A型肉毒毒素联合剥脱性点阵激光对面部痤疮瘢痕的疗效观察

范白露; 徐静; 田丽; 韩志强; 贾梦娜; 赵书含; 袁梅

doi:10.16766/j.cnki.issn.1674-4152.003629

A型肉毒毒素联合剥脱性点阵激光对面部痤疮瘢痕的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.003629

蚌埠医科大学第一附属医院整形烧伤科，安徽蚌埠 233004

基金项目:

安徽省高等学校自然科学研究重点项目 KJ2020A0576

详细信息

通讯作者:
徐静，E-mail：xj.69@163.com

中图分类号: R758.733 R619.6
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出版历程
- 收稿日期: 2023-09-20
- 网络出版日期: 2024-11-19

The efficacy of botulinum toxin type A combined with exfoliative fractional laser on facial acne scarring

Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨A型肉毒毒素联合激光对面部萎缩性痤疮瘢痕的临床疗效。方法选取2021年10月—2022年10月在蚌埠医科大学第一附属医院整形烧伤科就诊的50例面部萎缩性痤疮瘢痕患者，并采用随机数字法将患者分为对照组和观察组，每组25例。所有患者分别给予3次激光，激光治疗中均选择双模式覆盖，每次激光治疗间隔8~10周。其中观察组在第1次激光治疗后的7~14 d内在瘢痕下注射1次A型肉毒毒素。治疗前、治疗结束3个月后，分别采用痤疮瘢痕临床评分量表和调查人员视觉评分(IVS)对患者面部痤疮瘢痕的疗效进行评价，并记录患者的满意度及不良反应发生情况。结果观察组治疗后痤疮瘢痕临床评分为60.0(45.0, 60.0)分，其中平均秩次为21.96，对照组治疗后痤疮瘢痕临床评分为60.0(60.0, 60.0)分，其中平均秩次为29.04，观察组治疗后的痤疮瘢痕临床评分低于对照组，差异有统计学意义(Z=-2.014, P=0.044)。观察组治疗前后痤疮瘢痕临床评分差值为15.0(0.0, 15.0)分, 对照组为0.0(0.0, 7.5)分, 观察组治疗前后痤疮瘢痕临床评分差值明显高于对照组, 差异有统计学意义(Z=-2.076, P=0.038)。观察组IVS评分[3.0(2.0, 3.0)分]高于对照组[2.0(1.0, 2.0)分]，观察组的满意度评分[3.0(3.0, 4.0)分]高于对照组[2.0(2.0, 3.0)分]，差异均有统计学意义(P＜0.05)。结论 A型肉毒毒素联合剥脱性点阵激光治疗面部萎缩性痤疮瘢痕疗效较好，并能在一定程度上抑制皮肤油脂分泌，干预痤疮及其瘢痕发展，具有临床参考意义。
- A型肉毒杆菌毒素 /
- 剥脱性点阵激光 /
- 痤疮瘢痕
Abstract: Objective To investigate the clinical efficacy of botulinum toxin type A in combination with laser on facial atrophic acne scars. Methods Fifty patients with facial atrophic acne scars who visited the Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical University from October 2021 to October 2022 were selected. Patients were randomly divided into control group and observation group by random number method with 25 cases in each group. All patients received three laser treatments each, and dual-mode coverage was selected for laser treatment, with an interval of 8-10 weeks between each laser treatment. In observation group, an injection of botulinum toxin type A was given under the scar within 7-14 days after the first laser treatment. Before the treatment and three months after the end of the treatment, the efficacy of the patients ' facial acne scars was comparatively analyzed using the échelle d'évaluation clinique des cicatrices d'acné (ECCA) weighting scale and the integrated visualization system (IVS), respectively, and the patients ' satisfaction and adverse reactions were recorded. Results The ECCA score of observation group after treatment was 60.0 (45.0, 60.0) points, of which the mean rank was 21.96, and the ECCA score of control group after treatment was 60.0 (60.0, 60.0) points, of which the mean rank was 29.04, and the analysis of the data showed that the overall ECCA score of observation group after treatment was lower than that in control group, and the difference was statistically significant (Z=-2.014, P=0.044). The difference between the ECCA before and after treatment for the observation group was 15.0 (0.0, 15.0), compared to 0.0 (0.0, 7.5) for the control group. The change in ECCA for the observation group was significantly higher than that of the control group, with statistical significance (Z=-2.076, P=0.038). The IVS score in observation group [3.0 (2.0, 3.0) points] was higher than that in control group [2.0 (1.0, 2.0) points], and the satisfaction score of the observation group [3.0 (3.0, 4.0) points] was higher than that in control group [2.0 (2.0, 3.0) points], and the differences were statistically significant (P < 0.05). Conclusion Botulinum toxin type A combined with exfoliative fractional laser is effective in the treatment of facial atrophic acne scarring and can inhibit the skin ' s oil secretion situation and intervene in the development of acne and its scarring to a certain extent, which is of clinical reference.
- Botulinum toxin A /
- Exfoliative fractional laser /
- Acne scarring

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图 1 典型病例

注：A为治疗前，B为治疗后3个月。

Figure 1. Typical case

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表 1 2组面部痤疮瘢痕患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with facial acne scarring

组别	例数	性别(例)		年龄	BMI	病程
组别	例数	男性	女性	(x±s, 岁)	(x±s)	(x±s, 年)
对照组	25	10	15	25.96±3.32	20.82±2.03	9.36±3.48
观察组	25	6	19	25.88±3.63	21.00±1.89	9.60±3.24
统计量		1.471^a		0.081^b	0.322^b	0.253^b
P值		0.255		0.936	0.749	0.802
注：^a为χ²值，^b为t值。

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表 2 2组面部痤疮瘢痕患者治疗前后痤疮瘢痕临床评分比较[M(P₂₅, P₇₅), 分]

Table 2. Comparison of acne scar clinical scores before and after treatment between the two groups of facial acne scar patients [M(P₂₅, P₇₅), points]

组别	例数	治疗前	治疗后3个月	治疗前后差值
对照组	25	60.0(60.0, 60.0)	60.0(60.0, 60.0)^a	0.0(0.0, 7.5)
观察组	25	60.0(60.0, 60.0)	60.0(45.0, 60.0)^a	15.0(0.0, 15.0)
Z值		-0.197	-2.014	-2.076
P值		0.844	0.044	0.038
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组面部痤疮瘢痕患者治疗后IVS评分与满意度评分比较[M(P₂₅, P₇₅), 分]

Table 3. Comparison of IVS scores and satisfaction scores after treatment between the two groups of patients with facial acne scar [M(P₂₅, P₇₅), points]

组别	例数	IVS评分	满意度评分
对照组	25	2.0(1.0, 2.0)	2.0(2.0, 3.0)
观察组	25	3.0(2.0, 3.0)	3.0(3.0, 4.0)
Z值		-3.558	-3.191
P值		< 0.001	0.001

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参考文献(20)

[1]	李欢梅, 唐艳丽, 钟红丽, 等. 中西医结合治疗胸背部痤疮的效果观察及综合护理干预[J]. 中华全科医学, 2023, 21(5): 896-899. doi: 10.16766/j.cnki.issn.1674-4152.003009 LI H M, TANG Y L, ZHONG H L, et al. Effective observation and comprehensive nursing intervention in the treatment of acne on the chest and back by combining Chinese and Western medicine[J]. Chinese Journal of General Practice, 2023, 21(5): 896-899. doi: 10.16766/j.cnki.issn.1674-4152.003009
[2]	HENG A H S, CHEW F T. Systematic review of the epidemiology of acne vulgaris[J]. Sci Rep, 2020, 10(1): 5754. DOI: 10.1038/s41598-020-62715-3.
[3]	鞠强. 中国痤疮治疗指南(2019修订版)[J]. 临床皮肤科杂志, 2019, 48(9): 583-588. JU Q. Guidelines for acne treatment in China (2019 revised edition)[J]. Journal of Clinical Dermatology, 2019, 48(9): 583-588.
[4]	CARLAVAN I, BERTINO B, RIVIER M, et al. Atrophic scar formation in patients with acne involves long-acting immune responses with plasma cells and alteration of sebaceous glands[J]. Br J Dermatol, 2018, 179(4): 906-917. doi: 10.1111/bjd.16680
[5]	姜晓铮, 曹蒙, 王焱. 痤疮瘢痕的治疗新进展[J]. 中国美容医学, 2022, 31(2): 186-189. JIANG X Z, CAO M, WANG Y. New advances in the treatment of acne scarring[J]. Chinese Journal of Aesthetic Medicine, 2022, 31(2): 186-189.
[6]	ZHANG D D, ZHAO W Y, FANG Q Q, et al. The efficacy of fractional CO(2) laser in acne scar treatment: a meta-analysis[J]. Dermatol Ther, 2021, 34(1): e14539. DOI: 10.1111/dth.14539.
[7]	SHIRSHAKOVA M, MOROZOVA E, SOKOLOVA D, et al. The effectiveness of botulinum toxin type A (BTX-A) in the treatment of facial skin oily seborrhea, enlarged pores, and symptom complex of post-acne[J]. Int J Dermatol, 2021, 60(10): 1232-1241. doi: 10.1111/ijd.15574
[8]	KESTY K, GOLDBERG D J. A randomized, double-blinded study evaluating the safety and efficacy of abobotulinumtoxin a injections for oily skin of the forehead: a dose-response analysis[J]. Dermatol Surg, 2021, 47(1): 56-60. doi: 10.1097/DSS.0000000000002494
[9]	LI Y, CHEN X, LUO X, et al. Intradermal botulinum toxin A injection for scalp sebum secretion regulation: a multicenter, randomized, double-blinded, placebo-controlled, prospective study in chinese subjects[J]. Aesthet Surg J, 2023, 43(1): NP38-NP48. DOI: 10.1093/asj/sjac236.
[10]	RHO N K, GIL Y C. Botulinum neurotoxin type A in the treatment of facial seborrhea and acne: evidence and a proposed mechanism[J]. Toxins(Basel), 2021, 13(11): 817. DOI: 10.3390/toxins13110817.
[11]	MARTINA E, DIOTALLEVI F, RADI G, et al. Therapeutic use of botulinum neurotoxins in dermatology: systematic review[J]. Toxins(Basel), 2021, 13(2): 120. DOI: 10.3390/toxins13020120.
[12]	ALBALAT W, GHONEMY S, SALEH A, et al. Correction to: microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study[J]. Arch Dermatol Res, 2023, 315(10): 3007-3008. doi: 10.1007/s00403-023-02731-1
[13]	EBRAHIM H, ELARDI A, KHATER S, et al. Successful topical application of botulinum toxin after microneedling versus microneedling alone for the treatment of atrophic post acne scars: a prospective, split-face, controlled study[J]. J Clin Aesthet Dermatol, 2022, 15(7): 26-31.
[14]	FU Z, HUANG H, HUANG J. Efficacy and safety of botulinum toxin type A for postoperative scar prevention and wound healing improvement: a systematic review and meta-analysis[J]. J Cosmet Dermatol-US, 2021, 21(1): 176-190.
[15]	田丽, 徐静, 王怀谷, 等. 优化脉冲技术联合低能量CO₂点阵激光对面颈部瘢痕早期干预的临床效果[J]. 实用医学杂志, 2022, 38(15): 1919-1924. doi: 10.3969/j.issn.1006-5725.2022.15.013 TIAN L, XU J, WANG H G, et al. Clinical effect of optimised pulse technique combined with low-energy CO2 fractional laser for early intervention of facial neck scarring[J]. Journal of Practical Medicine, 2022, 38(15): 1919-1924. doi: 10.3969/j.issn.1006-5725.2022.15.013
[16]	YANG Z, JIANG S, ZHANG Y, et al. Self-contrast study of pinprick therapy combined with super pulse fractional CO₂ laser for the treatment of atrophic acne scars[J]. J Cosmet Dermatol-US, 2020, 20(2): 481-490.
[17]	李小燕, 聂磊, 郭伟, 等. 黄金微针联合富血小板血浆治疗凹陷性痤疮瘢痕的临床疗效[J]. 安徽医学, 2022, 43(12): 1425-1428. doi: 10.3969/j.issn.1000-0399.2022.12.012 LI X Y, NIE L, GUO W, et al. Clinical efficacy of gold microneedle combined with platelet-rich plasma in the treatment of depressed acne scarring[J]. Anhui Medicine, 2022, 43(12): 1425-1428. doi: 10.3969/j.issn.1000-0399.2022.12.012
[18]	MOON J, YOON J Y, YANG J H, et al. Atrophic acne scar: a process from altered metabolism of elastic fibres and collagen fibres based on transforming growth factor-β1 signalling[J]. Br J Dermatol, 2019, 181(6): 1226-1237. doi: 10.1111/bjd.17851
[19]	刘继松, 邢福席, 付全有, 等. 点阵二氧化碳激光治疗儿童深度烧伤后早期增生性瘢痕的效果评价[J]. 中华全科医学, 2023, 21(2): 250-254. doi: 10.16766/j.cnki.issn.1674-4152.002857 LIU J S, XING F X, FU Q Y, et al. Evaluation of the effectiveness of fractional carbon dioxide laser in the treatment of early proliferative scars after deep burns in children[J]. Chinese Journal of General Practice, 2023, 21(2): 250-254. doi: 10.16766/j.cnki.issn.1674-4152.002857
[20]	SOIKA K. "Micro Botulinum Toxin" for the treatment of a deep dermal burn after single IPL and a second combined IPL/Nd: YAG laser treatment for skin rejuvenation and discoloration[J]. Am J Surg, 2021, 39(2): 101-105.