Risk factors associated with striae gravidarum

Topical preparations for preventing stretch marks in pregnancy

BACKGROUND

Striae gravidarum (stretch marks developing during pregnancy) occur in 50% to 90% of women. They appear as red or purple lines or streaks that fade slowly to leave pale lines or marks on the skin. The abdomen, breasts and thighs are commonly affected. The exact cause of stretch marks is unclear and no preparation has yet been shown to be effective in preventing the development of stretch marks. They are a source of significant anxiety for women, impacting on their quality of life.

OBJECTIVES

To assess the effects of topical preparations on the prevention of stretch marks in pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011) and reference lists of retrieved reports.

SELECTION CRITERIA

We included randomised controlled trials and quasi-randomised controlled trials comparing topical preparations (with active ingredients) with other topical preparations (with active ingredients), with a placebo (that is, preparations without active ingredients) or with no treatment for the prevention of stretch marks in pregnant women.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed trial eligibility and trial quality, and extracted data. Data were checked for accuracy. The primary outcome was the presence of stretch marks and the secondary outcome was the severity of stretch marks.

MAIN RESULTS

We included six trials involving 800 women. Of the six trials, we judged the risk of bias for three as 'low risk' for random sequence generation, blinding of participants and personnel, blinding of outcome assessment, completeness of outcome data and selective reporting.There was no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received a placebo or no treatment (average risk ratio (RR) 0.74; 95% confidence interval (CI) 0.53 to 1.03; five trials, 474 women; random-effects model, Tau² = 0.09, I² = 65%) (Analysis 1.1).Results were consistent with the main effects when we performed a sensitivity analysis excluding studies judged to be at high risk of bias for random sequence generation, allocation concealment or more than 20% missing data for a given outcome (average RR 0.81; 95% CI 0.60 to 1.10; four trials, 424 women; random-effects model, Tau² = 0.05, I² = 57%).The was no statistically significant average mean difference in the severity of stretch marks (standardised mean difference (SMD) -0.31; 95% CI -1.06 to 0.44; two trials, 255 women; Tau² = 0.26, I² = 87%).There was no statistically significant difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received other topical preparations with active ingredients (average RR 0.51; 95% CI 0.16 to 1.60; two trials, 305 women; Tau² = 0.53, I² = 74%). There was no statistically significant difference in the severity of stretch marks (mean difference (MD) -0.20; 95% CI -0.53 to 0.13; one trial, 206 women; heterogeneity not applicable).

AUTHORS' CONCLUSIONS

We found no high-quality evidence to support the use of any of the topical preparations in the prevention of stretch marks during pregnancy. There is a clear need for robust, methodologically rigorous randomised trials involving larger sample sizes to evaluate the effects of topical preparations on the development of stretch marks in pregnancy. In addition, it is important that preparations commonly used by women to prevent and treat stretch marks are evaluated within the context of robust, methodologically rigorous and adequately powered randomised trials.

The effect of bitter almond oil and massaging on striae gravidarum in primiparaous women

AIM

This study aims to identify the effect of applying bitter almond oil with and without massage on preventing striae gravidarum during pregnancy.

BACKGROUND

Striae gravidarum is a dermatological problem bringing about cosmetic concerns in about 90% of pregnant women. On the onset, striae gravidarum appears as a pink-purple atrophic strip. Striae appear pale atrophic in the postnatal period, but they never disappear completely.

DESIGN

In view of the physiology of striae gravidarum formation, this study employs a posttest-only quasi-experimental design with a control group.

METHODS

The participants of this study were the primiparous women who visited the pregnancy unit of a medical centre in the eastern region of Turkey between February 1st, 2010 and April 15th, 2011. The participants were divided into three groups: the primiparous women who applied bitter almond oil with massage (n = 47), who merely applied bitter almond oil (n = 48) and who were in the control group (n = 46).

RESULTS

The frequency of striae gravidarum was 20% among the women who applied bitter almond oil with massage, 38·8% among those who merely applied almond oil and 41·2% in the control group. A statistically significant difference was observed in the frequency of striae gravidarum between the groups, and it was the group who applied almond oil with massage that accounted for the difference (p < 0·001). The frequency of striae gravidarum was also found to be lower in the group who applied almond oil with massage compared to the others (p < 0·05).

CONCLUSION

It was found that a 15-minute massage applied with almond oil during pregnancy reduced the development of striae gravidarum, but using bitter almond oil had no effect on this in itself. It is recommended that pregnant women be informed about the positive effects of massaging applied with almond oil early during their pregnancy.

RELEVANCE TO CLINICAL PRACTICE

Nurses and midwives can use the findings of this study in preventing the development of striae gravidarum during pregnancy.

Pregnancy and skin

INTRODUCTION

Skin changes occur in about 90 % pregnant women in one form or the other. The various skin changes maybe either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy-specific dermatoses. All of these dermatoses can be attributed to the profound hormonal, vascular, metabolic, and immunological changes occurring during pregnancy.

CLASSIFICATION

Pregnancy-specific dermatoses have now been classified into dermatoses which are definitively associated and dermatoses with uncertain association with pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy.

CONCLUSION

Careful history taking and examination will help us to identify each condition clinically and appropriate management can be instituted for the well-being of the mother and the fetus.

Ultrasound and 3D Skin Imaging: Methods to Evaluate Efficacy of Striae Distensae Treatment

Background. Over time, the striae rubra develop into striae alba that appear white, flat, and depressed. It is very important to determine the optimum striae management. In order to evaluate the effectiveness of these therapies, objective measurement tools are necessary. Objective. The aim of this study is to evaluate if ultrasonography and PRIMOS can be used to obtain an objective assessment of stretch marks type and stage; furthermore, we aim to apply these techniques to evaluate the efficacy of a topical treatment. Methods. 20 volunteers were enrolled with a two-month study. A marketed cosmetic product was used as the active over one body area. The controlateral area with stretch marks was treated with a "placebo" formulation without active, as a control. The instrumental evaluation was carried out at the beginning of the trial (baseline values or t(0)), after 1 month (t(1)), and at the end of the study (t(2)). Results. PRIMOS was able to measure and document striae distensae maturation; furthermore, ultrasound imaging permitted to visualize and diagnose the striae. Statistical analysis of skin roughness demonstrated a statistically significant reduction of Rp value only in a treated group. In fact, the Rp value represented a maximum peak height in the area selected. These results demonstrated that after two months of treatment only the striae rubra can be treated successfully. Conclusions. This work demonstrated that the 22MHz ultrasound can diagnose stretch marks; PRIMOS device can detect and measure striae distensae type and maturation. Furthermore, the high-frequency ultrasound and the 3D image device, described in this work, can be successfully employed in order to evaluate the efficacy of a topical treatment.

Fractional nonablative 1540-nm laser treatment of striae distensae in Fitzpatrick skin types II to IV: clinical and histological results

BACKGROUND

Current striae treatments are limited in their ability to deliver long-lasting improvements for all skin types. The success of fractional nonablative lasers for surgical scars has been attributed to the controlled wound-healing response stimulated by microscopic columns of epidermal and dermal thermal damage.

OBJECTIVES

The authors describe the safety and efficacy results of treatment with a fractional nonablative 1540-nm erbium:glass laser in patients with Fitzpatrick skin types II to IV for both striae rubra and striae alba.

METHODS

A 51-person clinical study was conducted on striae ranging in duration from one to 40 years. Nine different anatomical locations were treated, including the breasts, hips, and abdomen. Treatment parameters included two to three passes with the 1540-nm laser, with energy settings from 35 to 55 mJ/mb with the 10-mm optical tip or 12 to 14 mJ/mb with the 15-mm optical tip. Two to four total treatments were performed at four- to six-week intervals. Nonblinded efficacy evaluations were performed on all 51 patients; blinded evaluations were conducted by three independent clinicians on 14 randomized sets of pre- and posttreatment images on a 0% to 100% quartile improvement scale. Skin reactions were assessed by the treating physician and recorded at multiple time points, and histology was conducted with hemotoxylin and eosin as well as Orcein-Giemsa staining.

RESULTS

Nonblinded clinical assessments rated overall improvement as 50% or greater for all patients at six months or longer after the last treatment. Blinded evaluators reported an overall mean improvement score of 51% to 75% on properly selected images taken at least three months after treatment (n = 11). In all patients examined at either 18 or 24 months after treatment, there was no recurrence of striae. Typical side effects included transient erythema and edema. A small minority of patients experienced transient cases of trace postinflammatory hyperpigmentation (PIH), which all resolved. Histologic observations showed thickening of the epidermis and dermis, neocollagenesis, and increased elastin deposition one month after the last treatment.

CONCLUSIONS

Positive safety and efficacy results with the fractional nonablative 1540-nm erbium:glass laser for the treatment of striae rubra and striae alba ranging in maturation age from one to 40 years was demonstrated in Fitzpatrick skin types II to IV.

[Striae distensae in pregnancy: risk factors in primiparous women]

BACKGROUND

Striae occur in over 70% of pregnant women and tend to develop after 25 weeks of gestation. Despite the fact that their etiology has not yet been fully understood, it is accepted that a combination of genetic factors, endocrine alterations and mechanical stretching of skin play a significant role. Due to different results reported in the literature, the authors assessed commonly cited risk factors to determine whether they are associated with the development of striae in pregnancy.

OBJECTIVE

To assess hypothetical risk factors for the development of striae in primiparous women.

METHODS

This was a cross-sectional, observational, non-controlled, descriptive study with primiparous women. the study was conducted in a public maternity unit and Lasted for four months (from January to May 2008). 164 Primiparous women who had had a single fetus pregnancy took part in the study 48 hours after delivery. Fourteen Variables were recorded for each patient.

RESULTS

From the total sample, 59.8% developed striae during pregnancy. The association of maternal age range (p < 0,01), maternal weight gain during pregnancy (p < 0,01) and birth weight of newborn infants (p = 0,01) with the development of striae during pregnancy was statistically significant. The chisquared test of association was used.

CONCLUSIONS

Striae were more frequently observed in younger women, in those who gained more weight during pregnancy and/or those who had babies with higher birth weight. This study suggests that increased maternal age could be a protecting factor against striae during pregnancy.

Striae distensae (stretch marks) and different modalities of therapy: an update

BACKGROUND

Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment.

OBJECTIVE

To identify the current treatment modalities and their effectiveness in the treatment of stretch marks.

MATERIALS AND METHODS

Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications.

RESULTS

No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging.

CONCLUSION

The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies.

Signs of herniosis in women with vaginal prolapse and/or stress incontinence

Gynecological literature pertaining to prolapse or stress urinary incontinence published over the past four decades was reviewed to determine whether signs of herniosis, the systemic connective tissue co-morbidity known to play a significant role in abdominal herniation, were present and differed from controls. A total of eight indications were reported: (1) Genetic factors, i.e., family history and race, were predictive. (2) An increase in the incidence was observed in association with heritable diseases of collagen and their formes frustes (e.g., joint laxity). (3) Recurrence rate after repair was high (30%). (4) Fragmentation and degeneration of smooth muscle and collagen fibers were observed histologically. (5) Biochemistry demonstrated a decline of 24-40% in collagen content of skin, round ligament, cardinal ligament, periurethral vaginal wall, cervix, pubocervical, cervicococcygeal, and vesicovaginal fasciae. (6) In patients with stress urinary incontinence, collagen content decreased 60%. This change was independent of age, parity, menopausal status, and weight. (7) Matrix metalloproteinase (MMP-2 and MMP-9) activity increased fourfold and that of their inhibitor TIMP-1 decreased. (8) Cigarette smoking, an acquired factor, increased the incidence of stress urinary incontinence. This commonality with the etiology of abdominal herniae explains why gynecologists have decreased their emphasis on childbirth injury and, like herniologists, have moved to discard the dogma "prolapse" as a designate for extraperitoneal herniation in the pelvis.

Striae gravidarum: associated factors

BACKGROUND

Striae gravidarum (SG) is the most common change in connective tissue of pregnant women and may cause cosmetic concerns.

OBJECTIVES

To determine the frequency of SG in Iranian pregnant women and its possible associations with the characteristics of themselves and their newborns.

METHODS

One hundred and eighteen primigravid pregnant women were included in this prospective observational study at their first prenatal visit, among them 114 completed the study and gave birth.

RESULTS

One hundred (87.7%) of 114 women developed SG with a mean Davey's score of 4.04 +/- 2.47. The mean gestational age at which SG first appeared was 27.57 +/- 5.38 weeks. Family history of SG in mother, baseline and delivery body mass index, greatest abdominal and hip girths, newborn weight, height and head circumference were significantly associated with the presence of SG. All of these factors were also correlated with Davey's score.

CONCLUSION

Genetic and physical risk factors may be involved in the development of SG in primigravid women.

Risk factors for the development of striae gravidarum

Objective

The purpose of this study was to identify risk factors associated with striae gravidarum (SG).

Study design

A cross-sectional study of 112 primiparous women delivering at a private teaching hospital was conducted. Participants were assessed during the immediate postpartum period for evidence of SG. Presence and severity of SG were compared to characteristics of women using t tests and Chi-square tests.

Results

Sixty percent of the study participants had developed SG. Women who developed SG were significantly younger (26.5 ± 4.5 vs 30.5 ± 4.6; P < .001) and had gained significantly more weight during pregnancy (15.6 ± 3.9 vs 38.4 kg ± 2.7; P < .001). Birthweight (BW), gestational age at delivery, and family history of SG were associated with moderate/severe SG.

Conclusion

Maternal age and weight gain during pregnancy are associated with SG. BW, family history of SG, and gestational age at delivery are associated with moderate/severe SG.

Striae gravidarum

Striae are atrophic linear plaques, most often found on the breasts, abdomen, hips, and thighs. They develop in a variety of circumstances, some of which involve physical stretching of the skin, such as adolescent growth spurts, and during hormonal changes, such as Cushing's syndrome. It has been suggested that genetics may play a role in their development. Regardless of the etiology, all striae display the same histological changes in the dermis showing atrophy and loss of rete ridges. These findings are similar to those seen with scar formation. At present, no definitive treatments have been established.

Striae and pelvic relaxation: two disorders of connective tissue with a strong association

Pelvic relaxation, a weakening of pelvic support structures, is an under-reported condition that affects a multitude of women. In the United States alone, more than 338,000 procedures for prolapse are performed annually. Decreased collagen content has been noted in the tissues of women affected by this condition. Interestingly, biopsy specimens of women with striae also show a diminution of collagen. Using self-reported anonymous data, we compared the prevalence of striae in women with and without pelvic relaxation to see if an association between these two disorders of connective tissue existed. More than half the women with prolapse (54.7%) (n = 41) reported striae, whereas only 25.0% of women in the non-prolapse group (n = 8) reported striae (P < 0.01). Multivariate logistic regression analysis confirmed striae as a significant risk factor for the development of clinical prolapse (odds ratio 3.12, P < 0.05). There appears to be a strong association between the presence of striae and the development of pelvic relaxation, which is unrelated to conventionally cited risk factors, such as age, weight, number of pregnancies, or postmenopausal status.

Cosmetic aspects of pregnancy

There are a vast number of changes to the female body that occur during pregnancy, to which any pregnant woman will attest. The changes, although considered, for the most part, physiological and not pathological, are quite distressing to many women. This chapter serves to review those changes and comment on their physiological origins. Most of these changes can be definitively or inferentially linked to the dramatic hormonal changes that take place to support a pregnancy. Comments are also made about treatment as they pertain to pregnant women. In addition, a brief discussion about performing cosmetic procedures during pregnancy is included.

Blood vessel changes during pregnancy: a review

The profound endocrine upheaval of pregnancy is frequently associated with changes in the function and structure of the blood and lymph microvasculature of the skin and mucosae. Palmar erythema is frequent but rarely severe and is associated with burning sensations. Spider telangiectasias develop in the majority of pregnant White women but are less often identified in women with darker skin. Hemangiomas and glomus tumors occur in one-third of women. A firm edema may develop on the face and extremities in the final months of pregnancy. Venous hypertension and varicosities of the lower limbs are common. Gingivitis, gum hypertrophy, and pyogenic granuloma are common in the oral cavity. The vaginal mucosa is also affected, showing a violaceous aspect, at times accompanied by varicosities of the vulva. Many gestational vascular changes regress spontaneously in the postpartum phase. Some vascular tumors may need to be treated with a vascular laser or intense pulsed light.

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.