Fractional CO2 Laser Versus Intense Pulsed Light in Treating Striae Distensae

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.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.     

Treatment of striae distensae combined enhanced penetration platelet-rich plasma and ultrasound after plasma fractional radiofrequency

Abstract

Background: Striae distensae (striae alba) is a challenging cosmetic problem for which various treatment modalities have been applied. However, the treatment of striae distensae has not been satisfactory. Objectives: This study was done to evaluate the effectiveness and the safety of enhanced penetration of platelet rich plasma with ultrasound after plasma fractional radiofrequency for the treatment of striae distensae. Subjects and method: Eighteen participants with striae distensae were treated with a Legato system (Alma Lasers, Israel) every two weeks for a total of four sessions. Thereafter, in order to enhance platelet-rich plasma penetration, ultrasound is applied. Clinical photographs were taken before first treatment and two months after the final treatment. Objective and subjective improvement scores were evaluated to demonstrate the efficacy. Abdominal skin biopsies were obtained from three individuals and histological changes were analyzed by light microscopy. Results: During the two months after the last treatment, the average width of the widest striae had decreased from 0.75 to 0.27 mm. In the objective assessment, 71.9% of the participants reported ‘‘good” or “very good’’ overall improvement. In the subjective assessment, and 72.2% of the participants reported ‘‘very satisfied” or “extremely satisfied’’ with overall improvement. The only reported side effect was post-inflammatory hyperpigmentation (11.1%). Conclusions: The plasma fractional radiofrequency and transepidermal delivery of platelet-rich plasma using ultrasound is useful in the treatment of striae distensae.     

Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial

Background

Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite ''gold standard'' treatment modality has been determined.

Objective

To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO₂ fractional laser resurfacing in the treatment of striae distensae.

Methods

Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO₂ laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study.

Results

Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO₂ fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites.

Conclusion

These results support the use of nonablative fractional laser and ablative CO₂ fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.     

Efficacy of fractional carbon dioxide laser versus microneedling in the treatment of striae distensae

Background: Fractional photothermolysis is creation of microscopic thermal zones of controlled depth, width and density. Microneedling is a simple treatment modality to reduce striae distensae.

Objective: Evaluate and compare the efficacy of fractional carbon dioxide laser and microneedling as a treatment of striae distensae.

Methods: Individuals with striae distensae received three split-body treatments at four-week intervals. The right side of the body was treated with fractional CO₂ laser, while the other side with microneedling. Assessment was done by comparing photographs before and after treatments by two blinded physicians using a quartile grading scale. Evaluation also included patient satisfaction score and histopathological examination.

Results: In total 33 subjects were enrolled and 30 completed the study. By quartile grading score, we recorded 55% moderate-excellent improvement of striae in the dermaroller-treated side but with fractional CO₂ laser-treated side, we recorded 76% of patients had moderate-excellent improvement. Patients were more satisfied with fractional CO₂ laser than the microneedling. Post-inflammatory hyperpigmentation, as a complication of fractional CO₂ laser, appeared in 11 patients.

Conclusion: Fractional CO₂ laser is more effective in treating striae with acceptable side effects but still microneedling can be afforded as an effective, safe and cheap method.     

Striae distensae of pregnancy. An in vivo biomechanical evaluation

Background and objective Striae distensae of pregnancy is a common finding. There is currently a lack of information about the rheological characteristics of such lesions. The purpose of this study was to compare the mechanical properties of striae distensae before and after delivery. Patients and methods A total of 79 primigravid entered the study. Rheological properties of skin were evaluated in vivo using a Cutometer® equipped with a 2-mm probe. Results Mechanical properties of striae distensae developing during pregnancy resembled those of the surrounding skin. By contrast, significant differences were yielded during post-partum. Extensibility of striae distensae was increased although parameters of elasticity remained normal. Conclusions Rheological properties of striae distensae of pregnancy vary in time. This might reflect the changes in hormones and in the mechanical stresses normally setting the skin under tension.     

Long-term results of the treatment of pregnancy-induced striae distensae using a 1550-nm non-ablative fractional laser

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 compared the long-term clinical effectiveness of a 1550-nm non-ablative fractional laser (NAFL) in treating SR and SA. 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 decreased from 6.94 mm before treatment to 3.25 mm at the first follow-up visit (p = 3.95 × 10^?5) and to 3.13 mm at the second follow-up visit (p = 2.44 × 10^?5). Similarly, the mean strial length decreased from 6.06 to 2.88 cm at the first follow-up visit (p = 1.7 × 10^?4) and to 2.75 cm at the second follow-up visit (p = 9.52 × 10^?5). Conclusion: NAFL treatment was effective long term in both SR and SA patients.     

Clinical features and risk factors for striae distensae in Korean adolescents

BACKGROUND: Despite the high prevalence of striae distensae, clinical studies are few in number, and their pathophysiology still obscure. OBJECTIVES: To determine the prevalence and clinical characteristics of striae distensae that occur in Korean adolescents, and to correlate their clinical features with family history, other dermatological conditions, and body measurements. METHODS: One hundred and fifty-seven healthy Korean students, aged 15 to 17, were studied. A questionnaire and physical examination were employed to assess the subjects' past and family history, and the distribution, clinical features and severity of striae distensae. RESULTS: Striae distensae were present in 131 subjects (83.4%). Ninety-four (88.2%) of 109 male and 37 (77.1%) of 48 female subjects were affected. The striae were white in colour in 69.5% and asymptomatic in most of the subjects. They developed at an average age of 13.8 years. Family history was present in 18 subjects (11.5%). Seborrhoea of the face was positively correlated (P < 0.035) with striae distensae, and atopic dermatitis negatively correlated (P < 0.001). In both sexes, the buttock was the most prevalent area of striae development, followed by the lower back and knee in boys and by the thigh and calf in girls. Striae were significantly more common on the thigh of girls and on the knee of boys. CONCLUSIONS: Our results indicate that striae distensae are a common skin condition that occurs early in puberty regardless of gender, and that they have a different anatomical distribution and relationship with body measurements in each gender.     

Contractile forces generated by striae distensae fibroblasts embedded in collagen lattices

Striae distensae are characterized by linear, smooth bands of atrophic-appearing skin that are reddish at first and finally white. They are due to stretching of the skin, as in rapid weight gain, or mechanical stress, as in weight lifting. The pathogenesis of striae distensae is unknown but probably relates to changes in the fibroblast phenotype. In order to characterize striae distensae fibroblasts, alpha-smooth muscle actin expression and contractile forces were studied. Five healthy women with early erythematous striae and five healthy women with older striae were selected. Paired biopsies were taken from the center of lesional striae and adjacent normal skin. Fibroblasts were obtained by an explant technique and expanded in vitro in Dulbecco’s modified Eagle‘s medium. Contractile forces generated by fibroblasts in collagen lattices were measured with the Glasbox device developed in our laboratory. Alpha-smooth muscle actin expression was studied by immunofluorescence labeling of cells and by flow cytometry. Fibroblasts from early striae distensae were the richest cells in alpha-smooth muscle actin filaments and generated the highest contractile forces. Their peak contractile force was 26% greater than normal fibroblasts. There was a 150% higher level of alpha-smooth muscle actin content in fibroblasts from early striae distensae compared with fibroblasts from normal skin. In contrast, there was no significant difference in force generation between old striae fibroblasts and normal fibroblasts with cells expressing no alpha-smooth muscle actin. The contractile properties of fibroblasts from striae distensae varies depending on the stage of the disease. In early striae distensae, fibroblasts acquire a more contractile phenotype, corresponding to that of myofibroblasts.     

High-resolution epiluminescence colorimetry of striae distensae

BACKGROUND: Colours of striae distensae are often different from that of the surrounding skin. A close look using dermoscopy discloses distinct patterns of melanized networks at these sites. The aim of the study was to design a method of high-\resolution analytical analysis of the skin colours using the combination of photographic dermoscopy and small field reflectance colorimetry. METHODS: Clinical photographs were taken from striae distensae and their surrounding skin using a Dermaphot (Heine Optotechnik, Hersching, Germany). A final magnification of 125x was obtained on paper photographs. The reflectance colorimeter Visi-Chroma VC-100 (Biophotonics, Lessines, Belgium) was used to measure colours of the pigmentary networks in the L*a*b* system. Differential colour parameters (deltaE*ab, deltaL*, deltaa*, deltab*) were calculated for each case between the lesional and the surrounding normal skin, and between the melanized reticulated pattern and the enclosed lighter areas. RESULTS: Objective colorimetric assessments distinguished four distinct types, namely striae albae, striae rubrae, striae caeruleae and striae nigrae. The latter peculiar hyperpigmented type of striae distensae was specifically identified by epiluminescence examination in dark-skinned subjects. The fine-melanized honeycomb network present on the adjacent intact skin was reshaped inside striae in a streaky pattern perpendicular to the striae axis. Strong linear correlations were found between all combinations of deltaL* and deltab* evaluating colours of the reticulated and the honeycomb alveolar patterns both inside and outside the striae distensae. By contrast, no correlations were found between deltaa* and the other colorimetric parameters. CONCLUSION: The direct and/or indirect influences of melanocyte mechanobiology appear to have a prominent effect on the various colours of striae distensae.     

An investigation of striae distensae using reflectance confocal microscopy

Background: Striae distensae, otherwise known as stretch marks, are white or red scar‐like streaks on the skin. Although they are not associated with adverse health outcomes, striae are associated with significant cosmetic morbidity. While they have been well characterised histopathologically, a non‐invasive method of microscopic lesion assessment of striae would be welcome. Methods: To gain insight into the small‐scale morphological features associated with striae we undertook an in vivo investigation of nine patients with striae alba and one with striae rubra utilising reflectance confocal microscopy (RCM). Results: Here we demonstrate that features known to be present using light microscopy, such as parallel collagen bundles in the dermis, and some features that are not well recognised by light microscopy, including distortion of dermal papillae, are demonstrable using RCM. Conclusions: Characterising the features of early and established striae distensae with confocal microscopy is an important foundation for future work. The potential ability to reliably identify the earliest pathological changes in skin in early lesions or before clinically manifest striae develop – a task facilitated by our findings – will increase the understanding of their pathogenesis and will have significant practical utility in monitoring the impact of future preventative interventions.     

Treatment of striae distensae with needling therapy versus microdermabrasion with sonophoresis

Striae distensae (SD) is a challenging cosmetic problem for which various treatment modalities have been applied. Our aim was to evaluate the efficacy and tolerability of needling therapy versus microdermabrasion with sonophoresis in the treatment of SD. 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, Group 1 treated with needling therapy and Group 2 treated by microdermabrasion with sonophoresis. In Group 1, three sessions of needling therapy were performed for each patient with 4-week interval between the sessions, while in Group 2, ten sessions of combined microdermabrasion and sonophoresis were performed for each patient. Skin biopsies were taken from the most atrophic site stained with hematoxylin and eosin stain and Masson trichrome stains to study the histopathological changes and efficacy of treatment, respectively. Results: There was a significant clinical improvement in SD in Group 1 compared with Group 2. Amount of collagen, number of fibroblasts, and epidermal thickness increased in the dermis at the end of treatment sessions (90% in Group 1 compared to 50% in Group 2). Conclusion: Needling therapy is an easy, safe, and economic method and considered as a suitable modality in management of striae.     

Decreased expression of collagen and fibronectin genes in striae distensae tissue

Striae distensae are characterized by a thinning of connective tissue stroma to produce linear, atrophic-appearing skin. Excessive adrenocortical activity, genetic factors and inherited defects of connective tissues, etc. are important causative factors in the formation of striae distensae, but the basic aetiology is not known. Total RNA was extracted from skin biopsies of five patients with striae distensae. The expression of genes coding for types I and III procollagen, elastin, fibronectin and β-actin were studied and compared with those of four sex- and age-matched healthy individuals. The percentages of types I and III procollagen mRNA were 9.9 ± 2.9% (mean ± s.d.) and 10.6 ± 1.6%, respectively, of the corresponding controls. The value for fibronectin mRNA in striae distensae was 7.3 ± 1.8% of the control. The steady-state ratio fibronectin/type I procollagen mRNAs was 0.12 ± 0.01 in striae distensae and (MS ± 0.01 in the control. These observations suggest that expression of collagens, elastin and fibronectin genes are apparently decreased, and that there is a marked alteration of fibroblast metabolism, in striae distensae.     

CO2点阵激光与1550nm铒玻璃点阵激光治疗妊娠纹的自身对照研究

目的： 评价CO2点阵激光与1550nm铒玻璃点阵激光治疗妊娠纹的疗效及安全性。方法：收集妊娠纹患者,以前正中线分腹部为左右两侧,左侧妊娠纹采用10600nm CO2点阵激光,右侧妊娠纹采用1550nm铒玻璃点阵激光治疗。每次治疗间隔2个月,治疗3次,末次治疗后随访3个月。结果：剔除2例失访患者,共25例患者完成本研究。84%患者右侧和48%患者左侧的皮损改善51％～75％,差异有统计学意义（P<0.05）。自我满意度评分中80%患者对右侧满意,68%对左侧满意。治疗后20%患者左侧色素沉着,8%患者右侧色素沉着。患者在治疗过程中疼痛评分右侧（5.41±2.13分）高于左侧（4.19±2.12分）,两者差异有统计学意义（P<0.001）。两侧均未出现永久性色素改变。结论：1550nm铒玻璃点阵激光较10600 nmCO2点阵激光更能有效治疗妊娠纹。     

Efficacy of intradermal radiofrequency combined with autologous platelet‐rich plasma in striae distensae: a pilot study

Background Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post‐inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet‐rich plasma (PRP) is an effective treatment known for its wound‐healing effects. Methods Nineteen Asian female patients with striae distensae were enrolled in this study. Three sessions of intradermal RF (1134‐kHz frequency, 12‐W power, 26‐G electrode size) combined with autologous PRP were performed in each patient at intervals of four weeks. Patients were evaluated subjectively by the investigators and by themselves. Results Evaluation of clinical results at four weeks after treatment showed that only one (5.3%) of the 19 patients achieved excellent improvement, whereas seven (36.8%) demonstrated marked improvement, six (31.6%) showed moderate improvement, and five (26.3%) showed mild improvement. None of the patients showed worsening of striae distensae. A total of 63.2% of patients reported they were “satisfied” or “very satisfied” with the degree of overall improvement. Conclusions Intradermal RF combined with autologous PRP appears to be an effective treatment for striae distensae.     

Striae: stretching the long list of precipitating factors for ‘true koebnerization’ of vitiligo,lichen planus and psoriasis

Aims: To document the role of striae distensae and striae gravidarum in causing Koebner phenomenon in cases of vitiligo, psoriasis and lichen planus. Results: Striae are documented to cause Koebner phenomenon in patients with preexisting vitiligo, psoriasis and lichen planus, the three conditions where ‘true kobenerisation’ has been suggested according to Boyd and Nelder classification. Conclusions: Striae distensae and striae gravidarum are examples of blunt trauma. Just as happens with penetrating trauma, striae too are shown to be responsible for causing the Koebner phenomenon.     

Striae distensae: a comprehensive review and evidence‐based evaluation of prophylaxis and treatment

Striae distensae are an extremely common, therapeutically challenging form of dermal scarring. Risk factors have been reported but much remains to be understood about their epidemiology, diagnosis and treatment. Up‐to‐date knowledge of the scientific research and the evidence behind both preventative and therapeutic agents are vital in order to understand striae and to offer patients the best therapeutic alternatives. We present a clinical review of the current literature concerning striae distensae and their prevention and treatment. A systematic review of the literature was undertaken using Medline, Embase and Google Scholar. Articles in English, Spanish, Portuguese, Turkish and French were included. Striae distensae occur in pregnancy, puberty and obesity as well as in numerous medical conditions and following therapeutic interventions. Proposed aetiological mechanisms relate to hormones, physical stretch and structural alterations to the integument. Assessment methods include subjective visual scoring and various imaging modalities. Treatments that we have evaluated include topical agents, used prophylactically or therapeutically, as well as light and laser therapies, which have shown improvements in the appearance of striae. Few high level evidence based medicine randomized controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae.     

Striae distensae in darker skin types: the influence of melanocyte mechanobiology

Introduction Striae distensae in White people are commonly described as being reddish at first and turning white in time. This dual perception has been challenged. Indeed, the color difference between striae distensae and their surrounding skin varies on a wide range in part depending upon typology. Aim To study striae nigrae that are found only in subjects of darker complexion. Materials and methods In the present study conducted in 44 darker skin adults, dermoscopy was combined to reflectance colorimetry. Results Striae nigrae exhibited hypermelanosis of the epidermal rete ridges crossing transversally the lesions in a laddering pattern. By contrast, striae albae showed only faint melanotic networks. Conclusions As striae distensae are in part under the influence of skin stretching, their colors are likely to be controlled by some mechanobiological process activating or inhibiting melanogenesis in people of darker complexion. No argument involving an inflammatory mechanism is supported by the present observations.     

Dermatoses in overweight and obese children and their relationship with insulin and skin color

Background/Aim

The aim of the present study was to investigate the prevalence of obesity-related dermatoses in obese children, and the association between these dermatoses and insulin resistance as well as skin color.

Methods

Obese, overweight, and normal weight children according to body mass index who were followed up and treated in the outpatient clinics were included in the study. Dermatological examinations of the participants were performed, and fasting insulin and glucose levels were checked.

Results

The obese and overweight children were evaluated as the patient group (70 girls, 41 boys, mean age: 12.37 ± 3.14 years). One hundred one healthy children with normal weight were determined as the control group (59 girls, 42 boys, mean age: 12.15 ± 2.43). The first five common dermatoses in the patient group when compared with the control group were keratosis pilaris (KP), striae distensae, hyperhidrosis, acanthosis nigricans (AN), and plantar hyperkeratosis. The first five dermatoses which were positively correlated with formation and insulin resistance were KP, striae distensae, AN, hyperhidrosis, and plantar hyperkeratosis. According to the Fitzpatrick skin scale, we found that the darker the skin color, the higher the probability of AN and KP (OR, 0.298; 95% CI, 0.106–0.834, p = 0.021; OR, 0.306; 95% CI, 0.117–0.796, p = 0.015, respectively).

Conclusion

Some dermatoses associated with obesity and insulin resistance were not found in obese children, or there was no significant association. These results indicate that many skin morbidities may be prevented by preventing and treating obesity and insulin resistance in the early period.     

Laser therapy of stretch marks

Striae distensae, better known as stretch marks, are a common disfiguring skin disorder of significant cosmetic concern. Many sources have reported the use of lasers to diminish the appearance of striae. Controlled clinical studies of the various treatment modalities available for striae are relatively uncommon, and much of the clinical data are anecdotal. The use of lasers alone or in combination with other therapeutic modalities can provide a safe and effective reduction in the appearance of both red and white striae distensae. Many of these therapies require special measures for darker skin phototypes. This article reviews the historical use of laser therapy for this disorder and discusses current therapeutic options.     

The use of synchrotron infrared microspectroscopy to demonstrate the effect of intense pulsed light on dermal fibroblasts

Abstract

Intense pulsed light (IPL) has been used extensively to treat striae distensae (SD). Twenty-four patients (21 females and 3 males) with age ranging between 15–42 years with a mean of 24.2 ± 5.89 years were included in this study. All patients were treated with IPL for five sessions and were given 4-week interval between the sessions. Formalin-fixed, paraffin- embedded skin biopsies were cut into 5-μm-thick sections from patients before and after treatments. They were stained with hematoxylin and eosin (H&E) and collagen with Masson trichrome stain. Histological examination of SD revealed epidermal thinning, flattened rete ridges, and fragmentation with degeneration of the collagen and elastic fibers. After IPL treatments, collagen expression was found also to be increased in a highly significant manner and P values were < 0.001 after IPL treatments. The use of synchrotron infrared (IR) microspectroscopy also revealed that amide1and beta sheets were expressed in a significant manner after IPL treatment. In conclusion, it was demonstrated that IPL can treat striae through fibroblast stimulation which led to protein expression especially collagen stimulation, and it seems that it is a promising therapeutic modality for striae with minimal side effects.