本研究由重庆市卫生健康委员会和重庆市科学技术局联合开展的医学研究重点项目（2022ZDXM037）、武汉市卫生健康委员会中医药科研基金重点项目（WZ22A03）和重庆市自然科学基金（cstc2020jcyj-msxmX0592）提供资金支持。

所有涉及人类参与者的研究程序均符合重庆市中医院伦理委员会的伦理标准和《赫尔辛基宣言》（1964年）及其后续修正案的原则，并已获得上述伦理委员会的批准。图像数据收集是在患者的口头和书面同意下进行的，并且作为检查的常规部分，为教学目的拍摄的照片是使用多光谱皮肤镜获得的。
1. 患者选择
<ol><li>设置以下纳入标准5：<ol><li>根据面部浅色至深棕色、边界明确的斑块的存在来选择患者，通常具有对称分布、无炎症和脱屑。</li>
		<li>根据是否存在明显的主观症状（如瘙痒、灼热和疼痛）来选择患者。</li>
		<li>考虑到黄褐斑主要发生在女性身上，主要是在青春期之后，选择患者。</li>
		<li>在选择患者时，应考虑病情的季节性变化 - 通常在夏季更严重，在冬季较温和。</li>
		<li>如果存在可能导致色素沉着过度的其他疾病（如颧颧梭蓝痣、Riehl 黑变病和色素性日光性皮炎），则排除患者。</li>
	</ol></li>
</ol>2.滚筒微针治疗的准备工作
<ol><li>术前沟通<ol><li>了解患者的治疗目标和美容愿望，并收集完整的病史，包括用药史、过敏史、禁忌症和过去的美容治疗。</li>
		<li>告知患者治疗的效果、步骤、潜在并发症、恢复时间、持续时间和费用。讨论具体的治疗计划和替代方案，以确保所有患者的疑问都得到解决，帮助他们建立切合实际的期望并实现更高的满意度。</li>
		<li>要求患者签署知情同意书。</li>
	</ol></li>
	<li>环境要求<ol><li>留出一个安静、光线充足的治疗室用于操作滚筒微针，并在手术前用紫外线消毒 30 分钟。</li>
		<li>要求患者在进入治疗室时戴上鞋套和帽子。</li>
	</ol></li>
	<li>准备治疗所需的物品和药物<ol><li>检查并准备 物料清单中列出的所有材料。</li>
	</ol></li>
	<li>卸妆和清洁<ol><li>如果治疗区域被化妆品覆盖，请在清洁前用卸妆液彻底卸妆。</li>
		<li>对于不化妆的人，请用温和的清洁产品清洁治疗区域。</li>
	</ol></li>
	<li>多光谱皮肤镜检查记录 注意： 多光谱皮肤镜使用不同的光源来捕捉面部超高像素图像。<ol><li>治疗前和三次治疗后，使用多光谱皮肤镜从三个不同角度拍摄患者的前部、左侧（45°）和右侧（45°）的照片，并记录患者的紫外线浅层和深层斑点和褐色斑点的值</li>
	</ol></li>
	<li>局部麻醉的应用<ol><li>将5%利多卡因乳膏均匀涂抹在治疗区域，总剂量为30-40g，并用保鲜膜包裹以增强麻醉效果40-60分钟。 注意：一些患者可能会表现出对局部麻醉剂过敏的症状。患者可能会在应用部位出现严重的瘙痒、灼热或刺痛。如果发生此类反应，请立即移除麻醉剂并提供适当的对症治疗。</li>
		<li>在下次治疗之前，请确保在麻醉应用区域对皮肤进行适当的滋润。</li>
	</ol></li>
	<li>微针溶液的制备<ol><li>使用注射器提取 5 mL 5% 氨甲环酸溶液，并将其放在一边使用。</li>
	</ol></li>
	<li>微针器械的制备<ol><li>选择0.5mm滚筒微针（图1），并将其浸泡在0.1%苯扎溴铵溶液中约20分钟以消毒。</li>
		<li>用生理盐水冲洗微针 3 次以去除消毒剂。 注意：通过为每个患者使用单个滚筒微针来避免交叉污染，以防止由于钝针而对皮肤造成不必要的伤害，并防止疾病在患者之间传播。</li>
	</ol></li>
	<li>去除局部麻醉<ol><li>在局部麻醉应用足够长的时间后，取下保鲜膜并用刮刀刮掉麻醉剂。使用浸泡在0.9%生理盐水溶液中的纱布擦去面部残留的麻醉剂。</li>
	</ol></li>
	<li>消毒<ol><li>露出治疗区域，治疗面部时用消毒毛巾包裹头发，用0.1%苯扎溴铵棉球从顶部到发际线边缘，到下颌边缘和下巴3次消毒面部皮肤，遵循“自下而上，向内向外”的原则，防止感染。</li>
	</ol></li>
</ol>3. 滚筒微针手术
<ol><li>让治疗师洗手，戴上帽子、口罩和无菌手套。</li>
	<li>在告知患者开始手术后，指导患者闭上眼睛，按照左脸颊、右脸颊、前额、下巴、上唇和鼻子的顺序进行治疗。用注射器将适量氨甲环酸溶液注射到皮肤上，用手均匀涂抹，然后用生理盐水冲洗滚筒微针，在治疗区域沿水平、垂直、倾斜方向短距离滚动。</li>
	<li>逐渐在不同区域进行治疗，在滚动时涂抹溶液以增强吸收。在一个区域重复 3-5 次，最好是皮肤潮红且没有明显出血。均匀地用力，不要太重也不要太轻，不要用微针在皮肤上拖动。</li>
</ol>4.功效评价
<ol><li>使用滚筒微针和局部氨甲环酸溶液的组合 3 次治疗黄褐斑，每 4 周一次，作为一个疗程。</li>
	<li>治疗前后使用多光谱皮肤镜，3x，根据患者紫外线浅深斑点和褐色斑点的值观察疗效。值越小，黄褐斑越轻。</li>
	<li>统计分析处理前后UV浅层和深层斑点以及褐色斑点的变化。</li>
</ol>

用氨甲环酸和微针疗法加强黄褐斑治疗

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D. A., Paix&#227;o, M. P., Miot, H. 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提交人无需声明任何利益冲突。

黄褐斑的发病机制复杂，治疗方法包括全身用药、局部脱色剂、化学换肤和激光疗法。不幸的是，没有一种治疗方法对所有患者都普遍有效，不能总是保证满意的结果6.光疗治疗黄褐斑呈下降趋势，部分患者在光疗后黄褐斑恶化。这是由于炎症性黄褐斑中皮肤敏感和皮肤屏障功能受损的个体增加。针对黑色素的激光或其他治疗可能会加剧皮肤的炎症反应，导致黄褐斑症状加重。?...

黄褐斑，也称为黄褐斑，是一种慢性和获得性面部色素沉着过度的皮肤病。临床上，它表现为对称的浅棕色至深棕色斑块，边界不清晰，分布在脸颊、前额和下颌线。亚洲育龄妇女的发病率可高达 30%1。这种疾病很容易诊断，但很难治愈。黄褐斑的发病机制尚不完全清楚，但有三个主要因素促成了黄褐斑的发展：遗传易感性、暴露在阳光下和荷尔蒙变化。黑色素合成增加、皮肤病变部位的血管增生、炎症反应和皮肤屏障功能受损都在黄褐斑2 的发生中起作用。
目前，黄褐斑的治疗选择包括激光疗法和药物治疗，其中透皮给药是一种广泛使用的方法。然而，主要的挑战在于角质层的屏障功能，它阻碍了药物的渗透。微针疗法在短时间内在皮肤中产生多个微通道，破坏角质层，诱导胶原蛋白的产生，并增加皮肤的通透性。这种方法有望使药物扩散到皮肤中，然后迅速重新封闭，从而避免引入有毒或刺激性物质3.
常用的微针工具包括电子水光注射微针、滚筒微针、电助纳米晶微针、梅花微针和单针微针4。滚筒式微针的特点是创伤小，疗效好，操作方便，可以与其他一些药物合用治疗黄褐斑。对黄褐斑具有良好的治疗前景，在临床上值得进一步推广和使用。本文介绍了滚筒微针联合氨甲环酸治疗黄褐斑的操作和注意事项，并通过临床案例论证了滚筒微针联合氨甲环酸治疗黄褐斑的疗效。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>5 mL syringe</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Benzalkonium bromide solution</td>
			<td>Chongqing Traditional Chinese Medicine Hospital</td>
			<td>H20050531</td>
			<td>0.1%</td>
		</tr>
		<tr>
			<td>cling film</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Compound lidocaine cream</td>
			<td>Beijing Ziguang Pharmaceutical Co., Ltd.</td>
			<td>H20063466</td>
			<td>5.0%</td>
		</tr>
		<tr>
			<td>disinfectant towel</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>disposable curved disc</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Multispectral Dermoscope</td>
			<td>CBS Medical Skin Analysis, Wuhan, China</td>
			<td>CBS-2022</td>
			<td></td>
		</tr>
		<tr>
			<td>Roller microneedle</td>
			<td>Guangzhou Yuanxiang Biotechnology Co., Ltd</td>
			<td>221001</td>
			<td>(model: 0.22 x 0.5 mm, Figure 1)</td>
		</tr>
		<tr>
			<td>Sodium chloride solution</td>
			<td>Hubei Tiansheng Pharmaceutical Co., Ltd.</td>
			<td>H42021838</td>
			<td>0.9%</td>
		</tr>
		<tr>
			<td>sterile cotton swab</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>sterile gauze</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>sterile gloves</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>tongue depressor</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tranexamic acid solution</td>
			<td>Shanghai Hyundai Hasen (Shangqiu) Pharmaceutical Co., Ltd.</td>
			<td>H20184047</td>
			<td>5.0%</td>
		</tr>
		<tr>
			<td>treatment vehicle</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

roller microneedle combined with tranexamic acid solution in treating melasma

黄褐斑是一种常见的获得性面部色素沉着性皮肤病，临床诊断简单明了，但在有效管理方面存在挑战。黄褐斑的确切根本原因仍然难以捉摸，目前的治疗方法主要包括药物和激光干预，疗效有限。透皮给药是黄褐斑的一种普遍治疗方法，通常通过使用微针来促进。其中，氨甲环酸作为一种常用的治疗剂出现。微针的一个子集，称为滚筒微针，在这种方法中发挥着重要作用，它用多根细针巧妙地刺穿表皮，与药物输送协同作用。这种方法不仅可以增强药物吸收，还可以提高治疗效果，同时最大限度地减少组织创伤。这些特性预示着治疗黄褐斑的有希望的途径。本文主要介绍滚筒微针和氨甲环酸溶液联合治疗黄褐斑的情况，并通过临床案例论证了滚筒微针和氨甲环酸溶液治疗黄褐斑的疗效。

Melasma, also known as chloasma, is a chronic and acquired facial hyperpigmentation skin condition. Clinically, it presents as symmetrical, light to dark brown patches with unclear borders, distributed on the cheeks, forehead, and jawline. The incidence rate among Asian women of childbearing age can be as high as 30%1. The disease is easily diagnosed but difficult to cure. The pathogenesis of melasma is not yet fully understood, but three main factors contribute to its development: genetic susceptibility, exposure to sunlight, and hormonal changes. Increased melanin synthesis, vascular proliferation at the site of skin lesions, inflammatory reactions, and impaired skin barrier function all play a role in the occurrence of melasma2.
Currently, treatment options for melasma include laser therapy and medications, among which, transdermal administration is a widely used method. However, the main challenge lies in the barrier function of the stratum corneum, which hinders drug penetration. Microneedle therapy creates multiple micro-channels in the skin within a short period, disrupting the stratum corneum, inducing collagen production, and increasing skin permeability. This approach holds promise in allowing drugs to diffuse into the skin and then rapidly reseal, thus avoiding the introduction of toxic or irritating substances3.
Commonly used microneedle tools include the electronic water light injection microneedle, roller microneedle, electrically assisted nanocrystalline microneedle, plum blossom microneedle, and single needle microneedle4. The roller microneedle is characterized by less trauma, good curative effect, convenient operation, and can be combined with some other drugs to treat melasma. It has a good therapeutic prospect for melasma and is worth more promotion and use in clinical practice. This article introduces the operation and precautions of roller microneedles combined with tranexamic acid in the treatment of melasma and demonstrates the efficacy of roller microneedle combined with tranexamic acid in the treatment of melasma through clinical cases.

作者聚焦： 黄褐斑的非手术治疗 – 氨甲环酸微针

滚筒微针联合氨甲环酸溶液治疗黄褐斑

Our research focus on non-surgery therapy for pigmentated disease. We tested the efficacy of roller microneedling combined with tranexamic acid solution in treating melasma. We will investigate the effectiveness and the max easiness of using a combination of roller microneedles and tranexamic acid solution for treating melasma.

病例1为57岁女性，有10年病史，选取治疗及疗效评价。在治疗前和三个治疗疗程（图 2、 Figure 3 和 Figure 4）后评估滚筒微针和氨甲环酸溶液组合的疗效，并使用多光谱皮肤镜从不同角度观察。在正面视图中，紫外线浅斑点、紫外线深点和棕色区域分别减少了 35.91 mm2、163.32 mm2 和 82.4 mm2 。在45°的右侧视图中...

Watch this Scientific Journal Video about Roller Microneedle Combined with Tranexamic Acid Solution in Treating Melasma at JoVE.com

本文提出了一种通过使用滚筒微针结合氨甲环酸溶液进行黄褐斑治疗的方案，并评估疗效。

Melasma, a common, acquired facial pigmentation skin disorder, presents a straightforward clinical diagnosis but poses challenges in terms of effective ...

我们的研究重点是色素性疾病的非手术治疗。我们测试了滚筒微针联合氨甲环酸溶液治疗黄褐斑的疗效。我们将研究使用滚筒微针和氨甲环酸溶液组合治疗黄褐斑的有效性和最大难易程度。

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Research

JoVE Journal

Medicine

Roller Microneedle Combined with Tranexamic Acid Solution in Treating Melasma

531 次观看.  Chongqing Hospital of Traditional Chinese Medicine. 我们的研究重点是色素性疾病的非手术治疗。我们测试了滚筒微针联合氨甲环酸溶液治疗黄褐斑的疗效。我们将研究使用滚筒微针和氨甲环酸溶液组合治疗黄褐斑的有效性和最大难易程度。

视频: 作者聚焦： 黄褐斑的非手术治疗 – 氨甲环酸微针

Melasma, a common, acquired facial pigmentation skin disorder, presents a straightforward clinical diagnosis but poses challenges in terms of effective management. The precise underlying causes of melasma remain elusive, and the current therapeutic approaches predominantly encompass pharmaceutical and laser interventions, with limited efficacy. Transdermal administration stands as a prevalent treatment method for melasma, often facilitated by the application of microneedles. Among these, tranexamic acid emerges as a frequently employed therapeutic agent. A subset of microneedles, known as roller microneedles, plays a significant role in this approach by delicately puncturing the epidermis with multiple fine needles, synergizing with drug delivery. This methodology not only enhances drug absorption but also augments treatment efficacy while minimizing tissue trauma. These attributes forecast promising avenues for the treatment of melasma. This article primarily introduces the combination of roller microneedle and tranexamic acid solution in the treatment of melasma and demonstrates the efficacy of roller microneedle and tranexamic acid solution in the treatment of melasma through clinical cases.

This article presents a protocol to conduct the treatment of melasma by using roller microneedles in combination with tranexamic acid solution and evaluate the efficacy.

作者聚焦： 黄褐斑的非手术治疗 – 氨甲环酸微针

作者聚焦：黄褐斑的非手术治疗 – 氨甲环酸微针