ArticlePDF AvailableLiterature Review

Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update

Authors:
  • National Research Centre
  • Baumann Cosmetic and Research Institute

Abstract

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.
REVIEW ARTICLE INCENTIVE PROGRAM WINNERS
Striae Distensae (Stretch Marks) and Different Modalities of
Therapy: An Update
MOHAMED L. ELSAIE MD,
LESLIE S. BAUMANN MD,
AND LOTFY T. ELSAAIEE,MD
y
BACKGROUND 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.
OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of
stretch marks.
MATERIALS AND METHODS 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.
RESULTS No current therapeutic option offers complete treatment, although there are a number of
emerging new modalities that are encouraging.
CONCLUSION 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.
The authors have indicated no significant interest with commercial supporters.
Successfully treating striae distensae (SD; stretch
marks) has always been challenging. Nardelli
gave the first morphologically correct description of
these lesions in 1936, calling them striae atrophicae.
1
The exact origin of stretch marks remains unre-
vealed, with the factors responsible for its develop-
ment poorly understood.
2
Causes of SD are not clear, and a number of theories
have been proposed (Table 1). Kogoj anticipated that
a striatoxin damages the tissues in a toxic way, re-
sulting in striations.
3
Others had shown that me-
chanical stretching is the main cause, leading to the
rupture of the connective tissue framework.
4
Many
authors have denounced this theory, not finding any
relationship between growth in abdominal girth in
pregnant women and formation of SD.
5
Normal
growth has been suggested as another cause, with
these marks commonly developing during adoles-
cence and associated with the rapid increase in size
of particular regions of the body.
6
Similarly, SD are a
feature of high serum levels of steroid hormones.
They are a common feature of Cushing’s disease and
local or systemic steroid therapy may induce them.
High steroid hormone levels have a catabolic effect
on the activity of fibroblasts and decrease the de-
position of collagen in the substance of the dermal
matrix. Obesity and rapid increase or decrease in
weight have been shown to be associated with the
development of SD.
7
Finally, the absence of striae in
pregnancy in women with Ehlers-Danlos syndrome
and their presence as one of the minor diagnostic
&2009 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
ISSN: 1076-0512 Dermatol Surg 2009;35:563–573 DOI: 10.1111/j.1524-4725.2009.01094.x
563
Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida;
y
Department of Dermatology, Venereology and Andrology, Al Azhar University, Cairo, Egypt
criteria for Marfan syndrome emphasize the impor-
tance of genetic factors in determining susceptibility
of connective tissue.
8
Similarly, there is low expres-
sion of collagen and fibronectin genes in affected
tissue.
9
Other rarely reported causes of SD include cachetic
states, such as tuberculosis and typhoid and after
intense slimming diets.
10
They may also be seen in
anorexia nervosa.
11
SD have been reported to occur
rarely in patients positive for the human immuno-
deficiency virus receiving the protease inhibitor in-
dinavir.
8
A case of idiopathic SD was also
reported.
12
Men and women with chronic liver dis-
ease may also have SD.
13
Clinical Picture and Histopathology of SD
Recent or immature SD are flattened areas of skin
with a pink-red hue that may be itchy and slightly
raised. Stretch marks then tend to increase in length
and acquire a darker purple color. Over time, they
become white, flat, and depressed. Histologically,
14
earlier-stage or immature SD tend to appear pink or
red in color (striae rubra) and over time and with
atrophic changes attain a white color (striae alba).
High-resolution epiluminescence colorimetric as-
sessment of SD identified four distinct types: striae
alba, striae rubra, striae caerulea, and striae nigra.
The direct and indirect influences of melanocyte
mechanobiology appear to have a prominent effect
on the various colors of SD.
15
The histology of stretch marks is that of a scar, and
the development of SD has been likened to that of
wound healing or scar formation.
16
In the early
stages, inflammatory changes may be conspicuous,
but later the epidermis is thin and flattened. Recent
SD show a deep and superficial perivascular lymph-
ocytic infiltrate around the venules.
17
Collagen
bands on the upper third of the reticular dermis are
stretched and aligned parallel to the surface of the
skin. In the latter stages, there is thinning of the
epidermis due to flattening of the rete ridges and loss
of collagen and elastin.
18
SD are two and a half times
as frequent in women and affect up to 90% of
pregnant women. The commonest sites are the outer
aspects of the thighs and the lumbosacral region in
boys and the thighs, upper arms, buttocks, and
breasts in girls.
19
Recently it was demonstrated that
SD are associated with loss of fibrillin, a fact that
explains the counter replacement of fibrillin upon
retinoic acid therapy.
20
Treatments
Several treatments have been proposed, yet no con-
sistent modality is available. Some authors, have
suggested that time is the only treatment for SD and
that it returns to normal over years, which is not
true.
21
It has always been suggested that effective
treatment of SD be instituted during the active stage,
well before the scarring process is complete.
22
The
first reliable method of treatment involved using
tretinoin cream.
23
Subsequent modalities were
reported afterward, with variable results, which
will be discussed in this section. A summary of major
topical treatments is given in Table 2.
TABLE 1. Different Causes for the Development of
Stretch Marks
Different hypotheses on the development of stretch
marks in the literature
Infection leading to the release of striatoxin that
damages the tissues in a microbial toxic way
3
Mechanical effect of stretching, which is proposed to
lead to rupture of the connective tissue framework
(e.g., pregnancy, obesity, weight lifting)
4
Normal growth as seen in adolescence and the pub-
ertal spurt that leads to increase in sizes of partic-
ular body regions
6
Increase in the levels of body steroid hormones;
Cushing’s syndrome, local or systemic steroid
therapy that has a catabolic effect on fibroblasts
7
Genetic factors (absence of striae in pregnancy in
people with Ehlers-Danlos syndrome and their
presence as one of the minor diagnostic criteria for
Marfan syndrome suggest an important genetic
element)
8,9
Immunosuppression states associated with preg-
nancy-induced hypertension medications, human
immunodeficiency virus or diseases such as tu-
berculosis and typhoid
8,11
Associated with chronic liver disease
13
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STRIAE DISTENSAE AND DIFFERENT THERAPIES
Diet and Exercise
There is lack of data concerning the effect of diet and
diet restrictions on stretch marks. Eighty women
aged 24 to 53 participated in a 3-month weight-loss
program; 29 were on a diet, 31 were on a diet plus
aerobic exercise program, and 20 obese women were
on a diet plus a resistance exercise program. The
data suggested that the degree of SD does not change
with weight loss, regardless of the type of weight loss
program. SD were prevalent in 79% of the women.
The central abdomen was the most common area
where SD were present. No significant correlation
existed between SD and the number of births, the age
of the first birth, weight immediately before preg-
nancy, weight immediately after pregnancy, or weight
at age 20. Forty-five percent of the participants re-
sponded that they did not have negative feelings
about having SD, and it appeared that SD did not
affect the women’s psychological mood. It was in-
ferred that a weight loss program using diet alone or
a combination of diet and exercise did not change the
degree of SD. Further studies are required to establish
a clear effect of diet and exercise on SD.
24
Topical Therapies
Tretinoin
The use of topical tretinoin has yielded variable
results, and some of the studies had proven the in-
efficacy of the vitamin A derivative in the treatment
of SD,
25,26
but most of the patients included in these
early studies presented with old lesions that had
evolved into whitish atrophic scars.
25
More recently,
tretinoin has been shown to improve the clinical
appearance of stretch marks during the active stage
(striae rubra), although with not much effect during
the mature stage (striae alba).
27
In the same study, 22
patients applied 0.1% tretinoin (n= 10) or a placebo
(n= 12) daily for 6 months to the affected areas.
Patients were evaluated monthly in a physical ex-
amination and using analysis of biopsy specimens of
stretch marks obtained before and at the end of
therapy in comparison with untreated normal skin.
Targeted stretch marks in patients treated with
tretinoin had a decrease in mean length and width of
14% and 8%, respectively, compared with an in-
crease of 10% and 24%, respectively, in patients
who received the placebo. Rangel and colleagues
conducted an open multicenter study in Mexico on
20 women with stretch marks after pregnancy. They
all applied tretinoin (retinoic acid) cream 0.1% daily
for 3 months to pregnancy-related stretch marks in
the abdominal area. Efficacy was evaluated accord-
ing to analysis of one preselected target lesion, which
was rated on a 6-point scale (1 = worse to
4 = cleared). All target lesions decreased in length by
20%, and they demonstrated efficacy of tretinoin as
a modality for treating SD of pregnancy.
28
Hydrant Creams
Anecdotal treatments are numerous and unproven.
Despite the general understanding that proper
TABLE 2. Different Topical Products and Their Speculated Modalities of Action
Product Indication Suggested Mode of Action
Tretinoin Therapeutic Exact mechanism unclear, but recent studies suggest fibroblastic stim-
ulation.
Trofolastin Therapeutic Active ingredient (centella asiatica) stimulates fibroblasts and inhibits
glucocorticoids.
Verum Preventive Active ingredient hyaluronic acid is speculated to increase tensile re-
sistance to mechanical forces.
Alphastria Preventive Hyaluronic acid, the main ingredient, acts by increasing volume to op-
pose mechanical atrophy.
Massage with oils Preventive Dual action of massage and hydrant action of oils.
Glycolic acid and trichlo-
roacetic acid peels
Therapeutic Glycolic acid is reported to stimulate collagen production by fibroblasts
and to increase their proliferation in vivo and in vitro.
35:4:APRIL 2009 565
ELSAIE ET AL
hydration is necessary to maintain the integrity and
barrier function of skin, little in the literature is
available on the use of such creams in stretch mark
prevention. Three studies involving 130 men in total
were found.
29
The active creams in the studies de-
scribed are not widely available, and it was not clear
whether any particular ingredient was helpful. The
lack of clarity on the studies and the scientific data
available makes it difficult to conclude such creams
are effective, and larger studies are needed to deter-
mine the efficacy and safety of such products in
combating stretch marks.
Trofolastin One study involved 80 women and
investigated the effect of massage with a cream
containing Centella asiatica extract, vitamin E, and
collagen-elastin hydrolysates (Trofolastin, Novartis
Barcelona, Spain) and its preventive effect on the
development of stretch marks in pregnant women.
30
Forty-one subjects used the cream, and 39 used a
placebo. Results showed that 56% of the placebo
group and 34% of the treated group developed SD in
pregnancy. This study demonstrated that the active
component, Centella asiatica, induced significant
prevention of stretch mark development. The exact
mechanism of action was identified as the stimula-
tion of fibroblastic activity,
31
and an antagonistic
effect against glucocorticoids was also reported.
32
Verum Another study of 50 women, although lack-
ing a placebo control, examined a cream containing
vitamin E, panthenol, hyaluronic acid, elastin and
menthol (verum). It was associated with fewer
stretch marks during pregnancy than no treatment.
One-third of women in the treated group and two-
thirds of those who did not receive any treatment
developed SD during pregnancy. The results suggest
that the product could be helpful, although the trial
had no placebo and may show the benefit of massage
alone.
33
Alphastria Alphastria is a cream that is composed of
hyaluronic acid, allantoin, vitamin A, vitamin E, and
dexpanthenol. The name is composed of the Greek
word ‘‘alpha’’ prefix meaning ‘‘without,’’ and the
Latin word ‘‘stria,’’ which means ‘‘lines.’’ Hyaluronic
acid is an organic substance found in human skin
and is the main constituent of the cream. The
hyaluronic content stimulates fibroblast activity and
collagen production to restore any inhibition and
collagen loss induced by hormonal fluctuations or
mechanical stretch.
34
Only one study was conducted
to demonstrate the efficacy and safety of the cream.
Thirty pregnant women were recruited to receive the
cream, and 30 others received a placebo as a control
group. Three subjects in the exposed group and 21 in
the control group developed SD. The study con-
cluded that the product markedly lowered the
incidence of stretch mark development after
pregnancy.
35,36
Topical Oil Massage and Herbal
Topical Remedies
Some unconventional therapies and anecdotal re-
ports recommend applying unproven oils and natu-
ral remedies to stretch marks. The underlying
principle for this use would probably be keeping the
skin well hydrated. Sweet almond oil, wheat germ
oil, olive oil, avocado oil, and castor oil and applying
seaweed wraps have these properties.
37
Other rem-
edies such as comfrey, hypericum, maritime pine,
equisetum, slippery elm, and wheat grass and
eucalyptus tree oil are all used in creams or oils,
but no efficacy studies have been performed to
support these practices.
38
Glycolic Acid and Trichloroacetic Acid
Glycolic acid (GA) is an alpha hydroxyl acid. Al-
though there are several reports on the clinical effects
of GA in rejuvenation, peeling, and photoaging, no
data on the effectiveness of GA to prevent stretch
marks could be found in the scientific literature. No
epidemiological study on the use of GA in pregnant
women has been published. One study comparing
topical 20% GA and 0.05% tretinoin with 20% GA
and 10% L-ascorbic acid found that both regimens
improved the appearance of striae alba and showed
no difference in effect from combining 10% ascorbic
acid or 0.05% tretinoin with 20% GA, although
it was not determined which of the ingredients
DERMATOLOGIC SURGERY566
STRIAE DISTENSAE AND DIFFERENT THERAPIES
provided the effect.
39
The precise mechanism of ac-
tion of GA is still unknown because the biological
effects of GA on cells has not been fully studied,
although GA is reported to stimulate collagen pro-
duction by fibroblasts and to increase their prolifer-
ation in vivo and in vitro.
40,41
This mechanism can
be useful for stretch mark treatments, but further
investigations and studies are required to prove such
theory.
Trichloroacetic acid (TCA; 10–35%) has been used
for many years and is safe to use at low concentra-
tions. At higher concentrations (e.g., 50%), TCA
has a tendency to scar and is less manageable than
other agents used for superficial peels. TCA is found
in several proprietary peels at varying concentra-
tions, and some kits have instructions and buffering
agents so that the peel can be diluted as deemed
necessary. Anecdotal reports have indicated the
use of TCA in stretch marks, although there is a lack
of clarity and absence of data for assessment
of this subject. Some authors have had good success
using low concentrations (15–20%) of TCA and
performing repetitive papillary dermis-level
chemexfoliation repeated at monthly intervals with
reported improvement in texture and color of
marks.
42,43
Other Topical Products
Hundreds of products are available in the market, but
the potential efficacy of these products had never been
subjected to any clinical investigation or assessment.
Moy has reported improvement with a topical agent
alone (Striae Stretch Mark Formula with Regenetrol
Complex, Regenterol Labs, Los Angeles, CA). Another
formula available is MACROdermabrasion/Der-
maPhoresis Topical Kit (IntegreMed, Scottsdale, AZ)
designed for use with positive-pressure salt micro-
dermabrasion. Salt A-Peel DermaPhoresis system
(IntegreMed, LLC) was shown in one study of 12
weeks to attain a 39% improvement along with
positive-pressure microdermabrasion in 29 women
with SD.
14
Lasers and Light Devices
Of the many modalities used to ameliorate and im-
prove stretch marks, lasers have recently become a
popular therapeutic alternative. The 585-nm flash-
lamp-pumped pulsed-dye laser (PDL) is the most
commonly reported laser used in treatment of SD.
The use of ablative technologies such as the short-
pulse carbon dioxide and erbium-substituted yttrium
aluminium garnet (YAG) enjoyed a brief popularity
because of prolonged healing and pigmentary altera-
tions, especially in darker skin tones.
44
Newer appli-
cations of other laser modalities such as neodymium-
doped YAG (Nd:YAG), diode, and Fraxel are finding
a way into treatment of stretch marks (Table 3).
Pulsed-Dye Laser
The dilated blood vessels marked at the early stage of
the stretch mark formation render the striae rubrae a
good candidate for PDL.
45
According to McDaniel
and colleagues and Alster, a clinical improvement in
immature SD is achieved after several courses of
585-nm flashlamp PDL therapy using dynamic
cooling.
46,47
McDaniel demonstrated that the optimal
treatment fluence was 3 J/cm
2
using a 10-mm spot
size.
46
This laser has been purported to increase
the amount of collagen in the extracellular matrix.
Jiminez and colleagues documented the effectiveness
of the 585-nm flashlamp PDL in stretch marks of skin
types I to IV and demonstrated that collagen changes
precede any clinical significant change,
48
although it
was also reported that, for darker skin tones (IV–VI),
laser treatment of SD should be avoided or used with
great caution because of the possibility of pigmentary
alterations after treatment.
49
Excimer Laser
Advances in technology have recently brought the
308-nm xenon chloride (XeCl) excimer laser to
the laser arena. This newer technology allows
treatment of focal areas with a wavelength
close to that of traditional narrow-band ultraviolet B
(UVB) light. Recent studies have demonstrated effi-
cacy of the 308-nm XeCl laser in the treatment of
35:4:APRIL 2009 567
ELSAIE ET AL
psoriasis
50
and vitiligo.
51
The 308-nm XeCl laser has
the advantage over standard phototherapy of having
greater precision and the ability to deliver higher
energy fluences to the target tissue in less time.
It is also possible that UVB radiation delivered in
the form of laser light has a different light–tissue
interaction, which may cause greater efficacy.
52
After the use of the excimer in many hypopigmen-
tary conditions, it was used for striae alba. Two
studies have shown temporary repigmentation
and improvement of leukoderma in SD with excimer
laser. Post-laser biopsies showed greater melanin
content and hypertrophy of the melanocytes,
although it failed to show any improvement in
skin atrophy.
53,54
Copper-Bromide Laser
The copper-bromide laser is a 577-nm laser that is
only mentioned once in the literature as being used
for stretch marks. One study treated 15 patients with
different stretch marks on different areas of the body,
exposing them to laser settings of 4 J/cm
2
for SD
on the breast in women or 8 J/cm
2
for SD on
other parts of the body. The study concluded that the
copper-bromide laser was effective in decreasing
the size of the SD, although further studies are
needed to determine the ideal parameters and the
number of sessions needed for an optimum re-
sponse.
55
1,450-nm Diode Laser
The diode laser is a midinfrared greater-than-700-nm
non-ablative laser technology with an integrated
dynamic cooling device. In recent clinical trials, this
type of laser has demonstrated efficacy in the dim-
inution of rhytides, treatment of active acne, and
improvement of atrophic scars.
56
Only one study
examined the efficacy and safety of diode laser in the
treatment of 11 patients, Fitzpatrick skin types IV to
VI. Patients were assigned randomly to receive 4, 8,
or 12 J/cm
2
fluences, and treatment sessions were
offered every 6 weeks for a total of three sessions.
The incidence of postinflammatory hyperpigmenta-
tion was 64%, and there was no improvement
in the SD. It was concluded that, for skin types IV
to VI, treatment of SD is not useful, and the
incidence of postinflammatory hyperpigmentation is
significant.
57
1,064-nm Nd:YAG Laser
The 1,064-nm long-pulse Nd:YAG laser has also led
to an increase in dermal collagen when used in the
TABLE 3. Summary of Different Laser and Light Source Treatments for Stretch Marks
Type of Laser Effectiveness in Striae Distensae
Pulsed dye laser Demonstrated to be effective only for the immature element of striae (striae
rubrae), targeting the vascular element. Not effective in darker skin and as-
sociated with pregnancy-induced hypertension. When combined with radio
frequency, it showed a more promising response even on striae alba.
46–48
Copper bromide laser A 577-nm laser that showed a mild to moderate effect in one study on skin types
II and III; no histological analysis was carried out. Needs much evaluation.
55
1,450 nm diode laser Not useful in skin of color (IV–VI) and associated with many complications.
57
1,064 neodymium-doped
yttrium aluminium garnet
laser
Targets immature striae and satisfactory results in the few studies so far.
58–60
Excimer laser A 308-nm xenon-chloride laser with a good safety profile, although only repig-
ments temporarily and does not have an effect of atrophy.
53,54
Intense pulsed light A good alternative that was shown to be an effective tool in striae alba, although
with a high incidence of pregnancy-induced hypertension.
63
Fractional photothermolysis Fewer studies conducted, although all reported efficacy in mature and immature
striae and demonstrated an increase in the number of collagen and elastin
fibers and a good safety profile.
70–73
DERMATOLOGIC SURGERY568
STRIAE DISTENSAE AND DIFFERENT THERAPIES
nonablative treatment of facial wrinkles.
58
In addi-
tion, this laser has a strong attraction to vascular
targets
59
that, associated with its action on dermal
collagen, can lead to the beneficial effects observed
in the treatment of immature SD. The histopatho-
logic characteristics present in immature SD are
similar to those found in recent scars.
60
This would
explain why scars also show a significant improve-
ment after treatment with the 1,064-nm long-pulse
Nd:YAG laser. A recent study used the 1,064-nm
Nd:YAG on immature SD in 20 patients, and
observers and patients identified results as satisfac-
tory.
61
Owing to its physical characteristics, repre-
sented mainly by the 1,064-nm wavelength, the laser
used is safe. Complications rarely result when the
device and parameters are appropriately used in
epilation or vascular alterations, even in patients
with dark skin. In addition, the cooling of the SD
before and immediately after the use of the laser
represents another factor in epidermal protection.
More research will be devised for a better cosmetic
outcome and approach using the Nd:YAG lasers.
Intense Pulsed Light
Intense pulsed light (IPL) seems to be a good alter-
native treatment for SD. IPL is characterized by a
noncoherent filtered flashlamp with a broadband
spectrum (515–1,200 nm). Hernandez and col-
leagues used the IPL for 20 Hispanic patients of skin
types III and IV and on long-standing mature SD of
the abdomen. All patients received five sessions, and
the stretch marks were biopsied before and after
therapy. The study demonstrated an overall signifi-
cant difference in the post-dermal treatment thick-
ness and in the skin textures of the older stretch
mark lesions.
62
Studies have demonstrated that IPL
replaced dermal elastosis with neo-collagen, which
explains its usefulness in improving stretch marks.
63
UVB/UVA1 Combined Therapy
The MultiClear device (Curelight Ltd., Gladstone,
NJ) is a unique device combining UVB and selective
UVA1 wavelengths and emitting a high-intensity
noncoherent light with peaks at 313, 360, and
420 nm. It is currently approved by the Food and
Drug Administration (FDA) for use in UVB photo-
therapy as well as psoralen plus UVA phototherapy
to treat psoriasis, vitiligo, atopic dermatitis, and
hypopigmented scars. The device achieves a repig-
mentary effect of unknown length because of the
lack of studies conducted. A study was conducted on
nine patients with mature striae alba who received
10 treatment sessions, and biopsies were taken at the
baseline and end of the study. At the end of the study,
all patients reported some form of hyperpigmenta-
tion that was transient and did not affect any sur-
rounding tissues. No changes were seen on biopsy to
indicate an effective remodeling collagen effect of the
device, although it needs further assessment.
64
There
have been no reports of greater incidence of skin
cancer development with this form of phototherapy,
but further research is prudent before establishing a
safer profile of the device.
64
Fractional Photothermolysis
Fractional photothermolysis is a newer, nonablative
resurfacing laser technique. This 1,550-nm laser
creates microzones or microthermal zones (MTZs)
of ‘‘injury’’ onto the skin. Within these areas, local-
ized epidermal necrosis occurs alongside collagen
denaturation. Ultimately, the necrotic debris is ex-
pelled, and neocollagenesis occurs. Additionally,
because this laser treatment is nonablative, the is-
lands of normal skin serve to speed the healing
process. Fractional photothermolysis has been FDA
approved for dermatological procedures requiring
the coagulation of soft tissue; treatment of perior-
bital wrinkles; treatment of acne scars and surgical
scars; photocoagulation of pigmented lesions such as
lentigos (age spots), solar lentigos (sun spots), me-
lasma, and dyschromia; and skin-resurfacing
procedures.
65
There are several studies confirming the efficacy of
fractional photothermolysis for treatment of facial
scarring. Glaich and colleagues reported on seven
patients who were treated with fractional photo-
thermolysis for hypopigmented scars (secondary
35:4:APRIL 2009 569
ELSAIE ET AL
to inflammatory acne or gas fire burn). Patients
received two to four treatments at 4-week intervals.
No adverse events were noted. Independent physi-
cian clinical assessment revealed improvements of
51% to 75% in hypopigmentation in six of seven
patients 4 weeks after final treatment.
66
Alster and
colleagues reported on 53 patients who were treated
with fractional laser photothermolysis for atrophic
scars. No complications or adverse events were
noted. Ninety-one percent of patients had at least
25% to 50% improvement after a single treatment;
87% of patients receiving three treatments had at
least 51% to 75% improvement in the appearance
of scars after 1 month, with stable improvement
after 6 months.
67
Hasegawa and colleagues treated
10 patients with acne scars using fractional
photothermolysis. There was no hyperpigmentation
reported, and results as seen by patients were
successful.
68
The histopathologic characteristics present in im-
mature SD are similar to those found in recent
scars.
60
Some authors using hematoxylin and eosin
or orcein stain reported evidence of new collagen
formation and demonstrated an overall increase in
the density of collagen after fractional photo-
thermolysis.
69
This mechanism is the anticipated
mode of reversing the signs and atrophy associated
with stretch marks using fractional photothermoly-
sis, the technology receiving the most attention in
this regard. There are a few published studies on SD
and fractional resurfacing. A 2007 Brazilian clinical
study showed that Fraxel improved texture and ap-
pearance of mature, white SD in skin types I to IV.
Fifteen female patients, skin types I to IV, with
mature SD were treated with fractional photo-
thermolysis (1,550 nm Fraxel SL Laser). Treatments
included four to five sessions at weekly intervals,
pulse energy of 8 to 10 mJ/MTZ, and a final density
of 2,000 MTZs/cm
2
. The treatment response was
assessed by comparing pre- and 2-week post-treat-
ment clinical photography evaluated by two
physicians and patient questionnaires. The study
demonstrated an early new indication for stretch
mark treatment with Fraxel.
70
A Korean study
used fractional photothermolysis on four patients of
skin type IV with striae gravidarum. All patients
received just one treatment and were assessed
visually and histologically using skin biopsy. The
histology showed an increase in the number of elastic
fibers, and no side effects were demonstrated.
71
A
more recent study treated six patients with fractional
photothermolysis, and they all showed clinical
improvement in melanin and erythema indices and in
elasticity. The authors demonstrated an increase in
collagen and elastin deposition in the dermis.
72
The optimal settings and parameters to use have
not been decided upon, but investigators have
shown promising results with three to five
treatments sessions with their therapeutic
approaches.
73
Microdermabrasion
Aluminum oxide resurfacing has become a popular
method of resurfacing. Microdermabrasion is effec-
tive in many skin conditions such as acne scars,
mottled pigmentation, and fine wrinkles.
74
It has been
established too that microdermabrasion induces epi-
dermal signal transduction pathways that are associ-
ated with remodeling of the dermal matrix.
Microdermabrasion appears to set in motion a cas-
cade of molecular events capable of causing dermal
remodeling and repair.
75
There is a paucity of liter-
ature about the efficacy of microdermabrasion in
stretch mark therapy, but Mahuzier in his text book
on microdermabrasion stated that 10 to 20 sessions of
microdermabrasion at an interval of not less than 1
month, each session resulting in bleeding points,
provide satisfactory improvement in SD.
76
Amore
recent Egyptian study on the clinical and molecular
evaluation of treating SD with microdermabrasion
demonstrated a promising effect of dermabrasion on
stretch marks. The study used 20 patients with SD
receiving five microdermabrasion treatments at
weekly intervals on half of the body; SD on the other
half of the body served as a control. Biopsies from
patients were analyzed using real-time reverse tran-
scriptase polymerase chain reaction for assay of type I
procollagen I-mRNA levels. The results showed an
DERMATOLOGIC SURGERY570
STRIAE DISTENSAE AND DIFFERENT THERAPIES
overall good to excellent response in more than half
of the subjects, with improvement more marked in
striae rubra, and upregulation of type I procollagen
mRNA was found in all treated SD samples.
77
Further
studies on a larger scale are needed to identify the
efficacy of using such techniques for stretch marks.
Radiofrequency Devices
The use of radiofrequency (RF) devices have been
reported to be an effective and safe noninvasive
technique to tighten the face and neck skin. Unlike
lasers, which convert light to heat and target a spe-
cific chromophore through the selective photo-
thermolysis, RF devices transfer higher-energy
fluences to the skin through a coupling method. The
electrical energy transmitted is converted to heat
upon reacting with the skin’s resistance.
78
It is re-
ported that collagen fibril contraction occurs imme-
diately after RF treatments, which induces new
collagen formation.
79
A recent study evaluating the
effectiveness of a RF device (Thermage, Thermacool
TC, Thermage Inc., Hayward, CA) in combination
with PDL subjected 37 Asian patients with darker
skin tone with SD to a baseline treatment with a RF
device and PDL. This was followed by an additional
two sessions of PDL performed at weeks 4 and 8.
Histological evaluation was done on nine patients
who were selected randomly; 89% of the patients
showed good to very good overall improvement, and
59% were graded as good and very good in elastic-
ity. All histological evaluations demonstrated an in-
crease in the amount of collagen fibers, and six of the
nine specimens showed an increase in the number of
elastic fibers. Hyperpigmentation developed in one
study subject only and improved in 3 months.
80
The
effects of using RF devices in combination with la-
sers are yet to be decided, but preliminary studies
show a synergistic, effective, safe modality that could
be a good alternative for stretch mark therapy.
Summary
The complete evaluation of a patient with SD should
include consideration of the SD stage (rubrae or
alba) and of the skin type. Expectations must be
realistic, and the optimal treatment modality should
be carefully selected to avoid any exaggeration of the
problem or complications. The therapeutic strategies
are numerous, and no single modality has been far
more consistent than the rest. Fractional photo-
thermolysis, despite the smaller number of prelimi-
nary studies, shows much promise in dermal
remodeling and subsequent improvement of white
and pigmented SD. Finally, more research and clin-
ical trials should be encouraged to address this cos-
metic problem of concern to a large segment of
women worldwide.
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Address correspondence and reprint requests to: Moha-
med L. Elsaie, MD, MBA, Department of Dermatology
and Cutaneous Surgery, University of Miami, 7401 N.
Meridian Avenue, Nichol Building, Miami Beach, Fl
33140, or e-mail: egydoc77@yahoo.com
35:4:APRIL 2009 573
ELSAIE ET AL
... However, the efficacy of the treatment is uncertain. Moreover, some lasers have side effects, and the results are not satisfactory [7]. One promising treatment for striae is radiofrequency (RF) wave. ...
Article
Full-text available
ABSTRACT Introduction: Striae distensae present with structural change of collagen bundles, elastolysis and cellular infiltration, that led to skin flattening, discoloration, and scarring. There is no standard treatment nowadays. Fractional radiofrequency (RF) is a radio transmission that generates thermal effect that promote wound healing effect and stimulate collagen and elastin production. Microneedling is an alternate modality that can also stimulate collagen production. Objective: This study aimed to compare the efficacy and the safety of a combined fractional radiofrequency and microneedling versus fractional radiofrequency alone for treating striae distensae. Methods: This was a prospective, randomized-controlled, assessor-blinded, intra�individual split-side comparative, experimental study. Inclusion criteria included all participants aged 18-50 years with Fitzpatrick’s skin type III and IV with bilateral sides of striae alba. All participants were randomly assigned to be treated with combined fractional RF and microneedling therapy on one side of the body or fractional RF alone in contralateral side for 3 sessions. The primary outcome was the Global Aesthetic Improvement Scale (GAIS). The secondary outcomes included the width and length of striaes, patient’s satisfaction’s score, and adverse events. Results: There were 22 participants with the mean (SD) of 29 (7.8) years and 90.9% were female (n=20). The GAIS, assessed by two blinded dermatologists was significantly better improved in the combination group than fractional RF alone group at 4, 8, and 12 weeks (p < 0.05). The striae width and length significantly decreased in both groups without significant differences. There was no difference in patient’s satisfaction score at week-12 visit between the 2 groups. Common adverse event included post-inflammatory hyperpigmentation (PIH) (36.4%) in the combination group and (27.3%) in fractional RF alone group without significant difference. Conclusion: A combination of fractional radiofrequency and microneedling had better clinical efficacy in term of GAIS than fractional radiofrequency alone in treating striae distensae.
... Recent research on estrogen receptors in the extracellular matrix suggests the importance of estrogen in the development of striae [30] . When estrogen, androgen and glucocorticoid receptors in the skin of patients with striae were compared to those in healthy skin, their number was actually double [31] . These findings indicate that under certain conditions, there is an increase in hormone receptor expression in the skin. ...
Article
Full-text available
Langer’s lines are still the recommendation and matrix for surgical incisions in most surgical textbooks, even if they were never meant to be by their first describer in 1861. To achieve minimal scarring, surgeons should attempt to make incisions parallel to skin tension lines, i.e., in skin folds or skin creases. On the basis of visible stretch marks (striae distensae) in the skin, which always appear in the same direction against skin tension in men and women, the direction of skin tension lines can be manifested also in the skin of children and young patients. These invisible or virtual tension lines are the same as the main folding lines (MFL) in adults and run perpendicular to the stretch marks. While well-established on the face and abdomen, these folding lines may not be obvious on other parts of the body. On chest, back and extremities, optimal direction of surgical skin incisions should take into account the patterns of striae distensae, which develop perpendicular to skin tension lines. MFL should be used in elective incisions in children, adolescents, and young women as a guide for the prevention of later visible hyper- or hypotrophic scars.
... Although different therapeutic approaches are currently available, the treatment of stretch marks remains a challenge. Several and numerous treatments have been proposed, but with poor results [41]. For SD treatment, various laser parameters have been examined, alone or in combination with other treatment methods. ...
Article
Full-text available
A large part of the world’s population suffers from Striae distensae (SD) or stretch marks, which create physical and psychological discomfort in people. We evaluate the SD clinical improvement by using a non-ablative fractional Nd:YAP 1340 nm laser. The research was performed on 25 patients of both sexes, with a mean age of 31 ± 13.09 years. Each patient underwent from a minimum of 3 to a maximum of 4 treatments, with an Nd:YAP (1340 nm) medical device, every four weeks, with 3- and 6-month follow-up, in these areas: back, abdomen, breast, flanks, lower limbs, buttocks, and thighs. Manchester Scar Scale assessed stretch marks improvement. Side effects, patient pain, and SD overall appearance improvement were also recorded for all patients. Digital photographs measured the aesthetic results. Treatment was well-tolerated (pain score 1.08 ± 0.76) by all patients. There were no long-term side effects, and 88% of patients revealed an SD excellent improvement showing good aesthetic results achieved by the treatment. The total mean pretreatment Manchester Scar Scale score decreased from 13.80 (±1.58) to 10.36 (±1.70) after 3 months (p < 0.01) and to 8.36 (±1.07) after 6 months (p < 0.01). An Nd:YAP (1340 nm) laser seems to be a safe and effective treatment, showing a higher security profile with no side effects.
... As the dilated venules and perivascular infiltrate of lymphocytes present in SD lesions are the desirable targets of the Nd: YAG laser due to their content of oxyhemoglobin, the LP Nd: YAG laser causes deposition of a good energy packet in the dermal tissue. 18 When the LP Nd: YAG laser is absorbed by the dermal vessels, an increase in the temperature around these vessels is produced, causing thermal damage sufficient to trigger wound healing and collagen remodeling. 5 Moreover, this laser stimulates the formation of new collagen fibers augmenting the improvement of stretch marks. ...
Article
Introduction: Stretch marks, or striae distensae (SD), are the lesions of the dermis caused by its linear atrophy at the sites of stretching. They occur in more than 70% of pregnant women and adolescents as a result of cutaneous stretching. This study aimed at evaluating and comparing the clinical and histological efficacy of the fractional CO2 laser versus the long pulsed (LP) Nd: YAG laser in the treatment of striae alba. Methods: Thirty female subjects having bilateral symmetrical stretch marks were managed by the LP Nd: YAG laser on the right side and the fractional CO2 laser on the left side. The laser treatment course consisted of 3 sessions with an interval of 3 weeks. The patient satisfaction score and the Global Aesthetic Improvement Scale (GAIS) were employed in the study in order to assess the improvement 3 months after therapy. Punch biopsies measuring 4 mm were extracted from one lesion on each side at baseline and after the last treatment session by 3 months to evaluate the thickness of both collagen and epidermis Results: Clinical improvement was more significant in the lesions treated by the LP Nd:YAG laser than those treated with the fractional CO2 laser. The patient satisfaction score and the GAIS were higher with a statistically significant value in the side treated by the LP Nd:YAG laser. Collagen and epidermal thickness increased more in the LP Nd: YAG laser-treated lesions in comparison to their thickness in the fractional CO2 laser-managed lesions, but this difference did not have a statistical significance. Conclusion: The clinical efficacy of the LP Nd-YAG laser exceeded that of the fractional CO2 laser in the treatment of striae alba without severe side effects in spite of the insignificant histological difference between the two lasers.
... Nardelli [13] first described stretch marks as linear scars resulting from the stretching of the skin. These changes occur in all races and have the same clinical appearance regardless of the cause. ...
Article
Background Striae distensae (SD) or stretch marks are a common dermatological condition where the dermis becomes scarred. This phenomenon is associated with many risk factors. This study aimed to evaluate the clinical variables and risk factors in patients with SD in Riyadh, Kingdom of Saudi Arabia (KSA). Methods A cross-sectional study was conducted to assess the clinical variables and risk factors for stretch marks among adults in Riyadh, KSA. An electronic questionnaire with an informed consent section was distributed randomly to a sample of adult patients in Riyadh city, KSA, from April to June 2021. A sample size of 512 participants was calculated using the Cochran formula (n = Z2pq/e2), considering 95% confidence and precision of at least ±5%. A 95% confidence level yielded Z values of 1.96, per the normal tables. Results A total of 512 participants were included in this study. This study found that 41.4% of the participants were aged 15 to 25 years of which, 70.4% of the participants were females, and 38.2% had a body mass index (BMI) of 24 or more. More than half of the participants (54.0%) indicated white skin color. The most prevalent area of striae, as reported by the participants, was the abdomen (57%). Around 19.1% of the participants with stretch marks stated that they were smokers, and 23.9% stated that they were obese o, had a chronic condition such as hypertension or diabetes mellitus. The majority of the participants (70.5%) had a family history of stretch marks. Conclusions This study showed that the prevalence of stretch marks was higher in females, younger participants, smokers, participants with a family history of stretch marks, and participants with a higher BMI and multiparity. More studies should be conducted to assess the correlations between these factors and the presence of stretch marks, and their influence on the quality of life of individuals.
... Although little is known about the molecular pathogenesis of SG ( Korgavkar and Wang, 2015 ;Mitts et al., 2005 ;Salter and Kimball, 2006 ;Wang et al., 2015 ;2018 ), numerous risk factors predispose women to developing lesions, such as a family history of SG, personal history of SD on the breasts or thighs, and young maternal age ( Al-Himdani et al., 2014 ;Atwal et al., 2006 ;Chang et al., 2004 ;Osman et al., 2007 ). Interestingly, there are conflicting reports regarding the role of skin stretching as a risk factor ( Arem and Kischer, 1980 ;Mitts et al., 2005 ;Poidevin, 1959 ;Wang et al., 2015 ), as increased maternal baseline weight, maternal weight gain during pregnancy, abdominal and hip girth of the mother during pregnancy, and neonatal weight have inconsistently been associated with the emergence of lesions ( Al-Himdani et al., 2014 ;Atwal et al., 2006 ;Chang et al., 2004 ;Davey, 1972 ;Elsaie et al., 2009 ;Osman et al., 2007 ;Picard et al., 2015 ;Poidevin, 1959 ). ...
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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.
... However, there is no unified evaluation parameters about striae gravidarum. In some researches, subjective evaluation and relatively single objective parameters were used as observation parameters [13,21,22]. Keisha evaluated the striae gravidarum by scoring from 0 (no striae) to 4 (severe striae) [13]. ...
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Background Striae gravidarum is a common occurrence in pregnancy and many women expect to prevent its development. At present, laser treatment has been used to improve the appearance of striae gravidarum, but the choice of laser type, treatment time, and frequency depend on the therapeutic effect. How to obtain an effective evaluation of striae gravidarum during and after treatment is very important. However, there is no unified evaluation parameter about striae gravidarum. In this paper, we studied the methodology evaluation of striae gravidarum severity. First, the laser therapeutic apparatus was selected as the experimental equipment and different striae gravidarum photos during treatment were obtained. Second, the subject evaluation parameters were chosen based on the literature research and the dermatologists’ guidance. Then, the striae gravidarum photos were divided into different groups by dermatologists based on these parameters. Finally, the objective detection parameters were designed based on the photos feature and subject evaluation parameters. Then, the objective detection parameters were used as the input of the support vector machine and the evaluation results were compared. Results Based on the subject evaluation parameters, the experimental data could be divided into mild, moderate and severe groups. The experiment results showed that the striae gravidarum severity of two randomly patients were improved before and after treatment, which verified the validity of the parameters. In addition, the chosen objective detection parameters were different among different groups. With all the objective parameters as the support vector machine input, we could achieve the best recognition rate (82.71%) in the striae gravidarum severity classification. The four parameters (color difference, average density, average width, distribution area) calculated from the photos as the input could achieve acceptable accuracy (81.69%). Conclusions The subject evaluation parameters and objective detection parameters proposed in this paper can be used to evaluate the striae gravidarum severity, which is of great significance for the construction of auxiliary diagnostic instrument for striae gravidarum treatment.
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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Objective: This manuscript provides a review of the relationship between patients with an underlying eating disorder (ED) and the presence of striae distensae (SD). Researchers and clinicians have recognized many different skin manifestations associated with EDs. According to the Diagnostic and Statistical Manual of Mental Disorders, EDs include, but are not limited to, anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). The presence of specific skin findings often helps clinicians conclude whether or not a patient may have an underlying ED and require further evaluation. One skin finding associated with an ED with little current literature focus is SD. SD arises from a combination of hormonal imbalances and stretching of the dermis, triggering a local inflammatory response. The presence of SD leaves patients with diminished quality of life. There is no single guideline treatment for SD; however, topical and/or light and laser therapies can be utilized. Method: Using online medical literature databases and the PRISMA guidelines, 11 out of 574 articles met the acceptable criteria to be analyzed, emphasizing the lack of current literature on this subject. Results: Anxiety and depression were comorbidities demonstrated to be strongly related to AN and obesity, secondary to BED, in patients who developed SD. Higher degrees of suicidal ideation and insomnia, along with lower self-esteem levels, were more likely to be present in these patients. Conclusion: Altogether, this review highlights the importance of continued evaluation of SD and its overall impact on patient's mental health, emphasizing an underlying ED.
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BACKGROUND: Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL. OBJECTIVE: To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL. METHODS: Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used. RESULTS: All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness. CONCLUSION: Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.
Article
BACKGROUND: 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. OBJECTIVE: To assess gross and microscopical changes that occur in the striae distensae when treated by IPL. METHODS: 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. RESULTS: 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. CONCLUSION: 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
Striae distensae are difficult to treat. Several modalities have been used with moderate success. Fractional photothermolysis offers a novel treatment option for abdominal striae distensae. A 25-year-old white female patient (case 1) and a 39-year-old white female patient (case 2) with abdominal striae distensae were treated with fractional photothermolysis (1550-nm Fraxel SR laser). Multiple treatment sessions (2 for case 1 and 3 for case 2) were performed one month apart at 16 mJ and 125 microthermal zones for a total density of approximately 2000 microthermal zones/cm 2 for each treatment. Pretreatment and posttreatment clinical photographs (taken one month after the last treatment) and patient satisfaction ratings were used to assess treatment efficacy. An independent physician evaluator reported that a 50% clinical improvement in case 1 and a 45% clinical improvement in case 2 were achieved one month after the last treatment based on clinical photographs. Both patients measured their response rates as "significantly improved." Minimal to no side effects were noted. Clinical improvement continued at follow-up at 4 and 6 months. Fractional photothermolysis offers a new, safe, and effective treatment for abdominal striae distensae.
Article
Tensile properties of skin determine some important physical attributes of skin. They may be conveniently assessed using recent technologies. The aim of the study was to compare ex vivo the tensile properties of normal looking skin and striae distensae. The Cutometer was used with 2 and 4 mm diameter probes. Skin distensibility values were dependent on the suction force and area of the skin tested. Conversely, tensile ratios yielding elasticity parameters were not affected by the same variables. Although tensile properties of excised normal skin resembled thosepreviouslyreported in vivo, striaedistensae showed markedly different properties in vivo and ex vivo. The ex vivo and in vivo evaluations of the tensile properties and functions of skin are complementary particularly when the connective tissue is abnormal.
Article
BACKGROUND: 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. OBJECTIVE: The purpose was to evaluate the effectiveness of the Thermage in combination with pulsed dye laser. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: The Thermage and pulsed dye laser appear to be an effective treatment for striae distansae.