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Management of stretch marks (with a focus on striae rubrae)

Authors:
  • Städtisches Klinikum Dresden

Abstract

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.
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© 2018 Journal of Cutaneous and Aesthetic Surgery | Published by Wolters Kluwer - Medknow
124
Review Article
Management of stretch marks (with a focus on striae rubrae)
Uwe Wollina, Alberto Goldman1
Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany, 1Clinica Goldman, Porto Alegre/ RS, Brazil
Abstract
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.
Keywords: Lasers, stretch marks, striae albae, striae rubrae, therapy
IntroductIon
Stretch marks or striae distensae (syn. striae gravidarum)
are common cutaneous adverse reactions caused during
pregnancy affecting approximately 50–90% of pregnant
women. Stretch marks are seen in other conditions as well,
such as rapid weight gain (obesity), muscle hypertrophy
(bodybuilders), endocrinopathies (such as Cushing
syndrome), breast augmentation, or as a side effect of
topical corticosteroid use and abuse. They are a rare
complication when using tissue expanders. Stretch marks
are most commonly seen on thighs, abdomen, female
breasts, and upper arms in males.[1-6]
In pregnant women, independent predictors of stretch
marks have been identified: Younger age, maternal and
family history of stretch marks, increased pre-pregnancy
and predelivery weight, increased birth weight, and the
absence of chronic disease.[7-9] In pregnant women, itching
stretch marks may be a sign of herpes gestationis.[10]
Histological studies argue for a primary disruption of the
normal elastic fiber network. Instead of normal fibrils,
short, disorganized, thin, threadlike fibrils emerge in the
mid-to-deep dermis. These fibrils are rich in tropoelastin
and persist into the postpartum period without forming
normal-appearing elastic fibers. This is accompanied by
increased gene expression of tropoelastin and fibrillin-1.[11]
The disruption of elastin fiber network results in
changes in viscoelastic properties of affected skin,
which is significantly less firm, less elastic, and less
deformable than normal skin. Light scattering values are
significantly lower in stretch marks compared to adjacent
skin. Scattering values suggest an altered collagen fiber
structure in the dermis with parallel collagen bundles.[12]
No difference was observed in skin barrier function and a
slight difference was observed in skin hydration between
the stretch marks and uninvolved skin. Diffuse reflectance
spectroscopy showed no differences in the apparent
hemoglobin concentrations between stretch marks and
controls.[13] Skin pigmentation is significantly lower in
stretch marks compared to adjacent skin.[12]
Immunohistochemical studies suggested a significant
increase of estrogen, androgen, and glucocorticoid
receptors in stretch marks.[14] Pregnant women with
stretch marks have lower serum relaxin levels compared
to those without stretch marks at 36th gestational
week, 330.8 ± 175.2 vs. 493.8 ± 245.8 pg/mL (P=0.037).
However, there is no correlation between the severity of
stretch marks and serum relaxin levels.[15]
Address for correspondence: Uwe Wollina, MD,
Department of Dermatology and Allergology, Academic Teaching Hospital
Dresden, Friedrichstr. 41, 01067 Dresden, Germany.
E-mail: wollina-uw@khdf.de
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How to cite this article: Wollina U, Goldman A. Management of
stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg
2018;10:124-9.
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Wollina and Goldman: Management of stretch marks
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 10 ¦ Issue 3 ¦ July-September 2017 125
There is a characteristic feature of maturation of stretch
marks, which emerge as striae rubrae but eventually shift
to striae albae. Although striae rubrae are erythematous,
sometimes edematous, striae albae are depressed atrophic
scars with wrinkling surface.
Treatment targets are dermal collagen production,
vascularity (in striae rubrae), wrinkling, and roughness of
skin.[16]
AvAIlAble treAtments
Prevention of stretch marks
A number of topical treatments has been advertised for the
prevention of stretch marks. In a critical review, Korgavkar
and Wang[17] concluded that there is limited evidence that
centella, and possibly massage with bitter almond oil,
may prevent stretch marks. Weak evidence is present for
the use of topical hyaluronic acid. Acontrolled trial with
olive oil and Saj® cream demonstrated that neither of
these interventions could prevent stretch marks during
pregnancy.[18] Other authors came to the conclusion that
topical treatments are unable to prevent stretch marks.[19-21]
Reduction of severity of stretch marks with non-laser
approaches
In general, early stretch marks, i.e., striae rubrae, respond
better to treatment than the older lesions, i.e., striae
albae. Therefore, we focus on early stretch marks unless
otherwise mentioned.
A randomized, double-blind, placebo-controlled study
in pregnant women indicates that the severity of stretch
marks can be reduced by topical application of emollient
and moisturizer containing hydroxyprolisilane C, rose
hip oil, Centella asiatica triterpenes, and vitamin E.[22]
It seems that moisturizers are the critical component of
topical preparations for the treatment of stretch marks
and it is questionable, if there is an add-on effect of other
ingredients.[23]
In a prospective randomized open trial, microdermabrasion
was found to be as effective as the daily application of
topical 0.05% tretinoin cream in the reduction in the
severity of early stretch marks.[24] Microdermabrasion in
combination with topical platelet-rich plasma was found
to be more effective in reducing stretch mark severity than
the single component.[25] To enhance penetration of topical
tretinoid cream, ablative radiofrequency was combined
with ultrasound. In a pilot trial, striae albae improved by
this combined approach.[26]
In a pilot study with 16 females, noninvasive multipolar-pulsed
electromagnetic field and radiofrequency energy–generating
treatment resulted in some improvement in the length and
widths of stretch marks.[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.[30]
A pilot study with tripolar radiofrequency device for
1 week suggested a reduction in the severity of stretch
marks in women.[31]
In a comparative trial, 22 men and women with abdominal
striae were included. The abdomen was divided into four
equal quadrants. Bipolar radiofrequency potentiated with
infrared light and fractional bipolar radiofrequency were
applied, alone or in combination, and one quadrant was
left untreated. Of the 384 striae that were measured, the
mean depth was decreased by 21.6% at 6month follow-up
with the combined approach. The width of stretch marks
was not affected by any treatment. Histologically, thicker
collagen fibers were noted after treatment.[32]
All these studies support the fact that any type of
controlled damage or lesion mainly in early striae can
improve their aspect. They also support our results using
laser energy as alternative in the treatment.
lAser-bAsed treAtments
Several treatments have been proposed in an attempt
to obtain esthetic improvement of striae. Depending
on their extent, location, and the personal perception
of the patients, stretch marks may cause great esthetic
dissatisfaction and have a profound negative impact
on their self-esteem. Laser therapy has represented a
breakthrough in the approach to striae, in particular striae
rubrae.
The natural course of stretch marks argues for an
increased vascularity in the early lesions (striae rubrae).
Hence, here, vascular lasers should have a beneficial effect,
as hemoglobin is working as a chromophore for specific
lasers acting in this vascularity.
The 585-nm pulsed dye laser with a 10-mm spot size
using 3.0 J/cm2 fluence improved the appearance of striae
in a small study. Histologic evaluation argued for the
restoration of normal elastin fiber network.[33] The effect
has been scored as moderate for striae rubrae, but there is
no beneficial effect on striae albae.[34] Other groups observed
some beneficial effects using the flashlamp-pumped pulsed
dye laser (585 nm). Striae width was decreased and skin
texture was improved. Collagen expression was increased
with the exception of collagen I.[35] In ethnic skin (skin
types 4–6), such treatment should be avoided because of
the risk of permanent pigmentary changes.[36]
The copper bromide laser (577–511 nm) has been
evaluated in an Italian pilot trial for female patients,
Fitzpatrick phototype II–III, with a 2-year follow-up. The
authors described a mild beneficial clinical and histologic
effect on stretch marks.[37]
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Wollina and Goldman: Management of stretch marks
126 126 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 10 ¦ Issue 3 ¦ July-September 2017
Three treatments carried out 6 weeks apart with a 1450-nm
diode laser, 6-mm spot size, fluence between 4 and 12 J/cm2,
and dynamic cooling device, to protect the epidermis, did
not result in any improvement of stretch marks.[38]
A trial with the 1064-nm long-pulsed neodymium-doped
yttrium aluminium garnet (Nd:YAG) laser, spot size
of 2.5 mm, fluence of 80–100 J/cm2, and a frequency
of 2 Hz in 20 patients with striae rubrae resulted in
excellent results in 40% (physician’s assessment) and 55%
(patient’s assessment) [Figures1-4]. The average number
of treatments carried out 3 to 6 weeks apart was 3.5.
Observed side effects were mild and temporary such as
minimal edema and erythema, which lasted from a few
hours to a maximum of 3days.[39]
In a trial with 45 patients, efficacies of two fluences (75 and
100 J/cm2) of long-pulsed Nd:YAG laser on stretch marks
were compared. Spot size was 5 mm, pulse duration was
15 ms. Clinical and histological evaluation was performed
3months after treatment. Asignificant improvement in the
appearance of striae albae was seen with 100 J/cm2 fluence,
whereas striae rubrae showed a better improvement with
75 J/cm2. Histologically, the dermal content of both
collagen and elastin fibers increased.[40]
A trial comparing the efficacy of 1064-nm long-pulsed
Nd:YAG laser and 2940-nm variable square pulse
erbium yttrium aluminium garnet (Er:YAG) laser in
the treatment of striae albae could produce histological
improvement but no significant clinical improvement with
either treatment modalities.[41] A variable square pulse
Er:YAG laser resurfacing was performed in 21 women
of Fitzpatrick phototype ≥III with short pulse or smooth
mode twice with an interval of 4 weeks in between. Skin
roughness, skin smoothness, and surface of stretch marks
improved by both the modes. An adverse event in ethnic
skin is hyperpigmentation lasting as long as half a year.[42]
The 2940-nm Er:YAG ablative fractional laser can be
combined with other treatment modalities to improve striae
albae. In a study with 30 females with stretch marks, ablative
laser was applied 6 times at 4-week intervals. This treatment
was followed by topical application of recombinant
bovine basic fibroblast growth factor for 1 week. This was
followed by red light-emitting diode once every week for
three sessions between the two laser treatments. Clinical
improvement was noted for up to 12months posttreatment.
Post-procedural skin biopsies demonstrated an increase
in epidermal and dermal thickness, collagen, and elastin
density compared to baseline.[43]
In a comparative trial, patients with striae albae treated
with either 1550-nm fractional Er:glass laser or ablative
fractional CO2 laser achieved clinical and histologic
improvement.[44] A smaller group of patients with striae
rubrae after breast augmentation also benefited from the
1550-nm Er:glass laser.[45]
Treatment of stretch marks in Asian women with a
1550-nm fractional laser improved stretch marks clinically.
Skin elasticity was found to be partially normalized. Skin
biopsies argued for a significant increase in epidermal
thickness, collagen, and elastic fiber deposition after
fractional laser therapy. Adverse effects included mild and
transient pain and hyperpigmentation.[46] The Er-doped
fractionated 1550-nm laser has been recommended for the
treatment of stretch marks in a consensus conference.[47]
Ten women with stretch marks (striae albae) and
Fitzpatrick skin types III–V were treated with non-ablative
1540-nm fractional laser four times at 4-week intervals.
The fluence was 50–70 J/cm2. There was a clinically
appreciable improvement in striae ranging from 1% to 24%.
Three months after the final treatment, patients showed
noticeable improvement in the striae, when compared with
baseline. Mild post-inflammatory hyperpigmentation was
observed in a single patient.[48] This laser type has also been
Figure 1: Striae gravidarum in the abdomen. Before (a) and after (b) single
session of 1064-nm long-pulsed Nd:YAG laser
Figure 2: Stretch marks in the breast in a 17-year-old patient. Before
(a) and after (b) two sessions of 1064-nm long-pulsed Nd:YAG laser
Figure 3: Breast striae after cosmetic augmentation. Before (a) and after
(b) two sessions of 1064-nm long-pulsed Nd:YAG laser
Figure 4: Stretch marks in the abdominal region. Before (a) and after
(b) two sessions of 1064-nm long-pulsed Nd:YAG laser
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Wollina and Goldman: Management of stretch marks
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 10 ¦ Issue 3 ¦ July-September 2017 127
used successfully in patients with stretch marks because of
topical corticosteroids.[49]
A non-ablative fractional 1565-nm laser was used in 12
Caucasian patients with stretch marks. All participants
achieved three treatments. Good clinical improvement
(between 51% and 75%) was observed in all patients. Most
patients showed improvement in the volume of depressions
and in lesion color. The average downtime was 4days.[50]
A small study compared non-ablative fractionated lasers
of 1540 and 1410 nm. Nine patients were treated with
six laser sessions with intraindividual comparison. In all
patients, a clinical improvement was seen. Histologically,
increased epidermal and dermal thickness, and collagen
and elastin density were seen compared to baseline.
Clinical and histopathological differences between the
two wavelengths were comparable.[51]
A non-fractional 1550-nm laser was used for the treatment
of abdominal striae rubrae and striae albae in 16 females.
They were treated with five sessions at 1-month intervals.
The mean width and length of striae decreased with a
more pronounced effect on length. There was a further
improvement from 1 month after treatment to 1 year
follow-up.[52]
Fractional 10,600-nm CO2 laser was effective in striae albae
in patients of skin type III and IV. The laser parameters
were as follows:fluence 16 J/cm2, dot cycle 2, pixel pitch
0.8 mm. The treatment was performed in five sessions with
two passes, 2 to 4 weeks apart. The clinical improvement
was significantly better than topical treatment with 0.05%
tretinoin cream and 10% glycolic acid peels.[53]
In a pilot trial, 44 striae albae were treated with a combined
approach using fractional CO2 laser and pulsed dye
laser and compared to 44 lesions treated with fractional
CO2 laser only. The investigators scored the efficacy of
combined treatment as higher without any increase in
unwanted side effects.[54]
In another trial, 40 patients with stretch marks were
treated with fractional CO2 laser or intense pulse light.
The CO2 laser worked faster and was more effective.[55]
In our opinion, the fractional CO2 laser represents the first
option in the treatment of striae albae. Unfortunately, the
results are poor and the improvement very limited. We also use
Er:YAG laser here, but the results are limited and the redness
aspect consequent to laser action lasts a very long period.
Limited experience exists with the use of fractional Er:YAG
laser.[56]
In conclusion, laser therapy of early stretch marks (striae
rubrae) targets vessels. The treatment of early and later
(striae albae) stretch marks aims to increase collagen
production, restore elastin fibers, and epidermal thickness.
Skin texture improvements also contribute to clinical
effects of laser therapy.[57-60] The number of studies with at
least 20 patients is limited, and placebo-controlled studies
have not been published [Table1].
dIscussIon
Stretch marks are common. They can affect both men
and women, but are more frequent among women.
Although they rarely cause medical problems, stretch
marks are considered a major esthetic concern and have
negative impact on self-esteem and quality of life of an
individual.[1,5]
The typical appearance of early stretch marks is redness
and some edema, whereas matured stretch marks are
linear type of atrophic scars. The clinical response to any
treatment is better in early stretch marks.
Table 1: Laser therapy of stretch marks (studies with at least 20 patients included)
Laser type Comparison Study type NOutcome Reference
585-nm pulsed dye IPL Side by side 20 Improvement better in striae rubrae both
treatments effective
Shokeir etal. 2014
585-nm pulsed dye with
Thermage
Open 37 89.2% of patients rated the outcome “good”
or better
Suh etal. 2007
585-nm pulsed dye Open 20 Moderate benecial effect on striae rubrae Jiménez etal. 2003
1,064-nm long-pulsed
Nd:YAG
Open 20 55% of patients rated the outcome
“excellent”
Goldman etal. 2008
1,064-nm long-pulsed
Nd:YAG
Open 45 Signicant improvement in appearance Elsaie etal. 2016
1,540-nm Er:glass Open 51 ≥50% improvement for all patients after
6months
de Angelis etal. 2011
1,550-nm Er-doped
fractional
Open 20 Moderate improvement in 63% of patients Stotland etal. 2008
2,940-nm variable square
pulsed Er:YAG-
Open 21 Signicant volume reduction of stretch
marks after 6months
Wanitphakdeedecha etal.
2017
10,600-nm CO2 fractional Retrospective 27 Improvement after a single treatment Lee etal. 2010
10,600-nm CO2 fractional IPL Open 40 Improvement better than with pulsed light El Taieb and Ibrahim 2016
IPL= Intense pulsed light
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Wollina and Goldman: Management of stretch marks
128 128 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 10 ¦ Issue 3 ¦ July-September 2017
Topical treatments have only mild effects. It is questionable,
if creams and ointments with “specific ingredients” exert
a significant and better improvement than moisturizers.
Topical treatment cannot prevent the occurrence of stretch
marks under specific circumstances such as pregnancy.[16-23]
Laser treatment is a physical tool used in the improvement
of stretch marks with a focus on early stretch marks
[Table1]. Owing to its physical characteristics, represented
mainly by the 1064-nm wavelength and dye pumped laser,
these lasers are very safe. Complications are rarely produced
when the device and parameters are appropriately utilized,
even in patients with dark skin. In addition, the cooling of
the striae before and immediately after the use of the laser
represents yet another factor in epidermal protection.
Such cooling of the treated areas, however, should not
be too long so as to avoid local vasoconstriction and the
consequent decrease of the chromophore oxyhemoglobin.
The treatment of erythematous striae using the 1064-nm
long-pulsed Nd:YAG laser demonstrated clinical
improvement of such lesions, probably due to the laser’s
affinity toward the vascular target present in the striae. The
absorption of the laser by its target, i.e., oxyhemoglobin,
leads to an improvement in the redness. In addition, it
has become evident that, like other luminous sources, the
long-pulsed Nd:YAG laser also induces the formation of
new collagen; this leads to an improvement in the atrophy
of the skin and consequently, improves the appearance of
immature striae. This improvement was evident for both
the patients and doctors.[35,39] The full clearance of the
lesions is very rare and seems to be occasionally obtained
in some isolated areas of recent striae. Hence, it is vital to
start the treatment as early as possible.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for his/
her/their images and other clinical information to be
reported in the journal. The patients understand that
their names and initials will not be published and
due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
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Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18􀀀57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymiumdoped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.
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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.
Chapter
A scar is an undesirable outcome of wound healing. Whenever tissue is injured by trauma, inflammation or surgery, various cells and mediators get activated and try to repair this wound. When only the epidermal layer of the skin is injured, it heals with mild or no scar. When the dermal layer is injured, the tissues cannot reproduce back the initial, pre-injury structure, leading to reorganization of fibrous tissue resulting in scar formation [1, 2].
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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.
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Background: Striae Gravidarum (SG) popularly called as stretch marks, is a common pregnancy related asymptomatic skin condition, but is a cosmetic concern for females. A few epidemiological studies have been reported from Asian countries. However, no such study has been done in Nepal. Aims: This study was aimed to know the prevalence and risk factors associated with SG in a cohort of multi-ethnic postpartum Nepalese women who had delivered after completion of 36 weeks. Patients/method: A cross-sectional comparative study was conducted amongst. 420 postpartum females who had delivered after completion of 36 weeks of gestation. Data was collected in the form of a questionnaire and relevant physical examination was done. The severity of SG was assessed by using Davey's scoring. Result: Out of 420 females, 260(62%) had SG while 160(38%) did not. According to the results of logistic regression analysis, young age (<25 years), large abdominal circumference (>100 cm), increased weight gain during pregnancy (>15 kg), presence of family history of SG, gestational diabetes mellitus, altered bowel movement, and presence of striae on the breasts, thighs and buttocks were found to be independent risk factors for SG. Conclusions: Future expectant mothers must be informed about the risk factors of SG development. They need to be made aware that SG can be prevented by considering the modifiable risk factors, such as excessive weight gain. They should also be informed that SG is permanent and currently, there is no definite treatment.
Chapter
Stretch marks, or striae distensae, are one of the most common benign cutaneous lesions, and, for some, the aesthetic appearance can be distressful. Various treatments are available and include the use of preventative measures such as topical ointments and oils. Other methods such as the use of light and lasers in acute lesions (striae rubrae) have resulted in improvement of the appearance. In chronic lesions (striae albae) the outcome is poor. Recently, tattoo camouflage has been used for striae albae. It is a medical technique that employs pigment saturation to improve the aesthetic appearance and surgical results. The methodology employs tattoo devices and artistic methods. It uses light and shadow to camouflage obvious contour and skin irregularities. It may be used as an adjuvant treatment associated to other surgical procedures to the buttocks, in order to lighten scars, and stretch marks. Patients and medical practitioners have reported great outcomes with this technique from both a psychological and physiological perspective.
Article
Full-text available
Background: Striae gravidarum (SG) are atrophic linear scars that represent one of the most common connective tissue changes during pregnancy. SG can cause emotional and psychological distress for many women. Research on risk factors, prevention, and management of SG has been often inconclusive. Methods: We conducted a literature search using textbooks, PubMed, and Medline databases to assess research performed on the risk factors, prevention, and management of SG. The search included the following key words: striae gravidarum, pregnancy stretch marks, and pregnancy stretch. We also reviewed citations within articles to identify relevant sources. Results: Younger age, maternal and family history of SG, increased pre-pregnancy and pre-delivery weight, and increased birth weight were the most significant risk factors identified for SG. Although few studies have confirmed effective prevention methods, Centella asiatica extract, hyaluronic acid, and daily massages showed some promise. Treatment for general striae has greatly improved over the last few years. Topical tretinoin ≥0.05% has demonstrated up to 47% improvement of SG and non-ablative fractional lasers have consistently demonstrated 50 to 75% improvement in treated lesions of striae distensae. Conclusion: Overall, SG has seen a resurgence in research over the last few years with promising data being released. Results of recent studies provide dermatologists with new options for the many women who are affected by these disfiguring marks of pregnancy.
Article
Full-text available
Striae distensae are common undesirable skin lesions of significant aesthetic concern. To compare the efficacy of two fluences (75 and 100 J/cm2) of long-pulsed Nd:YAG laser in the treatment of striae. Forty-five patients (Fitzpatrick skin types III–V) aged between 11 and 36 years with striae (23 patients with rubra type and 22 with alba type) were enrolled in the study. Each stria was divided into three equal sections, whereby the outer sections were treated with long-pulsed 1064 nm Nd:YAG laser, at a fluence of 75 or 100 J/cm2, and fixed laser settings of 5 mm spot size and 15 ms pulse duration. The middle section was an untreated control. All subjects received four treatments at 3 weeks interval. Three 2-mm punch biopsies were taken from six subjects, all of the same stria, one before treatment and the other two from the outer sections, 3 months after the last session. Paraffin-embedded skin sections were subjected to histological and quantitative morphometric studies for collagen and elastic fibres. Results were assessed clinically through photographic evaluation and were considered satisfactory for both doctors and patients. A significant improvement in appearance of striae alba using 100 J/cm2 was found while striae rubra improved more with 75 J/cm2. Histologically, collagen and elastin fibres increased in posttreatment samples. A satisfactory improvement in striae distensae lesions was seen through clinical and histological evaluation. Thus, long-pulsed Nd:YAG laser is a safe and effective module of laser treatment for these common skin lesions.
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Full-text available
Context: Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried. Aims: To evaluate and compare the efficacy of fractional CO2 laser with intense pulse light in treating striae distensae. Subjects and methods: Forty patients with striae distensae were recruited. Twenty of them were treated by fractional CO2 laser and 20 were treated with intense pulse light. Length and width of the largest striae were measured pre- and post-treatment. Patient satisfaction was also evaluated and graded. Patients were photographed after each treatment session and photos were examined by a blinded physician who had no knowledge about the cases. Results: Both groups showed significant improvement after treatments (P < 0.05). Patients treated with fractional CO2 laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light (P < 0.05) in all parameters except in the length of striae (P > 0.05). Conclusions: The current study has provided supportive evidence to the effectiveness of both fractional CO2 laser and intense pulse light as treatments for striae distensae. Fractional CO2 laser was found to be more effective in the treatment of striae distensae compared with intense pulse light.
Article
Background: Striae distensae (SD) are a frequent skin condition for which treatment remains a challenge. Various laser treatments have been employed to remove the epidermis and cause dermal wound and heating with subsequent dermal collagen remodeling. Objective: To determine the efficacy and safety of a variable square pulse Erbium: YAG (VSP Er:YAG) laser for the treatment of striae in skin phototypes III-IV. Methods: Twenty-one women with SD were treated monthly for 2 months with VSP Er:YAG laser resurfacing using a 7-mm spot size. One side of their striae was randomly treated with one pass of 400 mJ in short pulse (SP) mode with 50% overlapping and one pass of 2.2 J/cm(2) in smooth (SM) mode with nonoverlapping. The other side of their striae was treated with two passes of 400 mJ in SP mode with 50% overlapping. Objective and subjective assessments were obtained at baseline and 1-, 3-, and 6-month after treatment. Results: In both SP&SM and SP only group, volume of SD measured by Visioscan VC98 reduced significantly at 6-month follow-up visit (P=.017 and P=.034, respectively). There were no statistically significant differences in skin roughness (SER), skin smoothness (SESM), and surface measured by Visioscan VC98. Transient postinflammatory hyperpigmentation (PIH) is the common side effect found in patients with darker skin tone even in nonsun exposure areas and can last as long as 6 months. Conclusions: VSP Er:YAG laser resurfacing is a promising treatment option for SD. Lower fluence should be used in patients with darker skin phototype to avoid the risk of PIH. In addition, pre- and post-treatment with topical preparations for PIH prevention may be needed.
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.
Article
Background: Striae distensae (SD) are a type of dermal scarring that is quite common and difficult to treat. Two forms are known: striae rubrae (SR) and striae albae (SA). Objective: We evaluated and compared the long-term clinical effectiveness of SR and SA treatment using a 1550-nm non-ablative fractional laser (NAFL). Materials and methods: We included 16 female patients (8 with SR and 8 with SA) who had developed abdominal SD during pregnancy. All underwent five moderately high-energy sessions of 1550-nm NAFL treatment at 4-week intervals. The strial widths and lengths were measured before, and 1 month and 1 year after, treatment. Results: The mean strial width fell from 6.94 mm before treatment to 3.25 mm at the first follow-up visit (P=3.95x10(-5)) and to 3.13 mm at the second follow-up visit (P=2.44x10(-5)). Similarly, the mean strial length fell from 6.06 cm to 2.88 cm at the first follow-up visit (P=1.7x10(-4)) and to 2.75 cm at the second follow-up visit (P=9.52x10(-5)). Conclusion: NAFL treatment was effective long-term in both SR and SA patients.
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.
Article
Materials and methods: Forty female patients with SD (mean duration 2.98± 2.66) were enrolled in this study. Patients were assigned to two groups, group1 treated with needling therapy and group 2 treated by microdermabrasion with sonophoresis. In group 1, three sessions of needling therapy were carried out for each patient with four weeks interval between the sessions, while in group 2, ten sessions of combined microdermabrasion and sonophoresis were carried out for each patient. Skin biopsies were taken from the most atrophic site stained with hematoxylin and eosin stain, Masson trichrome stains to study of histopathological changes and efficacy of treatment. Results: There was significant clinical improvement of SD in group 1 compared with group 2. Amount of collagen, number of fibroblasts and epidermal thickness were increased in the dermis at the end of treatment sessions (90% in group 1 compared to 50% in group2). Conclusion: Needling therapy is easy, safe, economic method and considered as a suitable modality in management of striae.
Article
Background: Aesthetically, striae distensae (SD) are a source of great concern. No treatment modality is currently considered the gold standard. However, studies of nonablative fractionated lasers (NAFLs) have been promising. Objective: To evaluate and compare the clinical and histopathologic efficacy and safety of a 1540-nm NAFL and a 1410-nm NAFL for the treatment of SD. Methods and materials: Nine patients with abdominal striae were treated for 6 sessions-half of the abdomen was treated with a 1540-nm NAFL whereas the other half was treated with a 1410-nm NAFL. Photographs were taken at baseline and at the 3-month follow-up visit, when subjects were given a questionnaire. Two blinded dermatologists scored the photographs using a pre-established clinical scale. Biopsies were taken from 2 subjects and graded by 2 dermatopathologists using a pre-established pathology scale. Results: All 9 subjects demonstrated clinical improvement bilaterally after treatment. Skin biopsies after treatment showed an increase in epidermal thickness, dermal thickness, and collagen and elastin density when compared with baseline. Clinical and histopathological differences between the 2 lasers were not statistically significant. Conclusion: Treatment with both the 1540-nm and the 1410-nm NAFL was shown to improve SD clinically and histopathologically. Further studies are needed to optimize treatment parameters.