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Exercise and Striae Distensae in Obese Woman

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... In one study of 80 nonpregnant individuals, 79% of whom had SD, a 3month weight-loss programme did not improve the severity of lesions, regardless of the intervention (diet alone, diet plus aerobic exercise, or diet plus resistance exercise). 24,25 Topical modalities for preventing striae gravidarum Centella • Creams containing centella, a medicinal herb, may be effective for preventing SG and reducing their severity. ...
Article
Striae gravidarum (SG), or stretch marks developing during pregnancy, affect up to 90% of women. While not medically dangerous, SG can be disfiguring, causing emotional and psychological distress. However, studies specifically addressing the prevention of SG, especially during pregnancy, are sparse. Furthermore, the molecular pathogenesis of SG is unclear and may differ from that of striae from other causes. Considering these factors, we review topical modalities that have been used specifically for preventing SG during pregnancy. We identify two major strategies (endpoints) for these modalities, including 1) preventing the de novo development of SG, and 2) reducing the severity of SG that have recently developed. We also identify risk factors for the development of SG and suggest that pregnant women with these risk factors are an appropriate target population for prevention. In reviewing the literature, we find that there is limited evidence that centella and possibly massage with bitter almond oil may prevent SG and/or reduce their severity. There is weak evidence that hyaluronic acid prevents SG. Tretinoin holds promise for reducing the severity of new-onset SG, but its use is limited by its pregnancy category. Finally, cocoa butter and olive oil are not effective for preventing SG or reducing the severity of lesions. We conclude that reliable methods for preventing SG are scarce. Furthermore, available topical modalities generally lack strong evidence from rigorous, well-designed, randomized controlled trials with ample numbers of subjects. Thus, further research is necessary to better elucidate SG pathogenesis, which may lead to effective prevention modalities.This article is protected by copyright. All rights reserved.
... Weight loss by diet alone or a combination of diet and exercise do not change the degree of striae distensae. [18] Topical tretinoin (0.1%) ameliorates striae and the improvement may persist for almost a year after discontinuation of therapy. [1], [19] A study comparing topical 20% glycolic acid and 0.05% tretinoin versus 20% glycolic acid and 10% L-ascorbic acid, found that both regimens improved the appearance of striae alba. ...
... However, a previous study demonstrated that these two variables had no effect on the striae development. 18 The effects of diet and exercise should be new research foci in the future, because there is a lack of data on these factors in pregnancy. ...
Article
Background: Striae gravidarum (SG), commonly called stretch marks, is an important cosmetic problem which is not treatable, although preventive measures might be effective. The aim of this study was to determine individual risk factors causing SG and the degree to which preventive measures could be effective. Methods: This prospective observational study included 211 singleton primiparous pregnant women who were hospitalized for birth and who did not have systemic diseases or other risk factors, like drug use or polyhydramnios. Patients were examined and divided into two groups with respect to whether or not they had striae. Individual features were compared between the two groups. Results: While 159 patients (75.4%) had SG, 52 (24.6%) did not. Patients with striae had a significantly lower mean age and higher mean preconceptional body mass indices than ones without striae (p < 0.001 and p = 0.001, respectively). Family history (p = 0.002), having a male baby (p = 0.042), and lower educational level (p = 0.033) were also statistically significant in predicting striae. Use of preventive oil or drugs, smoking status, skin type, water intake, and level of financial income did not significantly predict SG. Conclusion: Informing women preconceptionally on the importance of modifiable risk factors, such as body weight and maternal age before pregnancy, can be useful, considering that stretch marks are carried for a lifetime and there is no conclusive treatment.
... Dietary modifications and exercise plan were thought to be important for reduction of SD in earlier days. A study conducted by Schwingel et al. has failed to demonstrate effect of any weight loss programme diet and any type of exercise on SD. [15] ...
Article
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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.
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.
Article
Full-text available
Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies.
Article
Striae distensae are dermal atrophic scars with epidermal thinning and decreased collagen and elastic fiber. There is no 'gold standard' treatment modality in the treatment of striae distensae. Collagen is a major extracellular matrix component and is important in wound healing. The ablative CO(2) fractional laser is effective in various cutaneous scars and this study was attempted to evaluate the effect of succinylated atelocollagen and ablative CO(2) fractional laser in the treatment of striae distensae. Participants were divided into two groups and received three laser treatments at a 4-week interval. Clinical improvement was evaluated by participants and two blinded physicians by observing the comparative photographs. Skin biopsies were randomly taken from six participants. The ablative fractional resurfacing laser was effective in the clinical improvement of striae distensae. Statistically significant differences were partly observed between the collagen and placebo groups. Clinical improvement scored by doctors showed more improvement in the collagen group. However, scoring by participants did not show significant differences between the collagen and placebo groups. In conclusion, the ablative fractional resurfacing laser is effective in the treatment of striae distensae and succinylated atelocollagen may also be effective for striae distensae treatment. However, to prove the effect of succinylated atelocollagen, further research with a larger group of participants is needed.
Article
Striae distensae are an extremely common, therapeutically challenging form of dermal scarring. Risk factors have been reported but much remains to be understood about their epidemiology, diagnosis and treatment. Up-to-date knowledge of the scientific research and the evidence behind both preventative and therapeutic agents is vital in order to understand striae and to offer patients the best therapeutic alternatives. We present a clinical review of the current literature concerning striae distensae and both their prevention and treatment. A systematic review of the literature was undertaken utilising MEDLINE, EMBASE and Google scholar. Articles in English, Spanish, Portuguese, Turkish and French were included. Striae distensae occur in pregnancy, puberty and obesity as well as in numerous medical conditions and following therapeutic interventions. Aetiological mechanisms proposed relate to hormones, physical stretch and structural alterations to the integument. Assessment methods include subjective visual scoring and various imaging modalities. Treatments, which we have evaluated, include topical agents used prophylactically or therapeutically as well as light and laser therapies, which have shown improvements in the appearance of striae. No high quality, randomised controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae. This article is protected by copyright. All rights reserved.
Article
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Un approccio pratico per la valutazione clinica e lo score delle striae distansae nell'adolescente (II parte)
Article
Cutaneous atrophic striae (or striae distensae) is a very common skin condition that frequently motivates dermatological consultations. Due to its unaesthetic appearance, it can have a significant impact on patients' psychosocial status and quality of life. This study reviews the literature involving possible treatments for more recent and older cutaneous striae or stretch marks. Given the great number of etiological factors involved, the literature is abundant and divergent regarding the treatment of the condition.
Article
Striae distensae (SD) occur frequently during adolescence or pregnancy when there is rapid tissue expansion, but may also occur in severe weight loss and in a number of pathological conditions such as obesity, Cushing's and Marfan syndromes and long-term systemic or topical steroid use. They are characterized clinically by linear bands that are initially erythematous to violaceous and gradually fade to become skin colored or hypopigmented atrophic lines that may be thin or wide. The cause of SD remains unknown but clearly relates to changes in the structures that provide the skin with its tensile strength and elasticity. The anatomical distribution of striae, the severity of SD in each area and the colour and symptoms, if any, should be assessed. The evaluation scale provides an useful way to incorporate the number of SD as well as the width of SD covering the affected area. Subjects with a total score of 0 are graded as having no striae, a total of 1-3 are graded as having very mild and no significant striae, 4-9: mild, 10-15: moderate and >16: severe striae. This paper can help physicians for a better clinical assessment and to identify risk factors associated with striae.
Article
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A estria atrofica cutânea ou striae distensae e uma dermatose muito comum durante a gestacao, constituindo causa frequente de consulta ao dermatologista. Devido a seu carater inestetico, pode induzir importantes consequencias psicossociais e na qualidade de vida da gestante. O objetivo deste trabalho foi descrever os principais fatores associados ao surgimento das estrias de distensao, assim como apresentar as alteracoes fisiopatologicas decorrentes do desenvolvimento destas e revisar as possibilidades de tratamento preconizadas na literatura para estrias recentes e antigas. Observou-se que inumeros tratamentos para esta afeccao tem sido propostos, alguns nao apresentando resultados satisfatorios e que a combinacao de terapias pode fornecer melhor eficacia. Os estudos destacam a importância da prevencao das estrias com uso de cremes hidratantes, dieta e atividades fisicas durante a gravidez para se evitar as suas consequencias na vida das gestantes. Os tratamentos com lasers e radiofrequencia podem diminuir o tamanho das estrias e melhorar a sua aparencia.
Article
Full-text available
Striae distensae, commonly known as stretch marks, are benign skin lesions associated with considerable cosmetic morbidity. Despite considerable investigations into their origins, the pathogenesis of striae distensae remains unknown.Currently, there is no treatment which consistently improves the appearance of striae. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. The aim of present article is to appraise the readers with various newer treatment options in the management of this difficult condition.
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
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Abdominal stretch marks found during pregnancy may be indicative of poor skin elasticity. One who does not have stretch marks may have better skin elasticity and may be less likely to tear perineal and vaginal tissue during vaginal delivery. Striae gravidarum (SG) is a common phenomenon of stretch marks observed during pregnancy that may be an indicator of poor skin elasticity. The type and amount of collagen in connective tissue are considered to determine the individual’s elastic index. The skin surface is made up of a complex network of crossing thin lines. The two-dimensional relationship between primary and secondary lines determines the skin texture and its grade of irregularity. SG is caused by changes in the structural connective tissue due to a hormonal elect on the alignment and reduced elastin and fibrillin in the dermis. Severity scoring of SG was observed using the numerical scoring system of Atwal. This score provides a rank based on observation of four areas in which SG is most commonly observed (abdomen, hips, buttocks, and breast).
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