Article

Treatment of Striae Distensae Using Needling Therapy: A Pilot Study

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Abstract

Background: Striae distensae are dermal scars characterized by flattening and atrophy of the epidermis. Although many treatment modalities have been attempted with variable results, there is no criterion standard treatment modality for striae distensae. Objectives: To evaluate the effectiveness and safety of a disk microneedle therapy system (DTS) in the treatment of striae distensae. Materials and methods: Sixteen Korean volunteers with striae distensae alba or rubra were enrolled. Patients received three treatments using a DTS at 4-week intervals. Clinical response to treatment was assessed by comparing pre- and post-treatment clinical photographs, skin biopsies, and patient satisfaction scores. Clinical improvement was assessed using the quartile grading scale. Results: Marked to excellent improvement was noted in seven (43.8%) patients, with minimal to moderate improvement in the remaining nine. Patient satisfaction scores showed that six (37.5%) patients were highly satisfied, eight (50.0%) were somewhat satisfied, and two (12.5%) were unsatisfied. There were no significant side effects except mild pain, erythema, and spotty bleeding. Conclusion: Disk microneedle therapy system (DTS) can be effectively and safely used in the treatment of striae distensae.

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... [3][4][5][6] Transient erythema with RMN may last for a day and, if prolonged, often self-resolves within three to seven days. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Other common AEs of MN include mild pain, edema, and variable postin ammatory dyspigmentation. 6,7,10,12,13,15,19,20,22 Patients in one study reported increasing pain with each successive RMN treatment, 20 whereas another reported decreasing pain. ...
... [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Other common AEs of MN include mild pain, edema, and variable postin ammatory dyspigmentation. 6,7,10,12,13,15,19,20,22 Patients in one study reported increasing pain with each successive RMN treatment, 20 whereas another reported decreasing pain. 19 In one study, 15 subjects treated with RMNs reported an average pain score of 5.4 out of 10 points during the procedure. ...
... [4][5][6]13,21,24 Rarely, patients may nd the pain or hyperpigmentation of MN intolerable, as evidenced by ve patients who withdrew from study participation because of these AEs. 12 Pinpoint bleeding triggered by MN is desired for optimal results; however, in one instance of RMN, this progressed to spotty bleeding that self-resolved within several days. 15 Ecchymosis may be observed with RMN even in patients without a history of bleeding disorders. 11,12 For instance, after three monthly RMN sessions, three of 60 patients, none of whom had bleeding disorders, collagen vascular diseases, or were on anticoagulant treatments, developed faint ecchymotic lesions over bony prominences, without residual dyspigmentation. ...
Article
BACKGROUND: Microneedling is a relatively safe therapeutic procedure used to treat many dermatological conditions, including acne vulgaris, alopecia, melasma and other pigmentary disorders, as well as to promote skin rejuvenation, rhytide reduction, and scar remodeling. Given its popularity among patients and increasing use in the clinic and at home, we aim to explain the adverse effects associated with microneedling procedures. OBJECTIVE: We reviewed the current literature describing microneedling and the complications that may accompany this therapeutic procedure. PubMed was searched to identify studies that involved microneedling procedures using the standard roller microneedling, stamp microneedling, pen-type microneedling, and/or fractional radiofrequency microneedling devices. The resulting publications included clinical trials, retrospective studies, and case reports, which were then thoroughly reviewed for description of potential or observed complications that arose secondary to the microneedling procedure. RESULTS: In this systematic review, a total of 51 articles were reviewed, which included 1,029 patients who received microneedling procedures for a variety of different skin conditions. Overall, this review found that microneedling, regardless of the specific device used, is a relatively safe procedure with minimal adverse effects, including, but not limited to, expected erythema, pain, edema, and temporary skin irritation. CONCLUSIONS: Microneedling has become an attractive treatment option for many patients with dermatological conditions. We advise that clinicians and patients be informed about the adverse side effects associated with microneedling so that the risk of preventable complications can be reduced or avoided.
... Park et al. [9] conducted a study on 16 patients with SD using a disk microneedle therapy system. The device consists of a plastic body and head part. ...
... A study was done by Park et al. [9] on patients with SD treated with a microneedling, and assessment of the results revealed better skin texture, tightness, and color. The treatment was well tolerated, and no serious adverse effects were observed. ...
... Another study done by Ali et al. [12] showed a statistically significant clinical improvement of microneedling than microdermabrasion in the treatment of SD. Moreover, there was a statistically significant increase in clinical efficacy and improvement in striae rubrae than striae alba, which disagreed with the study by Park et al. [9]. ...
... Of the studies that used energy-based devices as a treatment, 16 were comparative studies (2,6,10-23), 4 were combination studies (24)(25)(26)(27), and the remaining 10 were noncomparative/noncombination studies (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). ...
... Of the studies that used topical therapy as a treatment, three were comparative studies (9,39,40), three were combination studies (41)(42)(43), and two were noncomparative/noncombination studies (38,44). ...
Article
Full-text available
Striae distensae (SD), otherwise known as “stretchmarks,” are a common presenting complaint, particularly in young healthy women. SD are hypothesized to form in a patient when the cross-linked collagen is “overstretched” and rupture of this collagen matrix causes the striae. Thus, many treatments work by increasing collagen synthesis. This review critically appraises the evidence to date for the treatment of SD, including both energy-based devices and topical treatments.
... Similarly, Park et al. treated 16 Korean patients with SD using the MN technique. The authors found marked to excellent improvement in some patients [13]. ...
... In the majority of the patients, there was a significant increase in elastin, collagen fibers, and dermal thickness correlating with the depth of needle penetration. Our results are also in lines with findings of skin needling used for treating patients with SD [13,36], burn scars [37], photodamage and skin laxity [38][39][40][41][42]. [34]. This added effect of PRP may due to it contains various growth factors like platelet degradation growth factor (PDGF-a, PDGF-b), fibroblast growth factor (FGF), transforming growth factor (TGF-b1 and 2), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF). ...
Article
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Background: Striae distensae (SD) are common skin conditions. Objectives: This study was done to test the hypothesis that ‘the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.’ Patients and methods: Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes. Results: As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis. Conclusions: This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.
... The affected areas of the abdomen were divided into three parts: Right, left and middle. The right part of the abdomen (Area A) was treated by microneedling only with 1.5mm depth [14]. Microneedling treatment was performed by derma pen ( Bomtech Electronics, Seoul, Korea). ...
... Patient satisfaction scores showed that six ( 37.5%) patients were highly satisfied, eight (50.0%) were satisfied and two (12.5%) were unsatisfied. There were no significant side effects except mild pain, erythema and spotty bleeding [14]. ...
... 27 Microneedling has recently emerged as a new method for treating stretch marks, and was shown to be bene cial after three treatments at monthly intervals. 34 The results of two subsequent studies indicate microneedling is superior to CO 2 laser application 35 and microdermabrasion with sonophoresis 36 for treating striae. Microneedling stimulates the release of growth factors and induces collagen production, 37 and it has been used in combination with glycolic acid peels for treating atrophic acne scars. ...
Article
Objective: Stretch marks (striae) can be distressing for many people, and currently available treatments are less than optimal. A previous study showed that the use of a calcium hydroxylapatite (CaHA) filler followed by the topical application of 20% ascorbic acid solution and microneedling significantly improved striae appearance. We sought to evaluate additional improvements in atrophy and color of striae following treatment with microfocused ultrasound with visualization (MFU-V) in subjects who received previous treatments using CaHA, 20% ascorbic acid, and microneedling. Participants: Subjects with remaining skin atrophy (N=20) were treated with MFU-V using transducers with a frequency of 7MHz and 10MHz and a focal depth of 3.0 mm and 1.5 mm, respectively, applied in a cross-hatch pattern. Measurements: Efficacy was based on changes in Manchester Scar Scale scores. Results: At Day 90 post-treatment, the mean (± standard deviation) baseline Manchester Scar Scale score decreased from 9.35 (±1.18) to 6.30 (±1.26) (p<0.001) and the mean Patient Satisfaction Scale score increased from 3.75 (±0.44) to 4.70 (±0.47) (p<0.001). Most subjects (70%) were very satisfied with their results. No adverse events were reported. Conclusion: The combined use of CaHA, 20% ascorbic acid, and microneedling appears to be effective in improving the appearance of striae. Additional esthetic improvements were seen with the application of MFU-V.
... This induced inflammation stimulates dermal wound healing by increasing collagen and elastin synthesis. [71] Aust et al. [72] and Park et al. [73] have independently used this therapy and reported marked improvements in appearance and texture of SD. Khater [74] et al. compared microneedling with fractional CO 2 laser, while Nasser et al. [75] used microneedling versus microdermabrasion (MDA) with sonophoresis; both studies found microneedling/percutaneous collagen induction therapy more effective than the other two. ...
Article
Full-text available
Striae distansae (SD) or stretch marks are very common, asymptomatic, skin condition frequently seen among females between 5 to 50 years of ages. It often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late, with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for stretch marks treatment. However, despite several advances, no fully effective treatment has emerged. Unfortunately, there is paucity of the strong evidence in the literature for the effective treatment of striae. A literature search using the terms 'striae distansae (SD or stretch marks' was carried out in the PubMed, Google Scholar and Medline databases. Only articles related to the treatment were considered and analysed for their data. Commonly cited treatments include topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q-switched Nd:YAG, pulse dye and excimer laser. Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture have also been used with variable success. This article reviews all currently accepted modalities and their effectiveness in the treatment of stretch marks.
... 12 Topical management, like retinoic acid and chemical acid peels, shows very little evidence of efficacy with positive results limited to early stages of SD. 13,14 Different approaches like medical needling, resulting in micro trauma extending to the papillary dermis, believed to increase collagen and elastin production, or radiofrequency (RF) devices, delivering current to skin, converting into heat, subsequently leading to an increased collagen production, both showed small clinical improvements in SD albae. [15][16][17] However, various studies using light and laser techniques showed promising outcome in the improvement of SD. 2,6,18 Intense pulsed light (IPL), with visible beam of highintensity light, increased dermal collagen level and led to skin tightening. [18][19][20] A broad range of laser devices has been utilized for the treatment of SD with variable outcome. ...
Article
Full-text available
Background and objective Striae distensae (SD) represent therapeutically challenging forms of dermal atrophic scarring. In addition to topical ointments, medical needling and various energy‐based devices, non‐ablative fractional lasers have been suggested for their improvement. However, objective evaluations of their efficacy are widely missing. In this study, we aimed to assess the clinical improvement of SD albae after three treatments with a non‐ablative fractional 1565 nm Er: glass laser by employing three‐dimensional analysis and several questionnaires. Methods A total of 16 Caucasians suffering from SD albae were included in this prospective study. Every patient received three treatments – one every 4 weeks – using a non‐ablative, fractional 1565 nm laser (two passes: 300 μbeams/cm², 40 mJ inside the SD; 150 μbeams/cm², 50 mJ inside the SD and within the surrounding area). Questionnaires (DLQI, POSAS), digital photography and three‐dimensional analysis employing PRIMOS® software and VECTRA® camera system were taken at baseline, 1 and 6 months after the last treatment. Results Evaluation of objective measurements at 6‐month follow‐up (FU) showed a significant reduction in depth of atrophic lesions by 31.7% and less skin irregularities with Smax at baseline of 621.2 μm decreasing to 411.6 μm (P < 0.01, respectively). Improvement in objective measurements was supported by significant changes in patients’ rating of skin appearance. POSAS patient total score declined from 33.5 points to 17.5 points throughout the study (P < 0.001). From baseline to 6‐month FU, patients’ life quality improved by 68.0% (DLQI score). Procedures showed no lasting negative side‐effects and little to no down time. Conclusion The use of a fractional non‐ablative 1565 nm laser represents a safe approach for the treatment of SD albae. Clinically observed improvements were supported by significant data from objective measurements. The results achieved at 1‐month FU represented at 6‐month FU, showing stable clinical improvements.
... Although there are limitations to directly using it for all types of burns, microneedling would be a cost-effective option to treat hypertrophic scars after wound management [81]. In addition, striae distensae scar characterized by epidermal flattening and atrophy has been managed by needling therapy [82]. ...
Article
Full-text available
Human skin is a multilayered physiochemical barrier protecting the human body. The stratum corneum (SC) is the outermost keratinized layer of skin through which only molecules with less or equal to 500 Da (Dalton) in size can freely move through the skin. Unfortunately, the conventional use of a hypothermic needle for large therapeutic agents is susceptible to needle phobia and the risk of acquiring infectious diseases. As a new approach, a microneedle (MN) can deliver therapeutically significant molecules without apparent limitations associated with its molecular size. Microneedles can create microchannels through the skin’s SC without stimulating the proprioceptive pain nerves. With recent technological advancements in both fabrication and drug loading, MN has become a versatile platform that improves the efficacy of transdermally applied therapeutic agents (TAs) and associated treatments for various indications. This review summarizes advanced fabrication techniques for MN and addresses numerous TA coating and TA elution strategies from MN, offering a comprehensive perspective on the current microneedle technology. Lastly, we discuss how microneedling and microneedle technologies can improve the clinical efficacy of a variety of skin diseases.
... Microneedles for drug delivery Various types of microneedle devices, either alone or in combination with other therapies, such as radiofrequency [4], iontophoresis [5], photodynamic therapy [6] and laser, have been used for the treatment of skin conditions, such as wrinkles, melasma, photo damaging, hirsutism [7] and scars [8]. The most common forms of the microneedle devices are dermal rollers, microinjections, solid microneedles and drug-laden microneedles. ...
Article
Delivering therapeutics in a painless manner is one of the many objectives for the treatment of clinical conditions. Micro and nanoneedles are small-scale devices that can help overcome the resistance encountered during drug diffusion by creating conduits of small dimensions through biomembranes. Microneedles for drug delivery applications were manually produced until the 1990s and after this the high precision technology from the semiconductor industry was adopted for their production [ 1 ]. Over the last decade or so, microneedles for transdermal applications have been widely studied. Currently, microneedle patches, mainly based on hyaluronates, are available over the counter for cosmetic applications. On the other hand, nanoneedles are used in atomic force microscopy, which has been explored for drug delivery and biosensing over the last two decades [ 2 , 3 ]. Micro and nanoneedle-based biosensing also poses potential for environment-responsive drug delivery. In this article, the current research, clinical studies and future perspectives of micro and nanoneedle-based systems are discussed for drug delivery and biosensing applications.
... 19 An increase in collagen and elastin has been observed in studies that have treated patients with different scarring conditions, 20-23 as well as an increase in epidermal thickness. 23 The trophic effects of acupuncture results in improved oxygenation of tissues and normalization of pH. 9 It has been shown that micro-needling triggers regenerative mechanisms and activates non-inflammatory wound healing in the treated skin. It activates the release of cytokines and molecules that communicate to induce collagen formation neoangiogenesis and skin cell proliferation. ...
Article
Objective To review current scientific knowledge as to the efficacy of dry needling of scars on pain and other related symptoms and explore the possible physiological mechanisms of action. Methods A narrative review of scientific literature published in English. Results Two randomized controlled trials found that dry needling of scars (using the classic “surrounding the dragon” technique in one study and intradermal needling in a second study) was more effective than sham or control interventions with respect to scar appearance and pain. Two case reports have suggested that scar needling generates a rapid decrease in pain and improvement of mobility in scarred tissues. Another two case reports have reported positive effects of scar needling on the wound healing process. These findings are supported by an animal study examining the effect of needling on the wound healing process and the physiological mechanisms of action underlying the technique. Conclusion There is preliminary evidence that the “surrounding the dragon” needling technique is a beneficial treatment for patients suffering from scar pain and other scar-related symptoms and can facilitate wound healing and make this process less painful. Further high-quality studies should be conducted to verify/quantify the efficacy of this method, to better understand the underlying mechanisms of action underlying the effects of scar needling and to establish an effective intervention protocol.
... Indeed, some evidence indicates that dermal needling is efficacious (also known as needle dermabrasion) in the treatment of a variety of scars. [57][58][59][60] Similarly, the injection of saline and/or fat into tissue planes directly below a scar results in matrix distention within the surrounding tissue and scar. The fibroblasts within this collagen matrix can be biologically altered by the resulting strain through mechano-transduction, a mechanism recognized as inductive to collagen production and scar remodeling. ...
Article
Full-text available
Background:. Autologous fat transfer—also referred to as fat grafting—has been reported to provide beneficial effects to overlying scar and skin. Despite procedural frequency, there is a paucity of high-level evidence guiding the surgeon in technique, patient selection, and efficacy. Methods:. A multicenter, double-blinded, randomized, internally placebo-controlled trial was performed with an aim to qualitatively and quantitatively evaluate the impact of autologous fat transfer on the quality of overlying scar tissue. Fat-grafted scars were evaluated and compared with paired, saline-injected “control” scars. Subjective and objective metrics were evaluated in treated sites for 12 months after treatment. Results:. Blinded qualitative results demonstrated a statistically significant improvement in scar quality over time in fat-grafted scars. However, these improvements were not found to be statistically different from changes noted in scars treated with saline. In addition, objective metrics did not statistically differ between saline-injected and autologous fat-grafted scars. Conclusions:. Our results demonstrate that autologous fat grafting can improve the qualitative profile of a scar from both the patient and observer perspectives. However, there was no difference in improvement when compared with scars that were treated with saline in a randomized and blinded fashion. These results demonstrate that any improvements in scar quality related to fat grafting are also achieved using saline and suggest that mechanisms other than cell activity may be at play. Additional randomized, blinded, placebo-controlled trials are required to either corroborate or contest the putative beneficial effect(s) of adipose tissue on scar remodeling.
... Microneedles for drug delivery Various types of microneedle devices, either alone or in combination with other therapies, such as radiofrequency [4], iontophoresis [5], photodynamic therapy [6] and laser, have been used for the treatment of skin conditions, such as wrinkles, melasma, photo damaging, hirsutism [7] and scars [8]. The most common forms of the microneedle devices are dermal rollers, microinjections, solid microneedles and drug-laden microneedles. ...
Article
The use of these reliable in vitro HF organoid models would allow the study of drug efficacy and uptake, hence, mimicking in vivo conditions for developing possible strategies for anti-AGA medications. Prospective models would also gravitate away from mice models to verify the inductivity of bioengineered spheroids.
... 99 Another case series reported improved skin texture and laxity at 6-month follow-up in 22 patients after 1 treatment with microneedling. 100 A different case series reported that 43.8% (7/16) of patients demonstrated marked to excellent clinical improvement in SD after monthly microneedling for more than 3 months. 101 Future researchers may consider an objective assessment method and longer treatment and follow-up period. ...
Article
Background: Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. Objective: Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. Methods and materials: A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. Results: The authors identified 68 articles that met inclusion and exclusion criteria. Conclusion: There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.
... [27] Microneedling improved early and late stretch marks in a pilot study carried out among Korean women. [28] This is substantiated by a study performed in South Africa and Germany with one to four treatments. [29] Microneedling therapy was more efficient than microdermabrasion with phonophoresis in the treatment of stretch marks. ...
Article
Full-text available
Stretch marks are one of the most common benign cutaneous lesions and encountered esthetic problems. Striae rubrae and striae albae can be differentiated on the basis of clinical appearance. Histologically, disturbances of the dermal fiber network and local expression of receptors for sexual steroids have been detected. The epidermal changes are secondary. Prevention of stretch marks using topical ointments and oils is debatable. Treatment of striae rubrae by lasers and light devices improves appearance. Microneedling and non-ablative and fractionated lasers have been used. This review provides an overview on current treatment options with a special focus on laser treatments.
... 11,31,35 In particular, microneedling has been found to normalize the extracellular collagen matrix in the reticular dermis, providing a possible treatment to improve skin structure and promote contracture relaxation at burn sites. 31,35,36 It has also been investigated as a treatment for melasma, 37, 38 striae distensae, or stretch marks, [39][40][41] and androgenic alopecia. 42,43 Relatively little research, however, has been conducted regarding microneedling's effects on fine lines and wrinkles. ...
Article
Background: While ablative techniques have been standard of care for the treatment of fine lines and wrinkles, microneedling is a minimally invasive alternative. Objectives: The purpose of this study was to assess the efficacy of microneedling on facial and neck fine lines and wrinkles. Methods: 35 subjects between 44 and 65 years old with Fitzpatrick skin types I-IV received four monthly microneedling treatments over the face and neck. Subjects returned one and three months post-treatment. At every visit, high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and BTC-2000 were performed. 0.33mm microbiopsies were collected pre-treatment, before the fourth treatment and three months post-treatment. Results: 32 subjects (93.75% female, 6.25% male) completed all seven visits. Facial dermal and epidermal density increased 101.86% and 19.28%, respectively from baseline at three months post-treatment. Facial elasticity increased 28.2% from baseline three months post-treatment. Facial attenuation coefficient increased 15.65% and 17.33% one and three months post-treatment. At study completion, blood flow 300µm deep decreased 25.8% in the face and 42.3% in the neck. Relative collagen type III and elastin gene expression was statistically higher three months post-treatment. However, total elastin protein levels unchanged compared to baseline. 58% of biopsies extracted three months post-treatment showed dermal muscle formation, compared to baseline 15.3%. Conclusions: The results illustrate the effects of microneedling treatments. Non-invasive measurements and biopsy data showed changes in skin architecture and collagen/elastin gene expression suggesting skin rejuvenation, with new extracellular matrix production and muscle formation.
... Microneedling is one method of treating stretch marks that works by stimulating intradermal collagen production. 7 Microneedling is also a means for achieving trans-epidermal drug delivery. 8,9 Ascorbic acid, which also enhances the production of normal collagen, can be delivered in this manner. ...
Article
Full-text available
Background:. Stretch marks can have a negative psychological impact on some individuals. Methods are available for treating stretch marks, but high-quality evidence supporting their use is limited. We treat stretch marks using injections of diluted calcium hydroxylapatite (CaHA, Radiesse) filler combined with microneedling and topical ascorbic acid. This retrospective study evaluated the effectiveness of this combined therapy. Methods:. Subjects presented with red (n = 25) or white (n = 10) striae on their buttocks, thighs, knees, abdomen, and breasts. CaHA filler was diluted 1:1 with lidocaine 2% without epinephrine. A maximum of 3.0 mL of filler was injected per patient at all skin depths using a 23G needle. This was immediately followed by microneedling and topical application of 20% ascorbic acid. Microneedling with ascorbic acid was repeated after 1 and 2 months. Skin biopsies were obtained from a patient who later underwent abdominoplasty. Results:. The mean (±SD) pretreatment Manchester Scar Scale scores were 12.0 (±0.8), decreasing to 7.1 (±1.4) 1 month after the final treatment, indicating improvement in stretch mark appearance (P < 0.001). Subjects were very satisfied (n = 22; 62.9%), satisfied (n = 8; 22.9%), neither satisfied nor dissatisfied (n = 4; 11.4%), or unsatisfied (n = 1; 2.8%) with their treatment results. Analysis revealed a significant correlation between Scar Scale scores and Patient Satisfaction scores (r = 0.483; P = 0.003). Skin biopsies showed increased quantity and quality of collagen and elastin fibers in areas treated with combination therapy. Procedures were well tolerated. Conclusion:. Combining 1:1 diluted CaHA with microneedling and topical ascorbic is safe and effective for treating stretch marks.
... 25 Similarly, other types of atrophic scars and burn scar contractures and striae distensae have also been improved with microneedling. [31][32][33][34] Unlike full ablative laser skin resurfacing which is typically limited to treatment of full cosmetic units, it is possible to microneedle discrete areas of scarring without producing lines of demarcation between treated and nontreated areas. ...
Article
Full-text available
Background: Microneedling is a relatively new treatment option in dermatology and has been touted for a broad range of applications including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery. The significant increase in minimally invasive procedures that has been reported over the past several years suggest that microneedling may occupy a specific niche for patients who desire measurable clinical results from treatments with little to no recovery. Objective: To review the published medical literature relating to microneedling in dermatology and provide a practical guide for its use in clinical practice. Materials and methods: A thorough literature search of microneedling in dermatology using PubMed was conducted, and all references pertaining to skin scarring and rejuvenation were reviewed. Based on the information presented in these publications and the authors' clinical experience, a microneedling technique is outlined for clinical practice. Pretreatment recommendations, intraoperative technique and treatment end points, and postoperative considerations are outlined. Results: Microneedling produces substantial clinical improvement of scars, striae, and rhytides with expedient recovery and limited side effects. Controlled dermal wounding and stimulation of the wound healing cascade enhances collagen production and is likely responsible for the clinical results obtained. Conclusion: Microneedling is a safe, minimally invasive, and effective esthetic treatment for several different dermatologic conditions including acne and other scars, rhytides, and striae. Given its expedient post-treatment recovery, limited side effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling.
... Другие методы коррекции стрий: воздействие неинвазивным многополярно-импульсным электромагнитным полем, введение микроигл -также могут быть относительно эффективными, но вместе с тем противопоказаны при беременности и лактации [17,18]. ...
Article
Striae may form on the skin due to a number of factors: rapid weight gain, muscle hypertrophy, endocrinopathies, breast enlargement, as a side effect of long-term topical use of strong corticosteroids. However, in some rare circumstances, striae can develop as a complication due to the use of tissue expanders. This cosmetic defect develops most often on the skin of the thighs, abdomen, mammary glands in women and the shoulders in men. Striae of pregnancy are a common cosmetic skin defect. The development of striae is associated with stretching and rupture of connective tissue in susceptible individuals against the background of influence of genetic and hormonal factors. The appearance of striae gravidarum does not have a significant effect on the health of patients, however, a cosmetic defect caused by the appearance of striae can generate psychoemotional (psychoemotional) stress and lead to a decrease in quality of life. The striae development occurs in certain stages. The initial period of striae development – red (immature) striae – is characterized by the absence of changes in the epidermis and signs of inflammation in the dermis. The appearance of white (mature) striae is accompanied by the architectural distortion of elastic fibre net and changes in the viscoelastic properties of the affected skin, which becomes much less elastic. The correction of striae requires topical treatment that help moisturize and soften the skin, stimulate the processes of collagen production, as well as physiotherapy techniques. However, many of them have contraindications for use during pregnancy. The article discusses the issues of the use of cosmetic products that can be used during pregnancy.
... Although SG are not physically detrimental, lesions can be undesirable and, in severe cases, cosmetically disfiguring ( Salter and Kimball, 2006 ;Yamaguchi et al., 2012 ). Despite the expense and lack of efficacy of various therapies for SG, many women report trying oils, emollients, massage, prescription and over-the-counter topical remedies, vitamins, lasers, and more recently microneedling to prevent lesions or improve their appearance ( Al-Himdani et al., 2014 ; Korgavkar and Wang, 2015 ;Park et al., 2012 ;Salter and Kim-ball, 2006 ). These observations suggest that SG cause concern for many women and are associated with increased self-consciousness. ...
Article
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Background: The impact of striae gravidarum (SG), or stretch marks of pregnancy, on quality-of-life is unclear. The purpose of this study was to investigate how SG impact life-quality in pregnant women. Methods: In this cross-sectional survey study of healthy pregnant women who developed SG during their current pregnancy, we asked about the impact of lesions on emotional, psychological, and life-quality facets. Spearman product-moment correlation coefficients (r) were generated to determine the strength of relationships between variables. Results: We analyzed 116 valid surveys. Participants reported permanency of SG as the top physical concern (n=87, 75%). Regarding severity, nearly three-quarters of participants rated their lesions as “very prominent” (n=24, 21%) or “moderate” (n=57, 49%). Among life-quality facets queried, embarrassment/self-consciousness was the one most frequently associated with SG, with over one-third of participants reporting “a lot” (n=19, 16%) or a “moderate” (n=26, 22%) amount of embarrassment/self-consciousness related to having SG. Lesion severity significantly correlated with the degree of embarrassment/self-consciousness (r=0.543), as well as the impact of SG on other life-quality facets, including overall quality-of-life (r=0.428), clothing choice (r=0.423), self-image/self-esteem (r=0.417), feelings of anxiety/depression (r=0.415), and social activities (r=0.313) (all p≤0.001). Nearly one-quarter of participants felt that emotional distress related to SG was similar or more than that caused by other skin problems, such as acne, psoriasis, or eczema. Conclusion: SG can be associated with a host of negative reactions reflecting increased psychological and emotional distress, including embarrassment and decreased quality-of-life. These consequences may compound the emotional stress of pregnancy, potentially warranting psychological support and adjustment strategies.
Article
Background and Objective Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non‐invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD. Study Design/Materials and Methods This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm², frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported. Results Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported. Conclusion Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Article
Objective: To assess the effects of galvano-puncture (GG) and dermabrasion (DG) in reducing striae distensae in the gluteal region of women. Methods: This randomized, controlled, single-blind clinical trial was conducted at the UNIFAL-MG. Participants were 48 female who had striae distensae alba in the gluteal region. They were randomly divided in GG; DG; and Control Group (CG). The length and width of the largest striae were measured (in millimeters) using a caliper. The same striae were assessed before and after treatment. Infrared thermography was performed in the gluteal region to assess local microcirculation. Results: Intragroup analysis showed a significant reduction in the dimension of the striae between baseline and treatment session 10 in the GG and DG groups. Between-group analysis revealed a reduction in the width and length of the striae for both the GG and DG groups, but there were no significant differences between the two groups. When compared to the CG and the DG group, the GG group had significant improvements, as shown by thermography. Conclusion: Both GG and DG are effective in reducing striae length and width. However, only the thermography results showed significant differences between GG and control, and between GG and DG.
Article
Objective: The aim of the study was to evaluate the effectiveness of carboxytherapy in the treatment of striae distensae. Additionally, discomfort and side effects associated with the treatment were assessed. Materials and methods: This study involved 15 women aged 22-40 years. They underwent 3 sessions of carboxytherapy at one-week intervals. Treatment was performed in skin area within stretch marks located on stomach, buttocks, and thighs. Cutometric probe was used to evaluate skin elasticity. Four measurements were performed-immediately before each treatment and one month after the last session. Photographic documentation was made before and after a series of treatment to perform clinical evaluation of changes in skin condition. Results: Statistical analysis of results obtained with the use of Cutometer (R2 and R8 parameters) demonstrated that carboxytherapy significantly improved skin elasticity within stretch marks (P < .05). The analysis of photographic documentation revealed 58% improvement in stretch mark visibility. The width and length of stretch marks decreased, and their color became more like the natural color of the skin. Carboxytherapy is associated with moderate pain/discomfort. The occurrence of hematoma is the main side effect of this procedure. Conclusions: Carboxytherapy seems to be an effective method of reducing stretch marks. This procedure is safe, and it can be performed without the risk of complications. Moreover, it does not require special postoperative convalescence. Photographic documentation is a method of assessment of aesthetic procedures effectiveness, which is complementary to other objective methods (eg, the use of MPA probes).
Article
Background: Striae distensae (SD) are a common dermatologic problem that plagues many people. Although there are many therapeutic modalities have been used to treat SD, effective method has been disappointing for striae Alba. Aims: To evaluate the clinical and histopathologic efficacy and safety of the 2940-nm erbium yttrium aluminum garnet (Er:YAG) ablative fractional laser (AFL) with recombinant bovine basic fibroblast growth factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for the treatment of striae alba. Patients and methods: Thirty volunteers with striae distensae alba were enrolled. The subjects completed treatments with the 2940-nm Er:YAG AFL 6 times at 4-week intervals. Following this treatment, the subjects were required to spray rb-BFGF for 1 week at home. They then received LED-RL once every 7 days for three sessions between the two laser treatments. Two independent investigators evaluated clinical improvement at pretreatment and 1, 3, 6, and 12 months post-treatment, patients also provided self-assessments of clinical improvement. Two biopsies were obtained from two subjects, both of the same sites of striae alba, one before the first treatment and one 6 months after the last session. Results: All 30 subjects demonstrated clinical improvement after treatment. Skin biopsies after treatment showed an increase in epidermal thickness, dermal thickness, and collagen and elastin density when compared to that at the baseline. Conclusions: The combination of the 2940-nm Er:YAG laser with rb-bFGF and LED-RL for the treatment of striae alba was a safe and effective approach for improving the appearance of striae alba.
Chapter
This chapter discusses the various microneedle (MN) approaches that have been explored to enhance photodynamic therapy (PDT) and charts the advancements that have been made in the area. The most commonly used approaches for MN‐mediated PDT are, skin pre‐treatment using MNs, and, photosensitiser delivery using MNS containing the photosensitising agent itself, with each discussed in the chapter. PDT has progressed considerably from the early application of sunlight and haemato‐porphyrin derivative, to the use of Photofrin and to second generation preformed photosensitisers and topical application of the prodrug 5‐aminolevulinic acid (ALA), which leads to in situ synthesis of the endogenous photosensitiser, protoporphyrin IX (PpIX). ALA and its methyl ester are not specifically photosensitisers but rather precursors of the endogenously produced photosensitising molecule, PpIX. While most studies investigating MNs incorporating the active agent within the device are dissolving systems, other MN forms have also been explored for MN‐assisted PDT.
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Background Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging. Objective This review aims to evaluate the current evidence in the literature on microneedling. Methods A systematic literature review was performed by searching the electronic databases Pubmed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence. Results Microneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distentiae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed significant results when used on its own and when combined with topical products or radiofrequency. When compared to other treatments, it showed similar results but was prefered due to minimal side-effects and shorter downtime. Conclusion This systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings and further research is required to truly establish microneedling as an evidence based therapeutic option for treating scars, wrinkles and other skin conditions.
Article
Background Striae distensae are permanent dermal lesions that can cause significant psychosocial distress. A detailed understanding of the numerous treatment modalities available is essential to ensuring optimal patient outcomes. Objective Our objective was to evaluate and summarize the different treatment methods for striae distensae by linking their proposed modes of action with the histopathogenesis of the condition to guide patient treatment. Methods A systematic review of the literature was performed with no limits placed on publication date. Relevant studies were assigned a level of evidence by the authors. Results Ninety-two articles were identified, with 74 being eligible for quality assessment. The majority of treatments aim to increase collagen production. The use of vascular lasers can reduce erythema in striae rubrae by targeting hemoglobin, whereas increasing melanin through methods such as ultraviolet light is a major focus for treatment of striae albae. Despite some topical treatments being widely used, uncertainty regarding their mode of action remains. No treatment has proved to be completely effective. Limitations Limitations of the study include low-quality evidence, small sample sizes, and varying treatment protocols and outcome measures, along with concerns regarding publication bias. Conclusions Further randomized, controlled trials are needed before definitive conclusions and recommendations can be made.
Chapter
Dieses Kapitel befasst sich mit den wesentlichen Aspekten der Behandlung von Striae distansae mittels Lasertechnologie. Neben den behandlungsstrategischen Maßnahmen werden die wesentlichen beachtenswerten Faktoren näher beleuchtet.
Article
Background: Fractional photothermolysis is creation of microscopic thermal zones of controlled depth, width and density. Microneedling is a simple treatment modality to reduce striae distensae. Objective: Evaluate and compare the efficacy of fractional carbon dioxide laser and microneedling as a treatment of striae distensae. Methods: Individuals with striae distensae received three split-body treatments at four-week intervals. The right side of the body was treated with fractional CO2 laser, while the other side with microneedling. Assessment was done by comparing photographs before and after treatments by two blinded physicians using a quartile grading scale. Evaluation also included patient satisfaction score and histopathological examination. Results: In total 33 subjects were enrolled and 30 completed the study. By quartile grading score, we recorded 55% moderate-excellent improvement of striae in the dermaroller-treated side but with fractional CO2 laser-treated side, we recorded 76% of patients had moderate-excellent improvement. Patients were more satisfied with fractional CO2 laser than the microneedling. Post-inflammatory hyperpigmentation, as a complication of fractional CO2 laser, appeared in 11 patients. Conclusion: Fractional CO2 laser is more effective in treating striae with acceptable side effects but still microneedling can be afforded as an effective, safe and cheap method.
Chapter
Striae distensae (SD; striae, stretch marks, striae atrophicans, striae gravidarum) are an extremely common and well-recognized dermatologic condition entity which can cause significant distress to those affected [1]. SD arise from progressive or rapid stretching of the dermis [2] and appear along cleavage lines perpendicular to the direction of greatest tension in areas with the most adipose tissue [3, 4] [Fig. 27.1]. There are two forms of SD: striae rubrae and striae albae. The acute stage (striae rubrae) is characterized by the initial erythematous, red, and stretched flat (in some cases appear slightly raised) lesions which are aligned perpendicular to the direction of skin tension and can be symptomatic, while the chronic stage (striae albae) is classified when SD have faded and appear atrophic, wrinkled, and hypopigmented [5–7]. Clinically, immature acute SD are flattened or slightly raised pink or red lesions (striae rubrae). Histopathologically, they appear as inflammatory alterations with elastolysis of the mid-dermis [8] and mast cell degranulation [9]. Over time and with atrophic changes, the lesions become white (striae albae). Histopathological findings of this latter phase demonstrate epidermal atrophy and loss of the rete ridges; densely packed, thin eosinophilic collagen bundles are arranged horizontally, parallel to the surface of the skin in a similar way to a scar [9, 10] [Table 27.1]. Striae nigrae and striae caerulea are two additional types of SD, which can occur in dark-skinned patient due to the increased melanization [11]. These atrophic dermal scars with overlying epidermal atrophy are found in all ethnic groups and are usually located on the buttocks, thighs, knees, breasts, calves, and lumbosacral areas [4, 8, 12] [Fig. 27.2]. The reported prevalence of SD has been variable in the literature with figures ranging from 11 to 88% [13–15]. SD severity has been noted to be worse in Black African women compared to Caucasians, within the same geographical region [16, 17]. The clear majority of SD has been reported in pregnant women and adolescents. They are sometimes associated with Crushing’s syndrome and chronic steroid use [16]. The exact cause of SD remains unclear, even though a combination of hormonal factors associated with mechanical stretching and rupture of connective tissue framework, tissue damage by striatoxin, pregnancy, normal growth especially in adolescents, rapid weight change, and high serum levels of steroids has been suggested [4, 8, 18]. Genetic predisposition is also presumed, since striae distensae have been reported in monozygotic twins [19, 20]. There is decreased expression of collagen and fibronectin genes in affected tissue [21]. The role of genetic factors is further emphasized by the fact that they are common in inherited defects of connective tissue, as in Marfan’s syndrome [18, 22]. Obesity and rapid increase or decrease in weight have been shown to be associated with the development of SD [23]. Young male weight lifters or bodybuilders develop striae on their shoulders [24]. Striae distensae also occurs in cachetic states, such as tuberculosis, typhoid, and after intense slimming diets [25]. Rare etiologies include human immunodeficiency virus-positive patients receiving the protease inhibitor indinavir and chronic liver disease [18, 24]. A case of idiopathic striae was also reported [26]. The theory of Rosenthal [27] proposed in 1937 is still actual. He suggested four potential etiological mechanisms of striae formation: insufficient development of tegument, including elastic properties deficiency; rapid stretching of the skin; endocrinal changes; and other causes, possibly toxic.
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Introdução: O controle postural é um comportamento sensório-motor complexo que consiste na habilidade de controlar o corpo no espaço em relação ao ambiente. Objetivo: Investigar, por meio de revisão da literatura, a influência do medo de quedas sobre o controle postural ortostático em indivíduos saudáveis. Material e métodos: Nove artigos foram selecionados, os demais artigos foram utilizados na contextualização do tema proposto. Resultados: Estudos que realizaram mudanças no ambiente, em que os participantes foram posicionados em plataformas hidráulicas elevadas a diferentes alturas, evidenciaram uma diminuição da oscilação postural na condição em que a plataforma estava elevada. Esta mudança no controle postural tem sido correlacionada com o medo de queda, que pode modular a atividade do fuso neuromuscular (reflexo-H) e induzir a um fenômeno de congelamento postural. Parece que este fenômeno de congelamento postural representa um tipo de ansiedade antecipatória diante de uma situação adversa (plataforma elevada). Conclusão: Mais estudos são necessários para compreender os mecanismos envolvidos neste tipo de fobia (medo de quedas) e sua relação com o controle postural, a fim de traçar estratégias para o seu diagnóstico precoce, tratamento e prevenção.Palavras-chave: medo, quedas, equilíbrio postural.
Article
Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of nonsurgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, microneedling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additionally combination treatments and resurfacing in acne scars, melasma, and skin of color.
Article
Background Striae distensae (SD) or stretch marks, a common condition causing significant cosmetic concern and distress, are linear dermal scars associated with epidermal atrophy that occur due to overstretching. Recently, micro-needling with dermapen is considered as one of the therapeutic modalities for SD. Also, plasma skin regeneration with plasma jet has been recommended as an effective method for the treatment of SD. Aim The aim was to compare between the efficacy of both methods in the treatment of SD. Methods This study included 30 patients with striae distensae. Body was divided into two halves; one was treated with plasma jet for two sessions with 1 month interval and follow-up one month after the last session and the other half was treated with dermapen for four sessions with two weeks interval and follow-up one month after. Results There was no statistically significant difference (p- value >0.05) between dermapen and plasma jet procedures as regard to width, Total Atwal Score, Atwal score component, score of erythema, and skin texture after treatment. There was high statistically significant difference (p value <0.01) between dermapen and plasma jet as regards pain with higher values with plasma jet while there were statistical higher values concerning hyperpigmentation and erythema with dermapen. There was high statistically significant difference (p value <0.001) between width of striae before and after treatment with dermapen. Conclusions Both lines of treatments are effective and promising therapeutic modalities for striae distensae with minimal side effects.
Chapter
Microneedling, a minimally invasive technique utilized to induce neocollagenesis, is frequently combined with platelet-rich plasma (PRP) to enhance results for a variety of medical and cosmetic dermatological conditions. It is generally well-tolerated and effective with preliminary data demonstrating improved outcomes for the treatment of acne scarring, striae distensae, melasma, and photoaging.
Article
Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.
Article
Stretch marks (striae distensae) are linear areas of cutaneous atrophy that appear in regions of greatest stretch of the skin. Their formation is a complex multifactorial process, its etiopathogenesis has not been fully understood yet. Aesthetic correction of stretch marks is an urgent problem of modern dermatocosmetology due to their widespread prevalence and pronounced negative impact on the patient’s quality of life. The aim of this paper was to provide a review of the literature on current reported treatment options for stretch marks. The principles of the effect of various methods of treatment, their classification and data from clinical trials are considered.
Article
Striae Distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost-effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by May 20, 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light-based devices and topical treatments are the most commonly-applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side-effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.
Chapter
Several treatments have been proposed that offer better results in reddish striations when compared to alba striations. Topical tretinoin in cream in high concentrations, applied as home therapy, improves the appearance of these lesions; however, it may not be well tolerated by the patient, considering climatic conditions and maintenance of her average activities. Interventions such as chemical peelings, microdermabrasion, fractionated lasers, and intense pulsed light, alone or in association, are some of the therapeutic options used by dermatology for the management of these lesions. However, there is no treatment considered ideal, and the results many times modest signal its challenge. PCI, regarding treatments with microneedles that induce collagen production, offers a stimulus in the production of this protein, without causing the deepithelialization observed in ablative techniques. The epidermis and dermis are perforated but not removed. Thus, the penetration of its needles in the skin causes micropunctures in the stretch marks, modifying their surface, destructuring the abnormal collagen and favoring neovascularization and neoangiogenesis. Both violent and white stretch marks respond to PCI, but the former commonly present satisfactory results with a smaller number of sessions, while the former need a longer time to achieve such results.
Article
Background Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women. Objectives The aim of our study was to compare the efficacy of a neodymium:yttrium–aluminum–perovskite 1340 nm non-ablative fractional laser (NAFL) and the microneedling (MN) technique to treat striae alba (SA). Materials and Methods NAFL and MN were used to treat striae on the longitudinally divided abdominal surface of 20 women classified as Fitzpatrick skin type III or IV (five sessions at monthly intervals). Photographs and skin biopsies were obtained during pretreatment and after the third and fifth treatment sessions for all patients. Patients and two independent evaluators assessed the clinical response using the Global Aesthetic Improvement Scale. Results Patient-reported evaluation showed improvement of striae using both modalities, with no statistically significant difference between the groups. Collagen and elastic fibers were significantly increased (p < 0.01) after the third and fifth treatment sessions, with no significant difference between the modalities. In addition, Dermatology Life Quality Index scores showed significant improvement (p < 0.001) after the third and fifth treatment sessions compared with pretreatment values, with average values of 8.4 (standard error [SE] ± 1.21), 3.17 (SE ± 0.55), and 2.64 (SE ± 0.60), respectively. The mean pain score using the Visual Analog Scale in the MN group versus the NAFL group was 5.23 (SE ± 0.31) versus 2.39 (SE ± 0.22) [p < 0.001], and the mean duration of adverse events in the NAFL group versus the MN group was 4.03 days (SE ± 0.45) versus 3 days (SE ± 0.37) [p = 0.02]. Conclusion NAFL and MN are safe for treating SD, particularly in individuals classified as phototype III or IV. MN is a useful non-technology-dependent, low-cost alternative therapy for SA. Clinical Trial Registration Number NCT03390439.
Article
Demand for safe, less aggressive and cost-efficient treatment modality to improve skin quality and appearance following scarring or photoaging is increasing steadily. A treatment modality that preserves the epidermis while promoting regeneration rather than cicatrization would be ideal. Percutaneous collagen induction (PCI) therapy or microneedling is claimed to approach this ideal objective. The current comprehensive literature review is intended to analyze the scientific basis supporting this therapeutic modality and to evaluate the efficacy of PCI microneedling therapy versus no treatment of patients with photoaged skin and scars of various etiologies on aesthetic skin rejuvenation, skin tightening and scar quality in prospective, retrospective and experimental studies. Twenty-five published studies were identified and included in this review. Four publications are experimental animal studies; most clinical reports are case series or small cohort non-randomized studies or trials lacking methodological unity with a heterogenous mix of scars, wrinkles and skin laxity being treated. The majority are studies about management of scars of various etiologies while only 4 specifically investigated the effect of PCI on wrinkles and aging skin. One study compared burn scar erythema in the treated area to the untreated area, and 5 studies included histologic evaluation of biopsies. Despite PCI promising therapeutic benefits and its increasing cosmetic applications, the current literature review unfortunately revealed a limited number of high-quality studies mostly experimental. Data and conclusions of clinical studies must be carefully interpreted before translating the evidence presented into clinical recommendations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
The skin is the largest and most accessible organ in the human body and, as such, it appears as the most convenient portal for drug delivery. However, the skin is also a formidable barrier which, while protecting us from physical, chemical, and immunological agents, requires appropriate technology for effective delivery. Today, the most effective administration method for large, lipophobic, and polar molecules continues to be hypodermic injection, which is associated with pain, needle phobia, and stick injury. As an alternative, a range of advanced strategies to overcome the skin barrier have been established over the last few decades including chemical enhancement, sonophoresis, iontophoresis, electroporation, thermal ablation, and mechanical approaches. Encouraged by the advances in nanotechnology, micro‐ and nanosystems have emerged as powerful tools to overcome the skin barrier, enabling significant advances on the existing methods. In particular, microneedle‐ and nanoparticle‐assisted transdermal delivery has gained significant traction and will most likely have a strong impact in the field. In this review, the most recent progress in the field of transdermal delivery based on microneedle and nanoparticle delivery systems is discussed and examples of key therapeutic application are provided. Finally, a critical summary is presented alongside a vision for future research directions. Transdermal delivery techniques promise great benefits for advanced clinical applications. In this review, transdermal microneedle and nanocarrier systems are discussed. An update on the most recent progress on transdermal methods and their versatile use for therapeutic treatments is illustrated.
Article
Background: Striae distensae (SD) are skin lesions of parallel streaks, which mostly occur during rapid tissue expansion. Considering the etiological mechanism of SD, including dermal network ruptures and alignment to mechanical stretch, structural directionality or anisotropy could be expected. Non-invasive objective methods for measuring the anisotropy of SD have not been suggested yet. Therefore, we evaluated the anisotropic properties of SD with regard to skin surface texture and viscoelasticity, to verify them as new objective evaluation parameters of SD. Methods: Thirty-two healthy subjects with SD on their body participated. Anisotropy of skin surface texture and biomechanical properties of SD-involved skin and adjacent normal skin was assessed and compared. Results: Analysis of skin surface texture, based on the ×60 magnified images, revealed that SD have more disordered patterns compared to the regular honeycomb patterns seen in the normal surrounding skin. SD have bigger sizes of each blob than normal skin. The overall anisotropy of skin texture was significantly higher in SD. Skin biomechanical parameters, measured using Cutiscan® , indicated the less deformable, less recovered, and less viscoelastic properties of SD. When comparing viscoelastic properties over 360°, SD were more anisotropic than the adjacent normal skin as well. Conclusion: We observed that SD were significantly more anisotropic than adjacent normal skin with regard to skin surface texture and viscoelasticity. Therefore, anisotropy could be an objective evaluation parameter to represent the distinctive features of SD. It can be applied for evaluation of the SD severity and clinical efficacy of various treatments.
Article
Background: Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation. Objective: To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae. Materials and methods: Twenty-five consecutive adults (SPT I-V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated. Results: Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed. Conclusion: The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.
Article
Transdermal drug delivery offers several attractive advantages over the traditional oral and parenteral routes. Particularly, in case of paediatric patients, it helps to overcome the issues specific to this population, such as difficulty in swallowing and palatability of oral medicines as well as fear and pain associated with needles. However, due to the formidable barrier characteristic of the stratum corneum, it fails in the effective systemic delivery of broad range of therapeutic molecules, especially macromolecules and genetic material. Over the last two decades, microneedle technology has been portrayed as a strategy to infringe the stratum corneum, in a minimally invasive manner, and enable the successful passage of molecules by creating transient channels across the skin. There has been an exponential surge in the number of studies exploring the design, development and fabrication of microneedles. This article reviews the evolution of microneedle technology and provides a comprehensive summary of microneedle research to date. It provides a detailed overview of the microneedle types, advanced fabrication strategies including the biodegradability and compatibility of the new materials used in fabrication. Research on microneedle-mediated paediatric drug delivery as well as insights on the application of this novel technology has been discussed. The up-to-date progress in clinical translation of microneedles and the regulatory requirements for their commercialization are highlighted along with a brief perspective on the future prospects of microneedle-mediated paediatric drug delivery. This review proposes that advanced research can further contribute to the improved therapeutic efficiency of microneedle-based delivery of numerous molecules, which are otherwise difficult to administer via the conventional transdermal delivery mechanisms.
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Dehnungsstreifen können, neben einer Laserbehandlung, auch mit Mikronadeln effizient gelindert werden. In einer Studie erwiesen sich beide Methoden nicht nur als ähnlich wirksam, sondern auch als etwa gleich sicher — wobei beim Microneedling, im Gegensatz zum Laser, keine Krusten, Hyperpigmentierungen oder Schmerzen nach dem Eingriff auftraten.
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The aim of our study was to follow-up 15 patients with stretch marks treated positively with the CuBr laser (577-511 nm) in 1998-99 and followed-up for 2 years. The patients were Italian women, young to middle age (average 30 years old), with skin coloration classified as Fitzpatrick II-III. Biopsies were taken on some patients before the treatment and 1 month after the first treatment. Double-blind histological, histochemical and photographic evaluation was performed. Results obtained as well as to the contradictory effects reported elsewhere in the literature were compared. On average, the results were positive and there were some pathogenic considerations that justified the use of laser.
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With the limitations of oral drug delivery and the pain and needle phobias associated with traditional injections, drug delivery research has focused on the transdermal delivery route. A formidable barrier to transdermal drug delivery is the stratum corneum, the superficial layer of the skin. In the last 10 years, microneedles were proposed as a mechanical tool to pierce through the stratum corneum, in order to create drug delivery channels without stimulating underlying pain nerves. Since then, the field of microneedles has rapidly evolved to spawn a plethora of potential transdermal applications. In this review, the authors provide an overview of the progress in microneedle research and design, and the advancements that have been made in employing this technology for transdermal applications.
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The mechanical and transport-enhancing properties of microneedles were examined. Microneedle arrays were inserted into epidermis and transdermal transport of calcein or fluorescein-labeled BSA was determined by spectrofluorimetry. Following this, microneedles were examined to determine if any breakage occurred during insertion and removal. It was observed that the microneedles are mechanically strong, able to increase transdermal transport by more than four orders of magnitude in vitro, and do not cause pain in human subjects.
Article
Intense pulsed light (IPL) and the microneedle therapy system (MTS) are currently available for the treatment of scars. Greater collagen deposition has been proposed as a mechanism for the treatment of scars. To compare the effects of IPL and MTS on collagen deposition. Fifty-four imprinting control region mice were divided into three groups: untreated controls, treatment with IPL, and treatment with MTS. A single pass of IPL 10.5 J/cm(2) and five passes (total 15 strokes) of MTS were performed three times every 2 weeks. Four weeks after the last treatment, skin thickness measurements using a caliper, microscopic examination, Western blot analysis for type I collagen, and enzyme-linked immunosorbent assay for total collagen content were performed. Measured using calipers, MTS, resulted in greater skin thickness than IPL that paralleled the dermal thickness of the biopsied specimens. MTS also increased expression levels of type I collagen and total collagen content more than IPL. IPL effects were superior to control. MTS increased collagen deposition more than IPL, and MTS might be more effective than IPL for scar treatment. The authors have indicated no significant interest with commercial supporters.
Article
Late-stage striae distensae is a type of scar characterized by a loss of collagen and elastic fibers in the dermis. Ablative 10,600-nm carbon dioxide fractional laser systems (CO₂ FS) have been used successfully for the treatment of various types of scars. To investigate the therapeutic efficacy of using CO₂ FS for the treatment of striae distensae. Twenty-seven women with striae distensae were treated in a single session with a CO₂ FS. Deep FX mode with a pulse energy of 10 mJ and a density of 2 (percent coverage of 10%) was used. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs and participant satisfaction rates. The evaluation of clinical results 3 months after treatment showed that two of the 27 participants (7.4%) had grade clinical 4 improvement, 14 (51.9%) had grade 3 improvement, nine (33.3%) had grade 2 improvement, and two (7.4%) had grade 1 improvement. None of the participants showed worsening of their striae distensae. Mean clinical improvement score was 2.6. Surveys evaluating overall participant satisfaction administered after the treatment was completed showed that six of the 27 participants (22.2%) were very satisfied, 14 (51.9%) were satisfied, five (18.1%) were slightly satisfied, and two (7.4%) were unsatisfied. Our observations demonstrated that the use of CO₂ FS can have a positive therapeutic effect on late-stage striae distensae.
Article
To evaluate the true efficacy of the 308-nm excimer laser for darkening striae alba using a modified approach. Ten subjects were treated using the excimer laser on the white lines of striae, while the normal skin near to and between the lines was covered with zinc oxide cream. Assessment of efficacy was performed by colorimetric scores based on mexameter measurement and also digital photographs showing before-after laser therapy, which were compared by two independent dermatologists. The mexameter-based data analysis showed that the excimer laser was weakly effective in the repigmentation of the lines of striae. The analysis using before-after photographs showed that 80% of patients had a poor or moderate result. The results of this study showed the weakly positive effect of the 308-nm excimer laser in the repigmentation of striae alba; the splaying of pigment was a major side effect.
Article
Ablative procedures that are used for the improvement of a degenerative process that leads to a loss of skin elasticity and integrity, injure or destroy the epidermis and its basement membrane and lead to fibrosis of the papillary dermis. It was recently shown in clinical and laboratory trials that percutaneous collagen induction (PCI) by multiple needle application is a method for safely treating wrinkles and scars and smoothening the skin without the risk of dyspigmentation. In our study, we describe the effect of PCI on epidermal thickness and the induction of genes relevant for regenerative processes in the skin in a small animal model. The purpose of this study in a rat model was to determine the effects of PCI on the skin both qualitatively and quantitatively. The epidermal and dermal changes were observed by histology and immunofluorescence. The changes in gene expression were measured by array analysis for cytokines, such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-7, epidermal growth factor (EGF) and extracellular matrix molecules such as collagen type I and type III. The present study showed that PCI with topical vitamins resulted in a 140% increase in epidermal thickness; an increase in gene and protein expression of collagen I, glycosaminoglycans (GAGs) and growth factors such as VEGF, EGF and FGF7. The collagen fibre bundles were increased, thickened, and more loosely woven in both the papillary and reticular dermis. We were able to show that PCI modulates gene expression in skin of those genes that are relevant for extracellular matrix remodelling.
Article
Acne is a common condition seen in up to 80% of people between 11 and 30 years of age and in up to 5% of older adults. In some patients, it can result in permanent scars that are surprisingly difficult to treat. A relatively new treatment, termed skin needling (needle dermabrasion), seems to be appropriate for the treatment of rolling scars in acne. To confirm the usefulness of skin needling in acne scarring treatment. The present study was conducted from September 2007 to March 2008 at the Department of Systemic Pathology, University of Naples Federico II and the UOC Dermatology Unit, University of Rome La Sapienza. In total, 32 patients (20 female, 12 male patients; age range 17-45) with acne rolling scars were enrolled. Each patient was treated with a specific tool in two sessions. Using digital cameras, photos of all patients were taken to evaluate scar depth and, in five patients, silicone rubber was used to make a microrelief impression of the scars. The photographic data were analysed by using the sign test statistic (alpha < 0.05) and the data from the cutaneous casts were analysed by fast Fourier transformation (FFT). Analysis of the patient photographs, supported by the sign test and of the degree of irregularity of the surface microrelief, supported by FFT, showed that, after only two sessions, the severity grade of rolling scars in all patients was greatly reduced and there was an overall aesthetic improvement. No patient showed any visible signs of the procedure or hyperpigmentation. The present study confirms that skin needling has an immediate effect in improving acne rolling scars and has advantages over other procedures.
Article
Photoaging is generally treated by ablative procedures that injure the epidermis and basal membrane and lead to fibrosis of the papillary dermis. Damaging the epidermis significantly can cause potential adverse effects such as dyspigmentation. It was recently shown in clinical trials that percutaneous collagen induction therapy is an alternative for safely treating wrinkles and scars and for smoothening the skin without the risk of dyspigmentation. The purpose of this study was to increase current knowledge regarding whether percutaneous collagen induction therapy presents an effective means for skin rejuvenation without risk of dyspigmentation, as the authors' clinical data suggested. Fifty-six rats were assigned to three groups: group A (n = 24), percutaneous collagen induction therapy plus skin care; group B (n = 24), skin care; and group C (n = 8) controls. The authors evaluated the effect of percutaneous collagen induction therapy on the epidermis, melanocytes, and the pigmentation markers interleukin-10 and melanocyte-stimulating hormone. Percutaneous collagen induction therapy left the epidermis intact without any damage to the stratum corneum, any other layers of the epidermis, or the basal membrane. No signs of dermabrasive reduction of epidermal thickness were evident 24 hours after the procedure. The number of melanocytes neither increased nor decreased in any of the groups. DNA microarray experiments demonstrated that interleukin-10 was increased in percutaneous collagen induction therapy-treated skin after 2 weeks. Concerning the MC1R (melanocyte-stimulating hormone) gene, gene expression microarray analysis indicated a faint down-regulation both 24 hours and 2 weeks after percutaneous collagen induction therapy. Percutaneous collagen induction therapy offers a modality with which to rejuvenate and improve skin appearance and quality without risk of dyspigmentation.
Article
A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced. To define the newly coined term "Subcision" and to describe this minor surgical procedure for treating depressed scars and wrinkles. A tri-beveled hypodermic needle is inserted through a puncture in the skin surface (hence, "incisionless" surgery), and its sharp edges are maneuvered under the defect to make subcuticular cuts or "-cisions." The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing. This technique is useful in treating a variety of cutaneous depressions, including scars and wrinkles.
Article
In this article we describe a technique of needle dermabrasion (tattoo without pigment) used to improve achromic, hypertrophic, and unsightly scars. It is simple, safe (no complications), and it gives us consistently good results.
Article
Topical treatment of striae rubra with 0.1% tretinoin and laser treatment of striae rubra and alba with the 585-nm pulsed dye laser are proven therapeutic options. However, little efficacy has been shown for treatment of striae alba topically, and the laser is currently not a suitable treatment option for darker ethnic skin types. The purpose of this study was to demonstrate that selected commercial topical agents can improve the appearance of striae alba. Ten patients of varying skin types (I-V) having straie distensae alba on the abdomen or thighs were selected to evaluate the effectiveness of two topical treatment regimens. Patients were placed on daily topical application of 20% glycolic acid (MD Forte) to the entire treatment area. In addition, the patients applied 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half to the treatment area and 0.05% tretinoin emollient cream (Renova) to the other half of the treatment area. The creams were applied on a daily basis for 12 weeks. Improvement was evaluated at 4 and 12 weeks in an objective unblinded fashion at the follow-up visits, a objective blinded fashion by visual grading at the conclusion of the study, and in an objective blinded fashion with profilometry. Additionally, histopathologic analysis was performed. Analysis of these data reveals: 1) both regimens can improve the appearance of stretch marks; 2) these topical therapy regimens are safe and effective in study patients with minimal irritation; 3) elastin content within the reticular and papillary dermis can increase with topical 20% glycolic acid combined with 0.05% tretinoin emollient cream therapy; 4) both regimens increased epidermal thickness and decreased papillary dermal thickness in treated stretch marks when compared with untreated stretch marks; 5) combined epidermal and papillary dermal thickness in stretch marks treated with either topical regimen approaches that of normal skin; and 6) profilometry can objectively measure differences in skin texture associated with striae treatments when compared to controls, however, it is not sensitive enough to justify comparison or quantitative improvements between similarly effective treatments.
Article
In an open-label, multicenter, prospective study, 20 women applied tretinoin (retinoic acid) cream 0.1% daily for 3 months to pregnancy-related stretch marks in the abdominal area. Efficacy was evaluated by analysis of one preselected target lesion, which was rated on a six-point scale (-1 = worse to 4 = cleared). At week 12, significant global improvement was noted from baseline in all stretch marks, and the target lesion decreased in length by 20% (P = .01). Erythema and scaling, the most common adverse events, occurred in 11 patients, decreased in severity after the first month of treatment, and were controlled with continued application of tretinoin and petroleum jelly ointment. In this small study, topical application of tretinoin significantly improved the clinical appearance of pregnancy-related stretch marks.
Article
Intense Pulsed Light (IPL) is a noncoherent, nonlaser, filtered flashlamp, emitting a broadband visible light. Its efficacy has been reported recently in the treatment of photodamaged facial skin, promoting the production of neo collagen and ordering of elastic fibers. We don't know however, its efficacy in the treatment of striae distensae. To assess gross and microscopical changes that occur in the striae distensae when treated by IPL. A prospective study was carried out in 15 women, all of them having late stage striae distensae of the abdomen. Five sessions of IPL were performed in each one, once every two weeks. Skin biopsies and before and after photographs were taken of all the patients. Data concerning skin features (number of stretch marks in a square of 5 cm per side, sum of all the stretch marks to determine the total length, discolorations and general appearance) were all assessed before each session and at the end of the study. Microscopical changes were all carefully assessed. For the statistical analysis a "t" test for small samples was used. All patients showed clinical and microscopical improvement in each one of the parameters assessed. The "t" test for small samples showed a statistically significative difference (p < 0.01) in the post treatment dermal thickness. Striae distensae improved clinically and microscopically after IPL. It seems to be a promising method of treatment for this common problem with minimal side-effects, a wide safety margin and no downtime.
Article
The response to tissue injury requires the symphonious interaction of immune cells, keratinocytes, fibroblasts, and endothelial cells, which unite to regenerate the damaged epithelium. Recent insights have elucidated the cellular and molecular mechanisms required for wound healing and have raised the prospect of novel therapeutic targets. Review of the pertinent literature. The initial inflammatory response leads to the influx of macrophages and neutrophils, which release cytokines, growth factors, and nitric oxide, and induce nearby keratinocytes to migrate across the wounded epithelium. This process, known as re-epithelialization, requires integrin-mediated activation of Rho-GTPases. The subsequent influx of fibroblasts and endothelial cells results in the production of tissue stroma and formation of new blood vessels, which lead to the generation of functional tissue. Importantly, disease states associated with impaired or excessive wound healing can be attributed to defects in these responses, providing a rationale for the use of evidence-based biological therapies. The elucidation of the cellular and biochemical response to wound healing is essential for an understanding to the treatment of clinical conditions during which impaired healing is encountered.
Article
Striae distensae are dermal scars with flattening and atrophy of the epidermis. Successful treatment of these stretch marks has been disappointing. The non-ablative 1,450-nm diode laser has been shown to improve atrophic scars and may be expected to improve striae. As yet, no study has been published to document the effects of this laser on striae. Our aim is to evaluate the efficacy of the 1,450-nm diode laser in the treatment of striae rubra and striae alba in Asian patients with skin types 4-6. Striae on one half of the body in 11 patients were treated with the 1,450-nm diode laser with cryogen cooling spray with the other half serving as a control. The following parameters were used: 6 mm spot size and dynamic cooling device (DCD) for 40 milliseconds to protect the epidermis. Patients were randomly assigned to receive either 4, 8, or 12 J/cm2. A total of three treatments were given at 6-week intervals. The following sites were treated: abdomen, arms, back, buttocks, and thighs. Two patients had striae rubra and nine striae alba. Clinical photographs were taken before and after each treatment and analysis was undertaken through photographic evaluation by non-treating physicians. At 2 months after the last treatment, no patients showed any noticeable improvement in the striae on the treated side compared to baseline and to the control areas. Side effects were limited to transient erythema and postinflammatory hyperpigmentation (PIH), which occurred in seven (64%) patients. The non-ablative 1,450-nm diode laser is not useful in the treatment of striae in patients with skin types 4, 5, and 6.
Article
Various lasers have recently been reported as effective treatment modalities for striae distensae, but pigmentary alterations are a major concern to the darker skin type. The Thermage (Therma Cool TC; Thermage Inc, Hayward, CA) is a radiofrequency device for the lifting of face and neck, and there is no report of using it for striae distensae. The purpose was to evaluate the effectiveness of the Thermage in combination with pulsed dye laser. Thirty-seven patients with abdominal striae distensae were treated with the Thermage and 585-nm pulsed dye laser in the first session at baseline. An additional two sessions of pulsed dye laser were performed at Weeks 4 and 8. Thermage was used at fluences of 53 to 97 J/cm2 and pulsed dye laser at fluences of 3.0 J/cm2 with 10-mm spot. Skin biopsies were taken of nine patients. In the subjective assessment, 89.2% of the patients showed "good and very good" to overall improvement, and 59.4% were graded as "good and very good" in elasticity. All of the nine specimens showed an increase in the amount of collagen fibers, and increased elastic fibers were found in six specimens. The Thermage and pulsed dye laser appear to be an effective treatment for striae distansae.
Article
Skin laxity, rhytides, and photoaging are generally treated by ablative procedures that injure or destroy the epidermis and its basement membrane, at least in the beginning, and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis. Percutaneous collagen induction takes us closer to this ideal. The authors performed a retrospective analysis of 480 patients in South Africa and Germany with fine wrinkles, lax skin, scarring, and stretch marks treated with percutaneous collagen induction using the Medical Roll-CIT to produce tighter, smoother skin. Most patients had only one treatment, but some have had as many as four treatments. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively. On average, patients in Germany rated their improvement between 60 and 80 percent better than before the treatment. Histologic examination was carried out in 20 patients and showed a considerable increase in collagen and elastin deposition at 6 months postoperatively. The epidermis demonstrated 40 percent thickening of stratum spinosum and normal rete ridges at 1 year postoperatively. Percutaneous collagen induction was started in 1997 and has proved to be a simple and fast method for safely treating wrinkles and scars. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the procedure can be repeated safely and is also suited to regions where laser treatments and deep peels cannot be performed.
Article
Medical clinicians are used to being consulted by patients who want to restore their youthful appearance. Although structural changes to the face and body may be achieved with surgery, for example, face lifts, the impression of youth also relies heavily on young-looking skin. It is desirable to have thicker and tighter skin to properly fulfill the desire for youth. Percutaneous collagen induction offers an antiaging effect to improve the appearance of old skin. It allows us to improve our patients' skin from the inside outward as well as from the surface. Experience has shown that percutaneous collagen induction works optimally when combined with a scientific skin care program to restore a youthful appearance. In addition, the same technique has proven to be very effective in minimizing acne scars and burn scars by removing scar collagen and replacing it with normal collagen. Consequently, scar contractures and depressed scars are improved. With the introduction of percutaneous collagen induction therapy in 1997, a simple and fast method was developed with regard to safely treating wrinkles and scars and producing lasting smoothness. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the operation can be safely repeated if needed, and it can be also applicable to regions where laser treatments or deep peelings cannot be done.
Article
The success of transdermal drug delivery has been severely limited by the inability of most drugs to enter the skin at therapeutically useful rates. Recently, the use of micron-scale needles in increasing skin permeability has been proposed and shown to dramatically increase transdermal delivery, especially for macromolecules. Using the tools of the microelectronics industry, microneedles have been fabricated with a range of sizes, shapes and materials. Most drug delivery studies have emphasized solid microneedles, which have been shown to increase skin permeability to a broad range of molecules and nanoparticles in vitro. In vivo studies have demonstrated delivery of oligonucleotides, reduction of blood glucose level by insulin, and induction of immune responses from protein and DNA vaccines. For these studies, needle arrays have been used to pierce holes into skin to increase transport by diffusion or iontophoresis or as drug carriers that release drug into the skin from a microneedle surface coating. Hollow microneedles have also been developed and shown to microinject insulin to diabetic rats. To address practical applications of microneedles, the ratio of microneedle fracture force to skin insertion force (i.e. margin of safety) was found to be optimal for needles with small tip radius and large wall thickness. Microneedles inserted into the skin of human subjects were reported as painless. Together, these results suggest that microneedles represent a promising technology to deliver therapeutic compounds into the skin for a range of possible applications.
Comparison of topical therapy for striae alba
  • Ash K J Lord
  • M Zukowski
  • Mcdaniel
Ash K, Lord J, Zukowski M, McDaniel DH. Comparison of topical therapy for striae alba (20% glycolic acid/0.05% tretinoin versus 20% glycolic acid/10% L-ascorbic acid).
Intense pulsed light in the treatment of striae distensae.
  • HernandezPerez
Treatment of striae distensae using an ablative 10,600nm carbon dioxide fractional laser: a retrospective review of 27 participants.
  • Lee