皮膚上最難解的複雜斑—肝斑的治療心得

隨著歲月的推移,紫外線曝曬的累積,我們的皮膚外層難免會透出許多斑斑點點。色素斑的治療在亞洲人膚質,一向是個不小的挑戰,因為天生膚種對雷射光束的敏感,點斑術後的反黑不在少數,淺層斑尤其如此、深層斑更是困難,其中最最最具挑戰性的就是肝斑的治療了。

肝斑的成因不是因為肝不好,而是因為呈現大片狀,色澤類似煮熟豬肝色,因而得名。常見於成年女性,好發在顴骨、耳前、眼尾、額頭,大片而隱約的輪廓。肝斑的形成,和個人體質、賀爾蒙、紫外線刺激、發炎都有關係,簡言之,就是個多因子、複雜性成因的斑點疾病。也因為如此,處理上棘手至極,防曬沒紮實、雷射操作不當、皮膚發炎、生活作息不正常、賀爾蒙失調,都有可能讓原本處理得好好的肝斑,又重新反撲回來。

肝斑的治療處理上,多管齊下的複合療程,從飲食、外用、美療換膚、點滴、雷射,來減少色素產生,以及加快色素排除,並且讓膚質穩定強健,降低發炎敏感,增加肌膚對外界刺激的調整能力。其中最受矚目與討論的便是雷射光療在肝斑治療上的應用

在台大醫院完成皮膚專科醫師受訓的精實歲月,日復一日的皮膚切片討論,讓我明白,肝斑的皮膚切片,可見散落在表皮細胞間及表皮細胞內的黑色素、表皮跟真皮之間基底層的光老化、真皮巨噬細胞內黑色素增多、微細血管增多。

因此,肝斑的治療,屏除防曬、擦美白藥膏或保養品等等,這些大家都知道的常識。雷射治療上針對肝斑,我們要做的就是掃除黑色素、移除多餘血管絲、增加表皮真皮交界基底層的健全,但是說來容易,劑量上的拿捏,卻是肝斑治療最最最困難的所在,一旦過多過強,隨之而來的就是讓人難以接受的反黑。

肝斑雷射治療的新曙光

在皮秒雷射問世前,肝斑的雷射治療不外乎,淨膚雷射加速色素移除、脈衝光/染料雷射清除真皮多餘血管、非汽化式飛梭來強化基底層的膠原結構完整,無奈這些傳統雷射治療總是伴隨著不等程度的熱刺激、熱傷害,修復過程隨之而來的發炎反應,很可能引發後續的色素沉著。因此,強調光震波取代光熱效應的皮秒雷射,不啻是肝斑治療的新曙光。

皮秒雷射利用突破性的極短擊發時間,將色素震碎的效率大幅提高,把對皮膚的熱傷害大大降低,並且透過特殊聚焦光束的探頭,有效增加真皮膠原含量,並且在大量皮膚檢測儀追蹤分析的過程中,一再驗證,不管755Picosure蜂巢皮秒或1064探索皮秒治療一個月後,皮下泛紅血管都有明顯減少的跡象。一次治療同時有高效色素震碎移除、低熱傷害、減少擴張血管、強化真皮膠原含量,這四大肝斑治療我們想達到的訴求。皮秒大膽預測在肝斑治療上,值得期待與研究,但現前最大的考驗,就在於劑量的拿捏,以及何時該用哪一類型、哪一波長的皮秒雷射。

璞之妍雙皮秒肝斑治療案例

*本圖文僅限實際案例分享,任何治療都有風險,且因人而異,治療前務必與醫師討論並詢問細節。

璞之妍具備有兩台皮秒雷射,涵蓋三種波長532nm、755nm、1064nm,還有專門移除擴張微細血管的Lumines M22頂級原廠彩衝光,肝斑的複合式雷射光療上,我們走得謹慎小心,精細高規格對待。

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