联合用药与单一用药局部治疗的疗效对比与清除黄褐斑:有高质量的证据显示,使用 4% 氢醌、0.05% 维甲酸和 0.01% 氟轻松三种药物联合治疗对黄褐斑的清除较任意两种单一药物联合治疗更显著。[1]Ball Arefiev KL, Hantash BM. Advances in the treatment of melasma: a review of the recent literature. Dermatol Surg. 2012;38:971-984.http://www.ncbi.nlm.nih.gov/pubmed/22583339?tool=bestpractice.com[22]Taylor SC, Torok H, Jones T, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis. 2003;72:67-72.http://www.ncbi.nlm.nih.gov/pubmed/12889718?tool=bestpractice.com[21]Chan R, Park KC, Lee MH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. 2008;159:697-703.http://www.ncbi.nlm.nih.gov/pubmed/18616780?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
联合用药与单一用药局部治疗的疗效对比与清除黄褐斑:有高质量的证据显示,使用 4% 氢醌、0.05% 维甲酸和 0.01% 氟轻松三种药物联合治疗对黄褐斑的清除较任意两种单一药物联合治疗更显著。[1]Ball Arefiev KL, Hantash BM. Advances in the treatment of melasma: a review of the recent literature. Dermatol Surg. 2012;38:971-984.http://www.ncbi.nlm.nih.gov/pubmed/22583339?tool=bestpractice.com[22]Taylor SC, Torok H, Jones T, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis. 2003;72:67-72.http://www.ncbi.nlm.nih.gov/pubmed/12889718?tool=bestpractice.com[21]Chan R, Park KC, Lee MH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. 2008;159:697-703.http://www.ncbi.nlm.nih.gov/pubmed/18616780?tool=bestpractice.com
壬二酸与黄褐斑的清除:有高质量的证据表明,20% 壬二酸凝胶比 2% 氢醌凝胶的疗效更好,在治疗黄褐斑方面,其疗效相当于 4% 氢醌。[25]Verallo-Rowell VM, Verallo V, Graupe K, et al. Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. Acta Derm Venereol Suppl (Stockh). 1989;143:58-61.http://www.ncbi.nlm.nih.gov/pubmed/2528260?tool=bestpractice.com[26]Balina LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. 1991;30:893-895.http://www.ncbi.nlm.nih.gov/pubmed/1816137?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
壬二酸与黄褐斑的清除:有高质量的证据表明,20% 壬二酸凝胶比 2% 氢醌凝胶的疗效更好,在治疗黄褐斑方面,其疗效相当于 4% 氢醌。[25]Verallo-Rowell VM, Verallo V, Graupe K, et al. Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. Acta Derm Venereol Suppl (Stockh). 1989;143:58-61.http://www.ncbi.nlm.nih.gov/pubmed/2528260?tool=bestpractice.com[26]Balina LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. 1991;30:893-895.http://www.ncbi.nlm.nih.gov/pubmed/1816137?tool=bestpractice.com
乙醇酸和黄褐斑的清除:有中等质量证据表明,在治疗黄褐斑方面,经历乙醇酸、水杨酸或三氯乙酸此一系列化学剥脱术的疗效中等。果酸换肤联合改良Kligman 配方的疗效好于单独使用改良 Kligman 配方的疗效。在一项小型研究中,联合使用果酸换肤和 4% 氢醌似乎并不比单独使用 4% 氢醌更有效。[29]Chun EY, Lee JB, Lee KH. Focal trichloroacetic acid peel method for benign pigmented lesions in dark-skinned patients. Dermatol Surg. 2004;30:512-516.http://www.ncbi.nlm.nih.gov/pubmed/15056140?tool=bestpractice.com[30]Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25:18-22.http://www.ncbi.nlm.nih.gov/pubmed/9935087?tool=bestpractice.com[31]Javaheri SM, Handa S, Kaur I, et al. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol. 2001;40:354-357.http://www.ncbi.nlm.nih.gov/pubmed/11555002?tool=bestpractice.com[32]Soliman MM, Ramadan SA, Bassiouny DA, et al. Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study. J Cosmet Dermatol. 2007;6:89-94.http://www.ncbi.nlm.nih.gov/pubmed/17524124?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
乙醇酸和黄褐斑的清除:有中等质量证据表明,在治疗黄褐斑方面,经历乙醇酸、水杨酸或三氯乙酸此一系列化学剥脱术的疗效中等。果酸换肤联合改良Kligman 配方的疗效好于单独使用改良 Kligman 配方的疗效。在一项小型研究中,联合使用果酸换肤和 4% 氢醌似乎并不比单独使用 4% 氢醌更有效。[29]Chun EY, Lee JB, Lee KH. Focal trichloroacetic acid peel method for benign pigmented lesions in dark-skinned patients. Dermatol Surg. 2004;30:512-516.http://www.ncbi.nlm.nih.gov/pubmed/15056140?tool=bestpractice.com[30]Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25:18-22.http://www.ncbi.nlm.nih.gov/pubmed/9935087?tool=bestpractice.com[31]Javaheri SM, Handa S, Kaur I, et al. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol. 2001;40:354-357.http://www.ncbi.nlm.nih.gov/pubmed/11555002?tool=bestpractice.com[32]Soliman MM, Ramadan SA, Bassiouny DA, et al. Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study. J Cosmet Dermatol. 2007;6:89-94.http://www.ncbi.nlm.nih.gov/pubmed/17524124?tool=bestpractice.com
联合使用脉冲二氧化碳激光和 Q 开关翠绿宝石激光可有效治疗真皮型黄褐斑患者:有低质量(可信程度有限)的证据表明,联合使用这 2 种激光比单独使用 Q 开关翠绿宝石激光更有效。[33]Nouri K, Bowes L, Chartier T, et al. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg. 1999;25:494-497.http://www.ncbi.nlm.nih.gov/pubmed/10469101?tool=bestpractice.com[34]Angsuwarangsee S, Polnikorn N. Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: split-face design. Dermatol Surg. 2003;29:59-64.http://www.ncbi.nlm.nih.gov/pubmed/12534514?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
联合使用脉冲二氧化碳激光和 Q 开关翠绿宝石激光可有效治疗真皮型黄褐斑患者:有低质量(可信程度有限)的证据表明,联合使用这 2 种激光比单独使用 Q 开关翠绿宝石激光更有效。[33]Nouri K, Bowes L, Chartier T, et al. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg. 1999;25:494-497.http://www.ncbi.nlm.nih.gov/pubmed/10469101?tool=bestpractice.com[34]Angsuwarangsee S, Polnikorn N. Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: split-face design. Dermatol Surg. 2003;29:59-64.http://www.ncbi.nlm.nih.gov/pubmed/12534514?tool=bestpractice.com
利用光热分解作用进行有效治疗:有低质量(可信程度有限)的证据表明,60% 的患者使用点阵激光法获得 75%~100% 的清除,而 30% 的患者获得<25% 的改善。[35]Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg. 2005;31:1645-1650.http://www.ncbi.nlm.nih.gov/pubmed/16336881?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
利用光热分解作用进行有效治疗:有低质量(可信程度有限)的证据表明,60% 的患者使用点阵激光法获得 75%~100% 的清除,而 30% 的患者获得<25% 的改善。[35]Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg. 2005;31:1645-1650.http://www.ncbi.nlm.nih.gov/pubmed/16336881?tool=bestpractice.com