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Melasma

“医生,你能用更强的激光打掉我的色素吗,” – 如何不治疗黄褐斑。

在过去的两年里,“皮秒”或“皮秒激光”已经成为色素沉着治疗邻域中最常听到的流行语之一,导致患有“色素问题”的患者到美容诊所询问有关“皮秒激光”的疗程已变得非常普遍。

没有一成不变的标准

然而,并非所有的色素问题都是相同的。

在我最近的一次门诊中,一名患者前来就诊,以解决其面部色素沉着的烦恼。几个月前,她在另一家诊所接受了“皮秒”疗程,并被告知她的色素将在一个疗程内清除。

然而,令她失望的是,色素不但没有消失反而变得更深,整个治疗过后她看起来更糟。她等了几个月,希望色素会消退,但却没什么起色。

她问是否可以用更强的皮秒激光来治疗她的色素。然而,我建议她使用色素淡化霜,而不是选择更强烈的激光。

你可能会问,为什么?显然某些波长的皮秒激光的确能色素性疾病起到很好的治疗作用,但是,面部或身体任何部位的色素可由多种因素引起,而一成不变的做法肯定不是正确的方法。

黄褐斑

MELASMA

根据她的情况,诊断为黄褐斑。黄褐斑是一种色素沉着过度的疾病,其病因被认为是紫外线照射、遗传和黄褐斑激素因素之间的相互作用。

它通常以对称的斑点状棕色斑块呈现在脸颊上,尽管该症状也会体现于额头、太阳穴、鼻梁、上唇和下颚线。女性相比较更容易患上这种疾病,一般在30岁左右发病。

黄褐斑也可能在怀孕期间或之后发病。增加黄褐斑发生几率的其他因素也可能是患者有过度日晒的经历、家族遗传、因使用激素替代疗法或口服避孕药而导致女性荷尔蒙增加、甲状腺疾病和睾丸素水平低下等等。

虽然不是危及生命的疾病,但对受其影响的人来说,可能会造成非常严重的毁容,并对生活质量产生不利影响。

黄褐斑无法治愈,但可以治疗。

难道色素激光不是治疗色素沉着的方法吗?

自钕雅铬镭射激光器问世以来,色素激光器已成为治疗晒斑、雀斑等色素性疾病最有效的工具之一,也成为美容医生或皮肤科医生临床上最宝贵的工具之一。

色素激光器引用了发色团的物理理论从光中导出能量。治疗过程中,皮肤中的色素将会充当发色团,并从特定波长的激光中吸收能量。这些色素随后由于激光的光声和光热效产生选择性碎裂,随后被我们的免疫系统摄取和排除。

现在,这疗程适用于大多数色素沉着的相关疾病,甚至对其他外源性色素如纹身也会有效。然而,为什么黄褐斑如此难以治疗?那它到底是对黄褐斑有效,但几乎马上就会复发,还是根本没有反应?

黄褐斑是一种由敏感的黑色素细胞过度分泌黑色素的疾病。

为了了解原因,我们必须首先了解黄褐斑是如何形成的。我之前提到,黄褐斑是紫外线照射、遗传和黄褐斑激素因素之间的相互作用。

然而,黄褐斑与由紫外线或炎症引起的皮肤色素沉着不一样。通过分子途径研究 ,研究人员认为,与正常人相比,黄褐斑患者的某些受体在黑色素生成和黑色素体转移上有着明显的活跃和上调,从而导致黄褐斑的持续性的色素沉着。

这意味着黄褐斑患者的色素生成细胞非常敏感和过度刺激,因此当被能够刺激黑色素生成的因素触发时,将导致更多色素生成并沉积到皮肤中。

到底要不要进行激光治疗

出于上述原因,面部色素的治疗必须从合理的医疗方法开始。在开始任何治疗之前,必须做出正确的诊断。

雀斑、晒斑、炎症后色素沉着等色素性疾病都可以通过激光治疗轻松解决。
另一方面,黄褐斑需要用更全面的方法来治疗。由于这种情况是基于色素生成细胞的上调和敏感所引起的,因此治疗应从治疗其根本原因开始,即尽可能减少色素生成的所有风险因素。

这将包括对荷尔蒙因素的治疗,如审查患者的药物中是否存在任何可改变荷尔蒙水平的药物,如口服避孕药或荷尔蒙替代疗法;使用广谱防晒霜进行防晒等。

治疗还应该包括治疗色素的外用药膏。氢醌色素霜仍然是治疗黄褐斑的标准方法,尽管近年来,人们对长期使用这种药物的担忧增加了,而且还使用了效果较差的替代品,如含有熊果苷、杜鹃花酸和抗坏血酸、烟酰胺曲酸的药膏。

当然,激光在黄褐斑的治疗中并不是没有作用。明智地使用激光和酸性换肤可以作为治疗黄褐斑的良好辅助手段。如果使用得当,它们可以加快色斑的淡化速度;并且当进行对外用药膏反应不佳的顽固性黄褐斑治疗中,激光和酸性换肤仍然具有强力的作用。

黄褐斑是可以成功被治疗的

黄褐斑是一种复杂且具有挑战性的疾病,治疗的过程中需要时间、耐心和毅力。医生采取合理和全面的医疗方法,病人勤奋地应用和使用规定的治疗方法,同时保持着适当生活方式,如远离阳光,避免使用刺激性化妆品,种种因素都是为了能在治疗黄褐斑中,实现明显的改善和保持良好肤色的关键。它可能无法治愈,但肯定可以得到良好的治疗。

如果你也受黄褐斑的困扰,请咨询您的医生,以便可以尽早处理。

Melasma

‘Doctor, can you hit my pigments with a stronger laser?’ –  How NOT to treat melasma. 

‘Pico’ or Pico Laser has in the last 2 years became one of the most commonly heard buzzwords in the treatment of pigmentation, so much that it has become very common for patients turning up at aesthetic clinics requesting for ‘picolaser’ for their ‘pigment problems’.

NO ONE SIZE FITS ALL

However, NOT all pigment problems are the same.

In one of my recent clinic sessions, a patient came in for a consultation to address her facial pigmentation. She had gone for a ‘pico’ session in another clinic a few months ago and was told that her pigments will be cleared in one session.

To her dismay, however, the pigment had become darker and she looked worse after the treatment. She waited a few months hoping that it will lighten out, but it did not.

She asked if she can have stronger pico laser to treat her pigments. I had however started her on a pigment lightening cream instead of hitting her harder with the laser.

Why you may ask. Indeed, picosecond lasers of certain wavelengths are useful in treating pigmentary disorders, however, pigments on the face or anywhere on the body can be caused by a myriad of conditions, and a one-size-fits-all approach is certainly not the way to go.

MELASMA

MELASMA

In her situation, the diagnosis of melasma was made. Melasma is a disorder of hyperpigmentation of which aetiology is thought to be an interplay between UV exposure, genetic and hormonal factors.

It typically appears as symmetrical, blotchy brown patches over the cheeks, although the forehead, temples, nasal bridge, upper lips, and jawline are also known to be affected. The condition affects women more than men and commonly appears in the mid-30s.

It can also develop during or after a pregnancy. Other factors increasing the chance of melasma include a history of excessive sun exposure, family history, increased female hormones either by being on hormone replacement therapy or oral contraceptive pills, thyroid disease and low testosterone amongst others.

Also Read: What Harm Can Ultraviolet Radiation Do

Although not a life-threatening condition, it can be very disfiguring for people affected by the condition and has a deleterious impact on the quality of life.

Melasma has NO CURE, but it can be treated.

IS PIGMENT LASER NOT A TREATMENT FOR PIGMENTATION?

Pigment lasers have since the days of Q-switched lasers become one of the most effective tools in the treatment of pigmentary disorders such as sunspots, freckles and have become one of the most invaluable tools in the clinic of an aesthetic physician or dermatologist.

Pigment lasers use the physics theory of chromophores attracting energy from light. Pigments in the skin act as a chromophore and absorb the energy from certain wavelengths of lasers. These pigments are then selectively fragmented due to photoacoustic and photothermal effects from the lasers and are subsequently ingested and cleared by our immune systems.

Now, this works for most pigments, and will even work for other exogenous pigments such as tattoos. However, why is melasma so difficult to treat? It either responds only to return with a vengeance almost immediately after or just does not respond at all?

MELASMA IS A DISEASE OF OVERPRODUCTION OF MELANIN PIGMENTS BY SENSITIZED MELANOCYTES

To understand why we have to first understand how melasma happens. I mentioned earlier that melasma is an interplay between UV exposure, genetic and hormonal factors.

However, melasma is a condition is not the same as skin hyperpigmentation that is induced by UV or inflammation. Through molecular pathway studies, it is now believed that people affected by melasma have increased expression and upregulation of certain receptors involved in the stimulation of melanogenesis and melanosome transfer compared to normal individuals resulting in persistent hyperpigmentation in melasmic lesions.

This essentially means that pigment-producing cells in people with melasma are sensitized and hyper-stimulated, thus when triggered by factors which can stimulate melanin production, will result in even more pigments being produced and deposited into the skin.

LASER OR NO LASER?

For the above reasons, treatment of facial pigments must start with a sound medical approach. The correct diagnosis must be made before embarking on any treatment.

Pigmentary conditions such as freckles, sun spots, post-inflammatory hyperpigmentation can be easily treated with lasers.

Melasma, on the other hand, needs to be treated with a more holistic approach. As the condition is due to upregulation and sensitization of pigment-producing cells, treatment starts with treating the root cause of it, by reducing all risk factors for pigment production as much as possible.

This will include treating hormonal factors such as reviewing a patient’s medications for any medications that can alter hormonal levels such as oral contraceptive pills or hormone replacement therapy; sun protection with broad-spectrum sunscreens.

Treatment should also include topical creams for pigments. The pigment cream hydroquinone is still the standard treatment of melasma although, in the recent years, concerns have grown regarding long term use of the medication and alternatives which work to a lesser degree such as creams containing arbutin, azeleic and ascorbic acids, niacinamide kojic acid have also been used.

Now, that does not mean that laser has no role in the treatment of melasma. Judicious use of lasers and acid peels can act as good adjuncts in the treatment of melasma. When used correctly, they can speed up the lightening of pigments; and in recalcitrant melasma which responds poorly to topical creams, lasers and peels still have a strong role to play.

MELASMA CAN BE TREATED SUCCESSFULLY

Melasma is a complex and challenging condition to treat and requires both times, patience and persistence. A sound and holistic medical approach by the doctor, and diligence on the part of the patients applying and using the prescribed treatments while maintaining lifestyle factors such as staying away from the sun, avoiding irritative cosmetics are crucial to achieving visible improvement and maintaining good complexion in the treatment of melasma. It may not be curable, but it certainly can be treated well.

If you are indeed suffering from melasma, speak to your doctor so that it can be addressed early.