Publication: Akne Vulgarisde 532 Nm Ktp Lazerin Etkinliğinin Değerlendirilmesi.
Abstract
Amaç: Akne vulgaris, pilosebase birimin kronik inflamatuar bir hastalığıdır. Tüm yaş gruplarında görülebilmesine rağmen esas olarak adelosanların hastalığı olup, 12-24 yaşları arasındaki gençlerin yaklaşık % 85' ini etkilemektedir. Etiyopatogenezinde foliküler epidermal hiperproliferasyon, sebum üretiminde artış, inflamasyon, Propionibacterium acnes, genetik faktörler, hormonlar ve immunojenik faktörler rol oynamaktadır. Klinik olarak özellikle yüz, göğüs, sırt ve omuzlar gibi seboreik bölgelerde yerleşimli, açık ve kapalı komedonlar, papül, püstül, nodül ve skarlar ile karakterizedir.Standart akne tedavileri topikal retinoidler, benzoil peroksit, azeleik asid, antibiyotikler ve oral izotretinoini içermektedir. İzotretinoine bağlı teratojenite ve antibiyotiklere karşı gelişen direncin giderek artması konusundaki endişeler nedeni ile bu uzun süreli tedavilere alternatif tedavi seçeneklerine ihtiyaç duyulmuştur. Son zamanlarda akne tedavisinde aminolevülinik asid ile fotodinamik tedavi, mavi ışık, PDL, KTP lazer ve kızılötesi lazerleri de içeren çoksayıda ışık kaynaklı sistem kullanılmaktadır. Bu metodların Propionibacterium acnes, sebase bezler ya da her ikisini de hedeflediği düşünülmektedir. Bu çalışmada amacımız 532 nm KTP lazerin, akne vulgaris tedavisindeki etkinliğini ve haftada bir veya iki defa uygulanan, iki farklı seans aralığı arasında iyileşme oranları açısından fark olup olmadığını değerlendirmektir.Yöntem: Bu çalışmaya klinik olarak hafif- şiddetli fasial inflamatuvar aknesi olan, toplam 44 hasta dahil edildi. Yaş ortalaması 20±3.2 (18-30) yıl ve Fitzpatrick deri tipi I-III olan, 24' ü erkek, 14' ü kadın, toplam 38 hasta tedaviyi tamamladı. Hastalar rastgele iki gruba ayrıldı. 20 hastadan oluşan 1. gruba haftada bir defa, 18 hastadan oluşan 2. gruba haftada iki defa olacak şekilde toplam dört seans tedavi uygulandı. Hastaların yüzünün yarısına, koruyucu jel sürüldükten sonra Gemini marka (Laserscope®, San Jose, California, U.S.A) 532 nm KTP lazer ( 4 mm spot genişlik, 20-40 milisaniye atım süresi ve 5-12 J/cm2 enerji) ile safir camlı başlık kullanılarak tarama şeklinde uygulama yapıldı. Uygulanan lazer dozları minimum ve maksimum doz aralığı olup kesin doz hastanın cilt tipine göre ayarlandı. Yüzün diğer yarısına koruyucu jel sürülerek, atış yapılmaksızın paralel soğutma başlığı ile tarandı.Hastalar tedavi başlangıcında, her tedavi öncesinde ve tedavi bitiminden sonraki 1. ve 4. haftadaki kontrollerde klinik olarak değerlendirildi. Tedavi edilen ve edilmeyen yüz yarısındaki komedon, papül ve püstüllerden oluşan lezyonlar sayıldı, akne şiddet skoru belirlendi ve fotoğraflandı. Hastalar tarafından her tedavi sonrasında yan etkiler (eritem, ödem, yanma, renk değişikliği, skar), 0-3 arasındaki skala ile değerlendirildi.Akne şiddetinin klinik değerlendirmesinde Michaëlsson akne şiddet değeri (MAŞD) kullanıldı. MAŞD; her bir tip (komedon, papül, püstül ve nodüllerden) lezyon sayısının, şiddet katsayısı ( komedon=0.5, papül=1, püstül=2 ve nodül=3) ile çarpılıp, toplanmasıyla elde edildi. Tedavi başarısı akne şiddet derecesi, lezyon sayıları, hastalar ve fotoğraflar üzerinden de araştırmacılar tarafından değerlendirilen iyileşme oranları üzerinden belirlendi.Bulgular: MAŞD `indeki azalma, tedavi edilen yüz yarısında, 1. ve 2. kontrolde Grup I' de sırasıyla % 21.2 ve % 31.4, Grup II' de % 21 ve % 39.7 idi. Tedavi edilmeyen yüz yarısında ise 1. ve 2. kontrollerdeki iyileşme sırasıyla Grup I de % 2.4 ve %5.9, Grup II de % 12.2 ve % 12.8 idi. Tedavi edilen ve edilmeyen yüz yarıları arasında istatistiksel olarak anlamlı fark mevcut iken (p=0.044, p<0.01), tedavi edilen yüz yarılarında iki grup arasında fark yoktu (p=0.317). İyileşme her bir lezyon sayısı yönünden değerlendirildiğinde, tedavi edilen yüz yarısında komedon ve papül sayılarında hafif derecede azalma mevcuttu. Hastalar ve resimler üzerinden de araştırmacılar tarafından yapılan iyileşmenin değerlendirilmesinde, gruplar arasındaki fark istatistiksel olarak anlamlı değildi. Hastaların hiçbirinde yan etki gözlenmedi.Sonuç: Bu çalışma 532 nm KTP lazerin hafif- orta şiddetteki akne vulgaris tedavisinde, güvenilir ve hafif derecede etkili bir tedavi olduğunu göstermektedir.Anahtar kelimeler: Akne vulgaris, 532 nm KTP lazer, Işık kaynakları
Introduction: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit. Although it can be seen in all age groups, it is primarily a disorder of adolescence and it affects approximately 85% of the young people between the ages of 12 and 24 years. Follicular epidermal hyperproliferation, excess sebum production, inflammation, P. acnes, genetic factors, hormones, immunologic factors play a role in the etiopathogenesis of acne. Clinically it is characterized by open and closed comedones, papule, pustules, nodules and scars, particularly located on the seborrheic areas like on face, back, chest and shoulders. Standart acne treatments include topical retinoids, benzoil peroxide, azeleic acid, antibiotics, and oral isotretinoin. With the increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these conventional treatments. Over the last several years, several ligth based systems have been employed in the management of acne vulgaris: photodynamic therapy with aminolevulenic acid, blue light alone, pulsedye laser, KTP laser and infrared lasers. These methots are believed to target either Propionibacterium acnes, sebase glands or both. The purpose of this study is to assess the efficacy and safety of KTP laser in acne vulgaris and compare the efficacy of different application methods as once a week and twice weekly.Materials and Methods: Fourty four patient clinically diagnosed with mild to severe facial inflammatory acne vulgaris were included in this trial. Thirty eight patients, 24 males and 14 females with mean age of 20±3.2 years (range 18-30) and Fitzpatrick skin types ranging from I to III, completed four treatment sessions. Patients were separated into two groups randomly. The first group of 20 patients, received KTP laser treatment once a week for four weeks and the second group consisting of 18 patients, received KTP laser treatment twice weekly for two weeks. After applying the cooling gel, the laser treatments were performed with the Gemini (Laserscope®, San Jose, California, U.S.A) 532 nm KTP laser system (fluence 10-12 j/cm2, 30-35 msec pulse width, 4 mm spot size ) on half of the face with a paintbrush technique using contact cooling through a chilled sapphire window. The other half of the face received only contact cooling.The setting and the number of passes varied depending on skin type and severity of acne. The controlateral control side received contact cooling only and no laser exposure during each sesion.Patiens were clinically assessed at baseline, before each treatment, one week and four weeks after the fourth treatment. Lesions including comedones, papules and pustules were counted, acne severty score was determined and digital photographs were taken. Patients were asked to assess the side effects such as dispigmentation, erythema, oedema, burning and scar by using the scala between 0 and 3.Clinic evaluation of acne activity was done using the Michaelsson acne severity score. This score counts the number of each type of lesions (comedones, papules, pustules, nodules), multıplies each number by the severity index for the particular acne lesion (comedones=0.5, papules=1, pustules=2, nodules=3) and adds up all the multiplies. The resultant number is the acne severity score. Treatment success was measured by lesion counts (comedones, papules, pustules, nodules), acne severity scores, photographs, and subjective improvement evaluation by the patient and investigator.Results: Michaelsson acne severity score on the laser- treated side decreased by 21.2% and 31.4% at the first and the second control, respectively in Group I and 21% and 39.7% at the first and second control, respectively in Group II. On the side receiving contact cooling only, the score decreased by 2.4% and 5.9% at the first and the second control, respectively in Group I and 12.2% and 12.8% at the first and second control, respectively in Group II (p=0.044, p<0.01). Mild improvement were exhibited on comedones and papules in treated side of the face. The assesment of the improvement by the patient and investigator based on the photographs, the difference between the groups was not statisticaly significant. No side effects were recorded.Conclusion: The study showed that the KTP laser is a safe and effective treatment method for mild or moderate inflammatory acne vulgaris.Key words: Acne vulgaris, 532 nm KTP laser, light sources.
Introduction: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit. Although it can be seen in all age groups, it is primarily a disorder of adolescence and it affects approximately 85% of the young people between the ages of 12 and 24 years. Follicular epidermal hyperproliferation, excess sebum production, inflammation, P. acnes, genetic factors, hormones, immunologic factors play a role in the etiopathogenesis of acne. Clinically it is characterized by open and closed comedones, papule, pustules, nodules and scars, particularly located on the seborrheic areas like on face, back, chest and shoulders. Standart acne treatments include topical retinoids, benzoil peroxide, azeleic acid, antibiotics, and oral isotretinoin. With the increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these conventional treatments. Over the last several years, several ligth based systems have been employed in the management of acne vulgaris: photodynamic therapy with aminolevulenic acid, blue light alone, pulsedye laser, KTP laser and infrared lasers. These methots are believed to target either Propionibacterium acnes, sebase glands or both. The purpose of this study is to assess the efficacy and safety of KTP laser in acne vulgaris and compare the efficacy of different application methods as once a week and twice weekly.Materials and Methods: Fourty four patient clinically diagnosed with mild to severe facial inflammatory acne vulgaris were included in this trial. Thirty eight patients, 24 males and 14 females with mean age of 20±3.2 years (range 18-30) and Fitzpatrick skin types ranging from I to III, completed four treatment sessions. Patients were separated into two groups randomly. The first group of 20 patients, received KTP laser treatment once a week for four weeks and the second group consisting of 18 patients, received KTP laser treatment twice weekly for two weeks. After applying the cooling gel, the laser treatments were performed with the Gemini (Laserscope®, San Jose, California, U.S.A) 532 nm KTP laser system (fluence 10-12 j/cm2, 30-35 msec pulse width, 4 mm spot size ) on half of the face with a paintbrush technique using contact cooling through a chilled sapphire window. The other half of the face received only contact cooling.The setting and the number of passes varied depending on skin type and severity of acne. The controlateral control side received contact cooling only and no laser exposure during each sesion.Patiens were clinically assessed at baseline, before each treatment, one week and four weeks after the fourth treatment. Lesions including comedones, papules and pustules were counted, acne severty score was determined and digital photographs were taken. Patients were asked to assess the side effects such as dispigmentation, erythema, oedema, burning and scar by using the scala between 0 and 3.Clinic evaluation of acne activity was done using the Michaelsson acne severity score. This score counts the number of each type of lesions (comedones, papules, pustules, nodules), multıplies each number by the severity index for the particular acne lesion (comedones=0.5, papules=1, pustules=2, nodules=3) and adds up all the multiplies. The resultant number is the acne severity score. Treatment success was measured by lesion counts (comedones, papules, pustules, nodules), acne severity scores, photographs, and subjective improvement evaluation by the patient and investigator.Results: Michaelsson acne severity score on the laser- treated side decreased by 21.2% and 31.4% at the first and the second control, respectively in Group I and 21% and 39.7% at the first and second control, respectively in Group II. On the side receiving contact cooling only, the score decreased by 2.4% and 5.9% at the first and the second control, respectively in Group I and 12.2% and 12.8% at the first and second control, respectively in Group II (p=0.044, p<0.01). Mild improvement were exhibited on comedones and papules in treated side of the face. The assesment of the improvement by the patient and investigator based on the photographs, the difference between the groups was not statisticaly significant. No side effects were recorded.Conclusion: The study showed that the KTP laser is a safe and effective treatment method for mild or moderate inflammatory acne vulgaris.Key words: Acne vulgaris, 532 nm KTP laser, light sources.
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