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

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.

Full text

Access this article online
Quick Response Code:
Website:
www.jcasonline.com
DOI:
10.4103/JCAS.JCAS_118_17
© 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
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
tweak, and build upon the work non-commercially, as long as the author is credited
and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
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.
jcas
MEDKNOW
Journal of Cutaneous and Aesthetic Surgery
JCAS
0974-2077
0974-5157
Medknow Publications & Media Pvt LtdIndia
10.4103/JCAS.JCAS_118_17
118_17
000000
000000
00
00
00
00
20171219
© 2017 Journal of Cutaneous and Aesthetic Surgery | Published by Wolters Kluwer
- Medknow2017
JCAS_118_17
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]

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]
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]

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
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]

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
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]

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.
references
1. Piérard-Franchimont C, Peters S, Hermanns JF, Lesuisse M,
Saint-Léger D, Piérard GE. Striae distensae, colors and
mechanobiology. Rev Med Liege 2014;69:151-4.
2. Wollina U, Dreßler M, Lohmann T. Bariatric surgery - Adermatologic
perspective. J Eur Acad Dermatol Venereol 2015;29:835-41.
3. Wollina U, Pabst F, Schönlebe J, Abdel-Naser MB, Konrad H,
Gruner M, et al. Side-effects of topical androgenic and anabolic
substances and steroids. Ashort review. Acta Dermatovenerol Alp
Pannonica Adriat 2007;16:117-22.
4. Tsai TL, Castillo AC, Moliver CL. Breast striae after cosmetic
augmentation. Aesthet Surg J 2014;34:1050-8.
5. Valente DS, Zanella RK, Doncatto LF, Padoin AV. Incidence
and risk factors of striae distensae following breast augmentation
surgery:A cohort study. PLoS One 2014;9:e97493.
6. Chan WY, Akhtar S, Phipps AR. Striae distensae in tissue-expanded
skin in the upper arm. Ann Plast Surg 2006;57:240-1.
7. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae
gravidarum: Risk factors, prevention, and management. Int J
Womens Dermatol 2017;3:77-85.
8. Kasielska-Trojan A, Sobczak M, Antoszewski B. Risk factors of
striae gravidarum. Int J Cosmet Sci 2015;37:236-40.
9. Chikvaidze N, Kristesashvili J, Gegechkori M. Peculiarities of
sexual development and reproductive function in young women
with childhood onset weight problems. Georgian Med News
2014;235:11-6.
10. Wollina U, Degen KW, Konrad H, Schönlebe J. Itching stretch
marks and bullous lesions in a pregnant woman. Int J Dermatol
2004;43:752-4.
11. Wang F, Calderone K, Smith NR, Do TT, Helfrich YR, Johnson
TR, et al. Marked disruption and aberrant regulation of elastic
fibers in early striae gravidarum. Br J Dermatol 2015;173:1420-30.
12. Stamatas GN, Lopes-DaCunha A, Nkengne A, Bertin C. Biophysical
properties of striae distensae evaluated in vivo using non-invasive
assays. Skin Res Technol 2015;21:254-8.
13. Bertin C, Lopes-DaCunha A, Nkengne A, Roure R, Stamatas
GN. Striae distensae are characterized by distinct microstructural
features as measured by non-invasive methods in vivo. Skin Res
Technol 2014;20:81-6.
14. Cordeiro RC, Zecchin KG, de Moraes AM. Expression of estrogen,
androgen, and glucocorticoid receptors in recent striae distensae. Int
J Dermatol 2010;49:30-2.
15. Lurie S, Matas Z, Fux A, Golan A, Sadan O. Association of serum
relaxin with striae gravidarum in pregnant women. Arch Gynecol
Obstet 2011;283:219-22.
16. Hague A, Bayat A. Therapeutic targets in the management of striae
distensae: A systematic review. J Am Acad Dermatol 2017;77:
559-568.e18.
17. Korgavkar K, Wang F. Stretch marks during pregnancy:A review of
topical prevention. Br J Dermatol 2015;172:606-15.
18. Soltanipour F, Delaram M, Taavoni S, Haghani H. The effect of
olive oil and the saj® cream in prevention of striae gravidarum:A
randomized controlled clinical trial. Complement Ther Med
2014;22:220-5.
19. Al-Himdani S, Ud-Din S, Gilmore S, Bayat A. Striae distensae:A
comprehensive review and evidence-based evaluation of prophylaxis
and treatment. Br J Dermatol 2014;170:527-47.
20. McAvoy BR. No evidence for topical preparations in preventing
stretch marks in pregnancy. Br J Gen Pract 2013;63:212.
21. Brennan M, Young G, Devane D. Topical preparations for
preventing stretch marks in pregnancy. Cochrane Database Syst Rev
2012;11:CD000066.
22. García Hernández JÁ, Madera González D, Padilla Castillo M,
Figueras Falcón T. Use of a specific anti-stretch mark cream for
preventing or reducing the severity of striae gravidarum. Randomized,
double-blind, controlled trial. Int J Cosmet Sci 2013;35:233-7.
23. Rawlings AV, Bielfeldt S, Lombard KJ. A review of the effects of
moisturizers on the appearance of scars and striae. Int J Cosmet Sci
2012;34:519-24.
24. Hexsel D, Soirefmann M, Porto MD, Schilling-Souza J, Siega C,
Dal’Forno T. Superficial dermabrasion versus topical tretinoin on
early striae distensae: A randomized, pilot study. Dermatol Surg
2014;40:537-44.
25. Ibrahim ZA, El-Tatawy RA, El-Samongy MA, Ali DA. Comparison
between the efficacy and safety of platelet-rich plasma vs.
microdermabrasion in the treatment of striae distensae:Clinical and
histopathological study. J Cosmet Dermatol 2015;14:336-46.
26. Issa MC, de Britto Pereira Kassuga LE, Chevrand NS, do Nascimento
Barbosa L, Luiz RR, Pantaleão L, et al. Transepidermal retinoic
acid delivery using ablative fractional radiofrequency associated
with acoustic pressure ultrasound for stretch marks treatment.
Lasers Surg Med 2013;45:81-8.
27. Dover JS, Rothaus K, Gold MH. Evaluation of safety and patient
subjective efficacy of using radiofrequency and pulsed magnetic
fields for the treatment of striae (stretch marks). J Clin Aesthet
Dermatol 2014;7:30-3.
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]

Wollina and Goldman: Management of stretch marks
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 10 ¦ Issue 3 ¦ July-September 2017 129
28. Park KY, Kim HK, Kim SE, Kim BJ, Kim MN. Treatment of striae
distensae using needling therapy: A pilot study. Dermatol Surg
2012;38:1823-8.
29. Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM.
Percutaneous collagen induction therapy: An alternative treatment
for scars, wrinkles, and skin laxity. Plast Reconstr Surg 2008;121:
1421-9.
30. Nassar A, Ghomey S, El Gohary Y, El-Desoky F. Treatment of
striae distensae with needling therapy versus microdermabrasion
with sonophoresis. J Cosmet Laser Ther 2016;18:330-4.
31. Manuskiatti W, Boonthaweeyuwat E, Varothai S. Treatment of
striae distensae with a tripolar radiofrequency device:A pilot study.
J Dermatolog Treat 2009;20:359-64.
32. Harmelin Y, Boineau D, Cardot-Leccia N, Fontas E, Bahadoran P,
Becker AL, etal. Fractionated bipolar radiofrequency and bipolar
radiofrequency potentiated by infrared light for treating striae:A
prospective randomized, comparative trial with objective evaluation.
Lasers Surg Med 2016;48:245-53.
33. McDaniel DH, Ash K, Zukowski M. Treatment of stretch marks
with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg
1996;22:332-7.
34. Jiménez GP, Flores F, Berman B, Gunja-Smith Z. Treatment of
striae rubra and striae alba with the 585-nm pulsed-dye laser.
Dermatol Surg 2003;29:362-5.
35. Shokeir H, El Bedewi A, Sayed S, El Khalafawy G. Efficacy of
pulsed dye laser versus intense pulsed light in the treatment of striae
distensae. Dermatol Surg 2014;40:632-40.
36. Nouri K, Romagosa R, Chartier T, Bowes L, Spencer JM.
Comparison of the 585 nm pulse dye laser and the short pulsed CO2
laser in the treatment of striae distensae in skin types IV and VI.
Dermatol Surg 1999;25:368-70.
37. Longo L, Postiglione MG, Marangoni O, Melato M. Two-year
follow-up results of copper bromide laser treatment of striae. J Clin
Laser Med Surg 2003;21:157-60.
38. Tay YK, Kwok C, Tan E. Non-ablative 1,450-nm diode laser
treatment of striae distensae. Lasers Surg Med 2006;38:196-9.
39. Goldman A, Rossato F, Prati C. Stretch marks:Treatment using the
1,064-nm nd:YAG laser. Dermatol Surg 2008;34:686-91.
40. Elsaie ML, Hussein MS, Tawfik AA, Emam HM, Badawi MA,
Fawzy MM, etal. Comparison of the effectiveness of two fluences
using long-pulsed nd:YAG laser in the treatment of striae distensae.
Histological and morphometric evaluation. Lasers Med Sci
2016;31:1845-53.
41. Güngör S, Sayilgan T, Gökdemir G, Ozcan D. Evaluation of an
ablative and non-ablative laser procedure in the treatment of striae
distensae. Indian J Dermatol Venereol Leprol 2014;80:409-12.
42. Wanitphakdeedecha R, Meeprathom W, Manuskiatti W. A pilot
study of treatment of striae distensae with variable square pulse
Erbium:YAG laser resurfacing. J Cosmet Dermatol 2017;16:466-70.
43. Shen J, Lu XG, Jin JJ, Wang HW. Combination of a 2940 nm
Er:YAG laser with recombinant bovine basic fibroblast growth
factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for
the treatment of striae alba:A pilot study. J Cosmet Dermatol 2017;
doi:10.1111/jocd.12376. [Epub ahead of print].
44. Yang YJ, Lee GY. Treatment of striae distensae with nonablative
fractional laser versus ablative CO(2) fractional laser:A randomized
controlled trial. Ann Dermatol 2011;23:481-9.
45. Guimarães PA, Haddad A, Sabino Neto M, Lage FC, Ferreira LM.
Striae distensae after breast augmentation: Treatment using the
nonablative fractionated 1550-nm erbium glass laser. Plast Reconstr
Surg 2013;131:636-42.
46. Kim BJ, Lee DH, Kim MN, Song KY, Cho WI, Lee CK, et al.
Fractional photothermolysis for the treatment of striae distensae in
Asian skin. Am J Clin Dermatol 2008;9:33-7.
47. Sherling M, Friedman PM, Adrian R, Burns AJ, Conn H,
Fitzpatrick R, etal. Consensus recommendations on the use of an
erbium-doped 1,550-nm fractionated laser and its applications in
dermatologic laser surgery. Dermatol Surg 2010;36:461-9.
48. Malekzad F, Shakoei S, Ayatollahi A, Hejazi S. The safety and
efficacy of the 1540 nm non-ablative fractional XD probe of star
lux 500 device in the treatment of striae alba:Before-after study. J
Lasers Med Sci 2014;5:194-8.
49. Alves RO, Boin MF, Crocco EI. Striae after topical
corticosteroid:Treatment with nonablative fractional laser 1540nm.
J Cosmet Laser Ther 2015;17:143-7.
50. Tretti Clementoni M, Lavagno R. A novel 1565 nm non-ablative
fractional device for stretch marks:A preliminary report. J Cosmet
Laser Ther 2015;17:148-55.
51. Wang K, Ross N, Osley K, Sahu J, Saedi N. Evaluation of a 1540-nm
and a 1410-nm nonablative fractionated laser for the treatment of
striae. Dermatol Surg 2016;42:225-31.
52. Gokalp H. Long-ter m results of the treatment of pregnancy-induced
striae distensae using a 1550-nm non-ablative fractional laser. J
Cosmet Laser Ther 2017;19:378-82.
53. Naein FF, Soghrati M. Fractional CO2 laser as an effective modality
in treatment of striae alba in skin types III and IV. J Res Med Sci
2012;17:928-33.
54. Naeini FF, Nikyar Z, Mokhtari F, Bahrami A. Comparison of
the fractional CO2 laser and the combined use of a pulsed dye laser
with fractional CO2 laser in striae alba treatment. Adv Biomed Res
2014;3:184.
55. El Taieb MA, Ibrahim AK. Fractional CO2 laser versus intense
pulsed light in treating striae distensae. Indian J Dermatol 2016;
61:174-80.
56. Gauglitz GG, Reinholz M, Kaudewitz P, Schauber J, Ruzicka
T. Treatment of striae distensae using an ablative erbium:YAG
fractional laser versus a 585-nm pulsed-dye laser. J Cosmet Laser
Ther 2014;16:117-9.
57. de Angelis F, Kolesnikova L, Renato F, Liguori G. Fractional
nonablative 1540-nm laser treatment of striae distensae in fitzpatrick
skin types II to IV:Clinical and histological results. Aesthet Surg J
2011;31:411-9.
58. Lee SE, Kim JH, Lee SJ, Lee JE, Kang JM, Kim YK, et al.
Treatment of striae distensae using an ablative 10,600-nm carbon
dioxide fractional laser:A retrospective review of 27 participants.
Dermatol Surg 2010;36:1683-90.
59. Suh DH, Chang KY, Son HC, Ryu JH, Lee SJ, Song KY.
Radiofrequency and 585-nm pulsed dye laser treatment of striae
distensae: A report of 37 Asian patients. Dermatol Surg 2007;
33:29-34.
60. Stotland M, Chapas AM, Brightman L, Sukal S, Hale E, Karen
J, et al. The safety and efficacy of fractional photothermolysis
for the correction of striae distensae. J Drugs Dermatol
2008;7:857-61.
[Downloaded free from http://www.jcasonline.com on Thursday, January 4, 2018, IP: 85.101.179.234]