特定波谱强脉冲光脱毛327例的疗效观察

特定波谱强脉冲光脱毛327例的疗效观察雷惠斌雷蕾粟宏跃（陕西医专附属医院激光美容中心陕西省西安市71007700）［摘要］目的：观察强脉冲光脱毛的疗效及不良反应。方法：采用RSH公司的IPL—GA型光子脱毛机，进行祛除体毛的治疗，取得了较好的疗效。结果：光于脱毛疗效肯定，治疗方法科学，对不同部位毛发都有治疗效果，其治疗的优良率与治疗部位、治疗次数、治疗间隔时间有密切的关系。［关键词］强脉冲光脱毛光子我院自2002年10月引入RSH公司的IPL—GA型光广脱毛机，进行祛除体毛的治疗，取得了较好的疗效，截至2005年2月，我院已对327例顾客进行了5次以上强脉冲光脱毛的治疗，治疗人次数达到1962例，现报道如下：临床资料和方法资料：共对327例顾客进行了强脉冲光脱毛治疗，年龄14455岁。设备：采用RSH公司的IPL--GA型光子脱毛机，可发射光谱波长范围为：680〜1200nm,能量密度为20~45J/Cm2，脉冲数6〜8个，总脉宽：12〜25ms,脉冲延时20ms，光斑大小为8mmX40mm。方法：术前拍照留存并清洁治疗部位，刮净毛发，适当保护眼部。根据肤色及毛发粗细，设定治疗参数，常使用脉冲个数7,总脉宽15ms，能量密度40mj/Cm2。首先在治疗部位涂抹专用冷凝胶，厚约1〜2mm,将导光晶体（即光头）垂直对准治疗部位，轻轻压紧皮肤，释放强脉冲光子，要注意按一定顺序逐一进行治疗，每个光斑衔接紧密，不留空隙，术毕填写治疗参数、及皮肤反应。治疗反应：术中应严密观察皮肤反应，一般照射时皮肤会有瞬间的刺痛感及轻微的烧灼感，并有可能出现毛囊性风团样疹，短时间内即可自行消失。尝试用拔毛镊拔取治疗后的毛发，如可轻易拔出，且无明显痛感，预示治疗剂量适合，如难以拔出或拔出时疼痛明显，预示剂量不足，可适当调整参数，增加剂量后，应严密观察皮肤反应，防止光子剂量过大而烧伤皮肤。术后不良反应及处理：一般术后30分钟内，皮肤有轻微发红表现，随后自行消退，要求患者在治疗后局部进行冷敷30分钟，1〜2天后，毛发较粗的治疗部位的有毛囊发炎的表现，可外涂0．1％的新洁尔灭溶液，一周后可痊愈，327例患者中有一例在治疗区山现与治疗光斑同形的皮肤紫癜，脱痂后出现暂时性色素沉着，半年后完全消失，15例患者皮肤出现小水疱，及时外涂“美宝”减轻疼痛和渗出反应，愈后未发现色素脱失或瘢痕。疗效评定疗程及疗效观察：我院光子脱毛术，要求患者按时治疗，全疗程为5次，疗程结束3个月后，进行复查和电话随访，并对疗效进行评定。疗效判定标准：优良：毛发祛除率在90％以上，再长出的为绒毛，患者能够接受；一般：毛发祛除率在50％以上，再长出的毛发较细，患者勉强接受；有效：毛发祛除率在20％以上，再长出的毛发虽较细，但患者不能接受：无效：祛除率在20％以下，患者不满意。治疗结果：见表1。表1不同部位脱毛治疗的效果治疗五次后的疗效治疗部位例数优良一般（％）有效（％）无效（％）腋毛121119（98.34）3（2.48）0（0）0（0）上肢5240（76.92）7（13.46）4（7.6）1（1.92）下肢6553（81.53）10（15.38）2（3.08）0（0）腮部胡须2813（46.42）11（39.28）4（14.28）0（0）额部发迹线1210（3）2（16.67）0（0）0（0）女性上唇毛4518（40.00）13（28.89）11（24.44）3（6.67）阴毛43（75.00）1（25.00）0（0）0（0）合计327256（78.28）1（25.00）0（0）0（0）4讨论：光子脱毛的原理：特定光谱的强脉冲光，能够有效穿透表皮达到真皮深度甚至皮下组织，选择性地作用于含有大量色素的毛干、毛囊上皮、毛乳头和毛凹。生长期毛囊的上皮、毛乳头和毛凹中含有丰富的黑色素，强光照射后能通过毛杆使这些黑色素选择性地吸收光子能量，其产生的热能形成瞬间毛囊高温，破坏毛干、毛囊，导致组织内的毛囊数目明显减少，阻碍和终止毛发的生长。4.2光子脱毛的安全性：IPL--GA型光子脱毛机，其光谱波长范围为：680〜4200nm,对各种颜色的毛发都有治疗效果。其独特的多脉冲可调技术，在治疗时每次照射时，由一系列温和的脉冲强光及可调间隙组成，能有效避免周围组织的热损伤，从而降低了强脉冲光灼伤皮肤的危险。4.3影响治疗效果的因素：从表1可以看出，由于不同部位的毛发性质各异，疗效不尽相同。327例病例，除上肢、唇毛外，其他部位的脱毛治疗，经过5次照射后有效率为100％。其中腋毛、发际线、阴毛的治疗满意率即可达到100％，由此可以看出，毛发愈粗愈黑（色素愈多），其吸收的光子能量愈多，疗效愈显著，治疗次数越少。相反，若毛发纤细或色素含量较少则疗效不佳，且治疗次数明显增加（如唇毛）。根据毛发生长规律，正常治疗时间间隔在一月左右为宜，唇毛的治疗间隔应缩短至3周，如果治疗时间间隔过长，毛囊的修复能力会使已受伤的毛囊修复，增加再生机会，从而导致治疗次数增加。例无效的患者，皆因未能按时治疗所造成；另外，治疗次数的多少与疗效成正比，治疗次数愈多，效果愈明显，这与毛发处于不同生长阶段有关，生长期毛母质细胞快速分裂，此期黑色素最多，因此，对强光极其敏感，故多次治疗可使人多数毛发在经历生长阶段即被强光照射而损伤，从而使再生减少，即可达到根治性治疗的目的。［参考文献］［1］ 孙林潮、高大文、赵丽莎，等．激光脱毛术。中国美容医学，2003，12（6）：670〜672。［2］ 周展超，余乐平。皮肤美容激光。东南大学出版社。2000：220—222。洪伟，蒋彪。IPL—Queen多功能光子嫩肤仪脱毛370例。中国美容医学，2004，Theobservationofthecurativeeffecton327casesofthehairremovalbyspecialspectralintensivepulselightHuibinLeiLeiLeiHongyueLi[Abstract]Objective:Toobservethecurativeeffectandtheadversereactionofhairremoval.Method:TousetheIPL-GAtypephotonhairremovinginstrumenttoremovethebodyhair,andgetabettercurativeeffect.Result:Thecurativeeffectandthescientificmethodofthetherapyhavebeenaffirmed.Thetherapyiseffectivetodifferentpart;itsexcellencerateiscloselyrelatedtothepart,thefrequencyandtheintervalofthetherapy.[keyword]theintensivepulselight,hairremoval,photonOurhospitalhasgotabettercurativeeffectofhairremovalafterwebroughtintheIPL-GAtypephotonhair-removinginstrumentfromthePSHCompanyinOct.2002.Wehavetreated327casesofhairremovalwithmorethan5timestherapiesbytheintensivepulselight,andthenumberofpatientshasreached1962.ClinicalmaterialsandmethodsMaterials:Totreat327patientsoftheagebetween14~55yearsoldwiththehair-removingtherapybyusingtheintensivepulselight.Equipments:UsetheIPL-GAtypehair-removinginstrumentoftheRSHCompany.Theextentofthepulselength:680~1200mm;theenergydensity:20~45J/cm2;thenumberofpulse:6~8;thetotalpulsewidth:12~25ms;thedurationofpulse:20ms;thesizeofphotospot:8mmx40mm.Methods:Photographandcleanthetreatingpartsbeforetheoperation,shavethehairofthetreatingpartsthoroughly,protectthepartofeyes,settheparameterofthetherapy.Accordingtothedifferentskincolorandthethicknessofhair,theusualnumberofpulseis7,thetotalpulsewidthis15ms,andtheenergydensityis40mj/cm2.Atfirst,smearthespecialcondensationglueatthetreatingpart,thethicknessoftheglueisabout1~2mm;aimattheopticcrystaltothetreatingpartverticallyandpresstheskintightlyandsoftly;releasetheintensivepulsephotons;payattentiontothecertainorder,makethephotospotsconnectedrapidlyandintenselywithoutleavingspace,writedowntheparameterofthetherapyandtheskinreactionaftertheoperation.Therapyreaction:Observetheskinreactioncautiouslyduringtheoperation.Usually,theskinwillproducesensationofstabbingpaininthetwinklingofaneyeandslightburningsensation,andmaybeappearthewindmassshapedrubellafalliculorum,whichwilldisappearautomaticallyinashorttime.Trytopulloutthehairafterthetherapywithtweezers,ifitcanbepulledouteasilyandwithoutobviouspain,itmeansthedosageissuitable;andifitishardtobepulledoutorthereisanobviouspainwhenpullingout,itmeansthedosageisnotsufficient,youcanadjusttheparameterproperly.Youshouldobservetheskinreactioncautiouslyafteraddingthedosagetopreventtheoverphotondosage,whichmayburntheskin.Theadversereactionandthemanagement:Usually,in30minutestherewillappearslightrubefaction,butitwilldisappearautomaticallysoon.Itdemandsthepatienttohavea30minuteslocalcoldcompressafterthetherapy.And2dayslater,therewillappearfolliculitisatthepartswiththickerhair,youcansmearthebromogeramineliquorof0.1%concentration,thenitwillrecoverafteraweek.Therewasonlyonecasethatappearedskinpurpuraasthesameformofthephotospotinthetreatingpartandthetemporarypigmentation,whichwilldisappearcompletelyinahalf-year;15casesappearedsomesmallblisters,smearthe“MeiBao”toreleasethepainandtheoverflowingreaction;Therewasnodepigmentationorscarappearedafterrecovery.Evaluationsofthecurativeeffect2.1Courseoftreatmentandobservationofthecurativeeffect:Wedemandthepatientstohavethetherapyontime,thewholecourseoftreatmentare5times.We'llrecheckandhavephonevisittoevaluatethecurativeeffect3monthslaterafterthecourseoftreatment.Standardsofthecurativeeffect'sevaluationGood:Thehairremovalratewasabove90%,theregeneratedhairisvillus,andthepatientscouldaccepttheresult.Common:Thehairremovalwasabove50%,theregeneratedhairisthinner,andthepatientsacceptedreluctantly.Effective:Thehairremovalwasabove20%,althoughtheregeneratedhairisthinner,butthepatientscouldn'taccept.Ineffective:Thehairremovalwasbelow20%,andthepatientswerenotsatisfied.3.ResultsofthetherapyLookattable1.Table1: thecurativeeffectofdifferentpartsafterhairremovalThecurativeeffectafter5timestherapiesTreatingpartsnumberofcasesineffective(%)good(%)common(%)effective(%)Hirci121119(98.34)3(2.48)0(0)0(0)Upperextremity5240(76.92)7(13.46)4(7.6)1(1.92)Lowerextremity6553(81.53)10(15.38)2(3.08)0(0)Whiskers2813(46.42)11(39.28)4(14.28)0(0)Hairlineofthefrontalpart1210(83.33)2(16.67)0(0)0(0)Hairofthefemale'supperlip4518(40.00)13(28.89)11(24.44)3(6.67)pubisure43(75.00)1(25.00)0(0)0(0)Total327256(78.28)47(14.37)21(6.42)4(1.22)4.Discussions4.1Principleofthephotonhairremoval:Theintensivepulselightofthespecialspectrumcanpenetratetheepidermistothedepthofthedermiseventhesubcutaneoustissuesefficiently.Itcanaffectthehair-shaft,theepitheliumofthehair-fillicle,andthepapillaofhair,whichcontainplentyofpigment.Theepitheliumofthehair-fillicle,thepapillaofhairandthepittingofhairintheperiodofgrowthcontainabundantmelanins,theycanabsorbtheenergyofphotondifferentlythroughthehair-shaftaftertheirradiationoftheintensivelight.Theheatproducedbytheintensivelightcanformthehighheatinthetwinklingofaneye,whichcandestroythehairshaftsandthehairfillicles,reducethenumberofthehairfilliclesinthetissues,hinderevenstopthegrowthofthehair.4.2Safetyofthephotonhairremoval:TheIPL-GAtypephotohairremovinginstrumentwiththeextentbetween680~1200nmofthespectralpulselengthcanmakedifferentcurativeeffecttothehairofdifferentcolor.Itsuniqueadjustablemulti-pulsetechnology,whichwascomposedbyaseriesofmildintensivepulselightandtheadjustableinterval,canavoidtheheatdamageofthesurroundingoftissuesefficiently,andreducethedangerofburnedskinbytheintensivelight.4.3Factorsthataffectthecurativeeffect:Wecanlearntfromtable1thatitwillproducedifferentcurativeeffectbecausethehairqualityofdifferentpartisnotthesame.In327cases,theeffectiverateofthetherapyis100%afterthe5timesirradiationexpectthehairoftheupperextremityandthelips.Thesatisfactionrateofthehirci,thehairline,andthepubisurecanreach100%.Fromtheseweknow,theblackerandthickerthehairis,themorephotonenergyitcanabsorb,andthemoreobviousandthelessnumberoftimesofthetherapywillbe.Onthecontrary,thethinnerthehairisorthelessthecontentofthepigmentis,theworsethecurativeeffectwillbe,andthemorefrequentthetherapywil