233,P<0.001;F=10.764,P<0.001;F=115.761,P<0.001).Compared with the 0th week,the m MASI score and MI value of the 12th week group were significantly lower,and the difference was statistically significant(P<0.05),and the m MASI score and MI value of group B were not significantly different from those at week 0(P>0.05);Compared with the 12th week,at the 20th week,the m MASI scores and MI values of the two groups A and B were significantly increased,the difference was statistically significant(P<0.05),and the group C increased but had no statistical difference(P>0.05).Comparison among groups A,B,and C at the same time points showed that there was no statistical difference in m MASI score and MI value at week 0(P>0.05),which were comparable;There were significant differences in m MASI score and MI value between groups at the 12th and 20th week(F=11.377,P<0.001;F=11.916,P<0.001),paired comparison both showed that group C was significantly lower than group A and group B,and the differences were statistically significant(P<0.05).Comparison of the improvement rate of m MASI score between groups:the improvement rates of m MASI score before and after treatment in group A,B and C were 50(20,50)%,10(10,40)%,70(50,80)%respectively,and there was significant difference in total score distribution(H=33.156,P<0.001).The improvement rate of m MASI score in group C was significantly higher than that in group A and B(P<0.05).2.EI value:There were significant differences among the three groups at different time points in group A,B and C(F=117.672,P<0.001).Compared with the 0th week,the 12th and 20th week,the EI value decreased significantly,and there was no significant difference among the three groups(P>0.05).3.Satisfaction:The satisfaction rates of group A,B and C were 55%,28.6%and 90%,respectively,and the difference was statistically significant(X~2=15.875,P<0.001).The paired comparison showed that the satisfaction rate of group C was significantly higher than that of group A and group B(P<0.05).4.Clinical recurrence rates:The recurrence rates of group A,B and C were 15%,52.4%and 5%,respectively,and the difference was statistically significant(X~2=13.878,P<0.05).Paired comparison showed that the recurrence rate of group An and C was lower than that of group B,and the difference was statistically significant(P<0.05).5.Adverse reactions:In group A,1 case developed skin pruritus after treatment,which was relieved in 1-2 days.There were no serious adverse reactions in the three groups during the treatment and follow-up period.Conclusion:1.Dual-wavelength dual-mode Nd:YAG picosecond laser combined with tranexamic acid cataplasm or single use is safe and effective in the treatment of stable melasma.2.Dual-wavelength dual-mode Nd:YAG picosecond laser combined with tranexamic acid cataplasm in the treatment of stable melasma has a lower short-term recurrence rate,better curative effect and higher patient satisfaction than single use,which is worthy of clinical promotion. |
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