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Wu TJ, Huang YL, Kang YN, Chen KH, Chen C. Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Dermatol Surg 2024:00042728-990000000-00825. [PMID: 38820425 DOI: 10.1097/dss.0000000000004252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable. OBJECTIVE The aim of this review was to determine the most effective type of EBD for improving the appearance of striae. MATERIALS AND METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted. RESULTS Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width. CONCLUSION Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.
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Affiliation(s)
- Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Cathay General Hospital, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Shu X, Huo W, Zou L, Li Z, Tang Y, Li L, Wang X. Treatment of Stretch Marks Using a New Formulation Combining Nanofractional Radiofrequency Plus Magnetic Nanofractional Radiofrequency. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00926-y. [PMID: 37171578 DOI: 10.1007/s13555-023-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Stretch marks are common atrophic dermal scars with significant physical and psychological effects. Therefore, there is a need for effective cosmetics and procedures for stretch mark treatment. This study aimed to evaluate the efficacy and safety of a novel treatment for stretch marks that is made up of topical formulations containing beta-glucan combined with nanofractional radiofrequency. METHODS This randomized, blinded control trial enrolled 64 Chinese women aged 20-45 years at > 6 months after delivery with obvious white or silver abdominal stretch marks. Participants were randomly allocated to group A (blank group), group B (topical product group), group C (product combined with nanofractional radiofrequency), and group D (vehicle combined with nanofractional radiofrequency). The stretch mark width, skin elasticity, skin color, skin thickness, and collagen density were noninvasively measured. Two trained assessors evaluated the severity, color, outline, and relaxation of the striae. RESULTS Group C showed the best treatment efficacy, with no adverse effects observed during the study period. CONCLUSION Our findings indicate that stretch mark treatment using topical formulations containing beta-glucan, combined with nanofractional radiofrequency plus magnetic nanofractional radiofrequency, is tolerable and effective. TRIAL REGISTRATION ChiCTR2200056725.
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Affiliation(s)
- Xiaohong Shu
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wei Huo
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lin Zou
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhaoxia Li
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ying Tang
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Li
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Dermatology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Wang
- Center of Cosmetic Evaluation, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
- Department of Dermatology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Mendes N, Alves PJ, Barros M, Machado J. Fractional CO 2 Laser versus Fractional Radiofrequency for Skin Striae Treatment: Study Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10122372. [PMID: 36553896 PMCID: PMC9778507 DOI: 10.3390/healthcare10122372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Striae are common dermal lesions associated with physiological and psychological alterations, affecting the quality of life. This proposed randomized controlled trial protocol will evaluate the clinical efficacy and treatment safety of fractional CO2 laser versus fractional radiofrequency (FRF) in clinical trials. We will randomly allocate 60 subjects who present abdominal striae into two different groups for the treatment, which will be performed once a month for a 3-month period. The results will be assessed by quartile scoring criteria; by comparing digital photos taken before and after each treatment; and also, by the measurement of cutaneous temperature, skin pH, and elasticity before and after the treatment. This paper describes the rationale and the design of the randomized controlled trial, which may provide evidence for clinical application of the methodology and the quality related to the efficacy and safety of fractional CO2 laser versus the FRF protocol for striae treatment.
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Affiliation(s)
- Nuno Mendes
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- CNM—Clínica Nuno Mendes do Grupo Saúde Nuno Mendes, Guilhufe, 4560-164 Penafiel, Portugal
- Correspondence:
| | - Paulo Jorge Alves
- ICS—Instituto de Ciências da Saúde da Universidade Católica Portuguesa—Centro Regional do Porto, 4169-005 Porto, Portugal
| | - Mafalda Barros
- CNM—Clínica Nuno Mendes do Grupo Saúde Nuno Mendes, Guilhufe, 4560-164 Penafiel, Portugal
| | - Jorge Machado
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- CBSin—Center of BioSciences in Integrative Health, 4250-105 Porto, Portugal
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Huang Q, Xu LL, Wu T, Mu YZ. New Progress in Therapeutic Modalities of Striae Distensae. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2101-2115. [PMID: 36213315 PMCID: PMC9532256 DOI: 10.2147/ccid.s379904] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022]
Abstract
Striae distensae (stretch marks/striae gravidarum) is one of the common cosmetic problems that can cause psychological distress and anxiety to patients due to its disfiguring damage, especially for women. The etiology of striae distensae is currently unknown, and risk factors include low maternal age, family history of stretch marks, excessive weight gain during pregnancy, and high neonatal weight. This article reviews the latest literature on the most commonly used, most popular, and novel treatment modalities and analyzes the hot spots and difficulties in striae distensae treatment in recent years. Topical treatment modalities are mainly used as an adjunctive treatment. Ablative lasers and non-ablative lasers are the most popular, among which picosecond has been tried in striae distensae treatment in the last two years. Combined treatment modalities are currently a hot spot for SD treatment, and microneedle radiofrequency and fractional CO2 laser combined with other treatments are the most common. Microneedle radiofrequency is the most commonly used and achieved therapeutic effect among the combined treatment modalities.
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Affiliation(s)
- Qing Huang
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Liu-li Xu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Ting Wu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Yun-Zhu Mu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
- Correspondence: Yun-Zhu Mu, Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing District, Nanchong, Sichuan, 637000, People’s Republic of China, Tel +8615984833231, Email
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Seirafianpour F, Sodagar S, Mozafarpoor S, Baradaran HR, Panahi P, Hassanlouei B, Goodarzi A. Systematic review of single and combined treatments for different types of striae: a comparison of striae treatments. J Eur Acad Dermatol Venereol 2021; 35:2185-2198. [PMID: 34021922 DOI: 10.1111/jdv.17374] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
Striae distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost-effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by 20 May 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light-based devices and topical treatments are the most commonly applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side-effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.
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Affiliation(s)
- F Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - S Sodagar
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - S Mozafarpoor
- Department of Dermatology, Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H R Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - P Panahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - B Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - A Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
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Kaewkes A, Manuskiatti W, Cembrano KA, Wanitphakdeedecha R. Treatment of abdominal striae distensae in Fitzpatrick skin types IV to V using a 1064-nm picosecond laser with a fractionated microlens array. Lasers Surg Med 2021; 54:129-137. [PMID: 34420222 DOI: 10.1002/lsm.23471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/21/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Striae distensae are atrophic dermal scars that can cause psychosocial distress among affected patients. Despite numerous available therapeutic modalities, no gold standard treatment has been established. OBJECTIVE To evaluate the long-term efficacy and safety of a fractional 1064-nm picosecond laser for the treatment of striae alba in individuals with dark skin types. MATERIALS AND METHODS Twenty volunteers with Fitzpatrick skin types IV-V who presented with striae alba were enrolled. Subjects were treated with a fractional 1064-nm picosecond laser for four sessions at 4-week intervals. The skin texture, average melanin index (MI), and melanin variation score were assessed using Antera 3D® before treatment, at 1 month after the second treatment, and at 1, 3, and 6 months after the last treatment. Two independent investigators evaluated clinical improvement by comparing pretreatment and posttreatment photographs. The patient satisfaction rates were likewise assessed. Adverse effects were recorded during the entire study period. RESULTS Significant improvement of skin texture was seen at 1 month after the final treatment (p < 0.001) and continuously improved until the 6-month follow-up visit (p = 0.003). The average MI significantly increased at 1 month after the final treatment (p < 0.001), whereas the melanin variation score decreased throughout the follow-up period. Investigator assessment at the 6-month follow-up revealed that 90% of subjects had moderate to marked improvement of striae appearance. Only two of 20 subjects (10%) developed transient postinflammatory hyperpigmentation (PIH) after laser treatment. CONCLUSION Fractional picosecond 1064-nm laser is effective and well-tolerated for the treatment of striae alba in dark-skinned individuals with a low incidence of PIH.
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Affiliation(s)
- Arisa Kaewkes
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kathryn Anne Cembrano
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Oliveira Paggiaro A, Pinheiro R, Soares K, Fernandes Carvalho V, Gemperli R. Evaluation of the evidence level for the use of radiofrequency in aesthetic treatments: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 20:2691-2702. [PMID: 34333828 DOI: 10.1111/jocd.14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiofrequency (RF) is a non-invasive or minimally invasive procedure with a low risk of complications. It has been employed for several aesthetic purposes. AIM This study aimed to conduct a systematic literature review on the use of RF for aesthetic applications and assess the level of accumulated evidence for each condition. METHODS Using the MEDLINE/PubMed and EMBASE databases, we searched for articles published from 2009 to 2019 describing the use of RF treatment for aesthetic purposes. RESULTS Our search approach identified 25 randomized clinical trials investigating the efficacy of RF in the following clinical situations: body contour improvement, facial rejuvenation, acne scar treatment, alopecia, and rosacea. There were problems with the quality of the studies, especially regarding selection, performance, and detection bias. CONCLUSION Our study revealed that RF treatment is potentially promising in all of the evaluated clinical situations; however, we were not able to identify a level of evidence that justifies its use over other therapeutic options currently available on the market.
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Affiliation(s)
- André Oliveira Paggiaro
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil.,Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Rafael Pinheiro
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Kaolanna Soares
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Rolf Gemperli
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil
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8
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Abstract
SUMMARY 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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9
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Comparative study of treatment for striae alba stage striae gravidarum: 1565-nm non-ablative fractional laser versus fractional microneedle radiofrequency. Lasers Med Sci 2021; 36:1823-1830. [PMID: 33411130 DOI: 10.1007/s10103-020-03203-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Striae gravidarum is a common dermatologic condition for females caused by multiple factors during pregnancy. It remains a therapeutic challenge especially in the striae alba (SA) stage, generating psychological and emotional distress to those affected. This study aims to compare the efficacy and safety of 1565-nm non-ablative fractional laser (NAFL) and fractional microneedle radiofrequency (MRF) for treatment of SA striae gravidarum. Fourteen Chinese women with SA striae gravidarum were included in this study. Patient abdomens were randomly divided into NAFL and MRF treatment sides, treated three times at 6-week intervals. Treatment efficacy was evaluated by subjective (clinical assessments, patient satisfaction rating, adverse effects assessment) assessments and objective (skin melanin index measurement, histological study) assessments. Clinical assessment suggested MRF was more effective (P = 0.0143) for improving the appearance of SA striae gravidarum. Both NAFL and MRF demonstrated effective improvement (P = 0.0082 and P = 0.0158, respectively), with no significant difference according to patient satisfaction ratings and changes in melanin index (P = 0.5900). Both treatments induced limited adverse reactions, but MRF treatment caused significant pain compared with the more moderate NAFL treatment (P = 0.0003). MRF treatment increased neocollagen and elastic fibers more significantly than NAFL, based on histological assessments (P = 0.0298 and P = 0.0048, respectively). MRF treatment improved collagen regeneration in SA striae gravidarum more than NAFL but caused considerable pain during treatment. Corresponding treatment or therapeutic strategies should be applied according to clinical scenario.
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10
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Yu Y, Wu H, Yin H, Lu Q. Striae gravidarum and different modalities of therapy: a review and update. J DERMATOL TREAT 2020; 33:1243-1251. [PMID: 33003983 DOI: 10.1080/09546634.2020.1825614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The term striae gravidarum (SG) refers to a kind of striae distensae (SD) that develops particularly during pregnancy. According to the level of maturity of the lesions, SG is divided into striae rubra (SR) and striae alba (SA). The pathogenesis remains unclear; recent studies have implicated abnormalities in elastic fibers, collagen fibrils, and other extracellular matrix (ECM) components. Changes in the expression of hormone receptors and hormone levels have also been hypothesized. Considering this new information, we reviewed successful treatments of SG and listed them in two tables. Our review found that topical treatments were relatively weak compared with laser and light treatment, with which the appearance of SR and SA can be significantly improved. Lasers combined with other modalities, such as additional energy devices and topical agents, were also proven effective, but more large-scale trials are necessary.
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Affiliation(s)
- Yangyiyi Yu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Haijing Wu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Heng Yin
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
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11
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Al-Muriesh M, Huang CZ, Ye Z, Yang J. Dermoscopy and VISIA imager evaluations of non-insulated microneedle radiofrequency versus fractional CO 2 laser treatments of striae distensae. J Eur Acad Dermatol Venereol 2020; 34:1859-1866. [PMID: 32030833 DOI: 10.1111/jdv.16266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUNDS Striae distensae (SD) has a known psychological impact due to the resulting cosmetic disfigurement. Many treatment modalities have been used over the years, but no standard interventions or evaluation methods have been proposed to date. OBJECTIVE We compared the efficacy and safety of non-insulated microneedle radiofrequency (NIMRF) and fractional CO2 laser treatments of SD by objective measurements with dermoscopy and VISIA. METHODS Fourteen females with severe SD were enrolled. These subjects had been treated three sessions of NIMRF and fractional CO2 laser for the right and left abdomen, respectively. Dermoscopy and VISIA imaging data, and photographs were collected at baseline and 2 months after the last treatment session. The global aesthetic improvement scale (GIAS) was scored by patients, and blinded investigators, pain score and satisfaction score were also documented. Any side effects were recorded. RESULTS Ten patients completed the study. The GIAS from investigators and patients showed an overall improvement but without a significant difference (P = 0.18, P = 0.17, respectively). The decreased width measured by dermoscopy was between 5% and 32% (right side) and 6-31% (left side). There was no significant difference between both sides in either the per-protocol or intention to treat analyses (P = 0.149, P = 0.161, respectively). The mean pain score was 5.35 and 2.35 on the right side and left side, respectively, which was significant (P = 0.0016). Post-inflammatory hyperpigmentation (PIH) manifested in six patients on their left sides and four patients on their right sides. In most cases, this had resolved by the 3-month follow-up. CONCLUSION Non-insulated microneedle radiofrequency and fractional CO2 laser are both effective and safe treatment options for SD. PIH is a possible side effect but is more likely with fractional CO2 laser treatment. However, it clears up in most cases. Dermoscopy and VISIA are both convenient, digitalized methods of tracking subtle changes and monitoring the efficacy of SD treatments.
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Affiliation(s)
- M Al-Muriesh
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - C-Z Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Z Ye
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - J Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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12
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Weiner SF. Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications. Facial Plast Surg Clin North Am 2019; 27:291-303. [PMID: 31280844 DOI: 10.1016/j.fsc.2019.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Radiofrequency (RF) skin rejuvenation is improved using RF microneedling (RFM) devices. More aggressive treatments are performed safely with minimal downtime than previous RF devices. Optimizing treatment parameters is essential for safety and efficacy. Multiple RFM studies support minimal risks even in dark skin types. RFM has been used to treat acne scarring successfully as well as skin laxity and hyperhidrosis.
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Affiliation(s)
- Steven F Weiner
- 2050 West County Highway 30A, Suite 114, Santa Rosa Beach, FL 32459, USA.
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13
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Abstract
Striae distansae (SD) or stretch marks are very common, asymptomatic, skin condition frequently seen among females between 5 to 50 years of ages. It often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late, with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for stretch marks treatment. However, despite several advances, no fully effective treatment has emerged. Unfortunately, there is paucity of the strong evidence in the literature for the effective treatment of striae. A literature search using the terms 'striae distansae (SD or stretch marks' was carried out in the PubMed, Google Scholar and Medline databases. Only articles related to the treatment were considered and analysed for their data. Commonly cited treatments include topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q-switched Nd:YAG, pulse dye and excimer laser. Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture have also been used with variable success. This article reviews all currently accepted modalities and their effectiveness in the treatment of stretch marks.
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Affiliation(s)
- Archana J Lokhande
- Department Of Dermatology, ESIC PGIMSR, Model Hospital, Basaidarapur, New Delhi, India
| | - Venkataram Mysore
- Venkat Charmalaya Centre for Advanced Dermatology and Postgraduate Training, Bangalore, Karnataka, India
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14
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Meningaud JP, SidAhmed-Mezi M, Billon R, Rem K, La Padula S, Hersant B. Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients. Lasers Surg Med 2018; 51:230-238. [PMID: 30480320 DOI: 10.1002/lsm.23042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD. STUDY DESIGN/MATERIALS AND METHODS This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm2 , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported. RESULTS Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported. CONCLUSION Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230-238, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Jean Paul Meningaud
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
| | - Mounia SidAhmed-Mezi
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
| | - Raphaelle Billon
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
| | - Kessara Rem
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
| | - Simone La Padula
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
| | - Barbara Hersant
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Hopital Henri Mondor, Creteil, 94010, France
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Guertler A, Reinholz M, Steckmeier S, Gauglitz GG. Evaluation of a non-ablative, fractional 1565 nm laser for the improvement of striae distensae albae. J Eur Acad Dermatol Venereol 2018; 33:220-226. [PMID: 30169914 DOI: 10.1111/jdv.15228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Striae distensae (SD) represent therapeutically challenging forms of dermal atrophic scarring. In addition to topical ointments, medical needling and various energy-based devices, non-ablative fractional lasers have been suggested for their improvement. However, objective evaluations of their efficacy are widely missing. In this study, we aimed to assess the clinical improvement of SD albae after three treatments with a non-ablative fractional 1565 nm Er: glass laser by employing three-dimensional analysis and several questionnaires. METHODS A total of 16 Caucasians suffering from SD albae were included in this prospective study. Every patient received three treatments - one every 4 weeks - using a non-ablative, fractional 1565 nm laser (two passes: 300 μbeams/cm2 , 40 mJ inside the SD; 150 μbeams/cm2 , 50 mJ inside the SD and within the surrounding area). Questionnaires (DLQI, POSAS), digital photography and three-dimensional analysis employing PRIMOS® software and VECTRA® camera system were taken at baseline, 1 and 6 months after the last treatment. RESULTS Evaluation of objective measurements at 6-month follow-up (FU) showed a significant reduction in depth of atrophic lesions by 31.7% and less skin irregularities with Smax at baseline of 621.2 μm decreasing to 411.6 μm (P < 0.01, respectively). Improvement in objective measurements was supported by significant changes in patients' rating of skin appearance. POSAS patient total score declined from 33.5 points to 17.5 points throughout the study (P < 0.001). From baseline to 6-month FU, patients' life quality improved by 68.0% (DLQI score). Procedures showed no lasting negative side-effects and little to no down time. CONCLUSION The use of a fractional non-ablative 1565 nm laser represents a safe approach for the treatment of SD albae. Clinically observed improvements were supported by significant data from objective measurements. The results achieved at 1-month FU represented at 6-month FU, showing stable clinical improvements.
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Affiliation(s)
- A Guertler
- Clinic of Dermatology and Allergy, Department for Aesthetic Dermatology and Laser Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - M Reinholz
- Clinic of Dermatology and Allergy, Department for Aesthetic Dermatology and Laser Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - S Steckmeier
- Clinic of Dermatology and Allergy, Department for Aesthetic Dermatology and Laser Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - G G Gauglitz
- Clinic of Dermatology and Allergy, Department for Aesthetic Dermatology and Laser Medicine, Ludwig-Maximilian-University, Munich, Germany
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16
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Kravvas G, Veitch D, Al-Niaimi F. The use of energy devices in the treatment of striae: a systematic literature review. J DERMATOL TREAT 2018; 30:294-302. [DOI: 10.1080/09546634.2018.1506078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - David Veitch
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK
| | - Firas Al-Niaimi
- Department of Dermatologic Surgery and Laser Unit, St. John’s Institute of Dermatology, St. Thomas’ Hospital, London, UK
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17
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Hague A, Bayat A. Therapeutic targets in the management of striae distensae: A systematic review. J Am Acad Dermatol 2017; 77:559-568.e18. [PMID: 28551068 DOI: 10.1016/j.jaad.2017.02.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/14/2017] [Accepted: 02/19/2017] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Adam Hague
- Centre for Dermatological Research, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Centre for Dermatological Research, University of Manchester, Manchester, United Kingdom.
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Striae Distensae: Preventative and Therapeutic Modalities to Improve Aesthetic Appearance. Dermatol Surg 2017; 43:635-648. [DOI: 10.1097/dss.0000000000001079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
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[What's new in instrumental dermatology (laser)?]. Ann Dermatol Venereol 2016; 143 Suppl 3:S11-S18. [PMID: 29429504 DOI: 10.1016/s0151-9638(18)30044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This year, What's new in Interventional Dermatology will be dedicated to lasers and other interventional devices. Many articles have been published these past two years emphasizing how dynamic this field of dermatology is. However, most of published papers were case reports or open series. Thus, innovative approaches, prospective randomized trials and large retrospective studies were the main criteria of selection of the articles.
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