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Liu Y, Sun DD, Chang SY, Ma LL, Jiang G. Study of different pre-treatments in the comparison of the efficacy of photodynamic therapy for moderate to severe acne vulgaris. Photodiagnosis Photodyn Ther 2024:104298. [PMID: 39089477 DOI: 10.1016/j.pdpdt.2024.104298] [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: 05/18/2024] [Revised: 07/03/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To evaluate the efficacy of CO2 fractional laser and microneedling pretreatment combined with ALA-PDT for moderate-to-severe acne, aiming to optimize clinical treatment. METHODS Patients were randomly divided into three groups: Group A (CO2 fractional laser + ALA-PDT), Group B (microneedling + ALA-PDT), and Group C (ALA-PDT). Each group underwent photodynamic therapy once a week for 3 weeks. Efficacy was assessed at the end of the 4th week, and recurrence was assessed at the end of the 12th week. RESULTS A total of 150 patients with moderate to severe acne were included in this study, with 50 patients in each group. Four weeks after the end of treatment, the effective rates were 88% for Group A, 62% for Group B, and 36% for Group C. Statistically significant differences were found between the groups (P < 0.05), with Group A showing superior efficacy compared to Group B (P < 0.05). No serious systemic or local adverse reactions were observed in any group. No recurrence was seen in any group 12 weeks after the end of treatment, and some patients continued to show improvement in skin lesions over time. CONCLUSION Both the CO2 fractional laser group and the microneedling group improved the efficacy of photodynamic therapy for moderate to severe acne compared to the control group, with the CO2 fractional laser group demonstrating better efficacy and fewer adverse effects.
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Affiliation(s)
- Yue Liu
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China
| | - Dan-Dan Sun
- Department of Dermatology, Xuzhou City Hospital of Traditional Chinese Medicine, Xuzhou, China
| | - Shu-Ying Chang
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China
| | - Lin-Lin Ma
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China
| | - Guan Jiang
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China.
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Hafez V, Mahgoub D, Satour EMA, Mikhail MMS, El-Kalioby M. Photobiomodulation versus fractional carbon dioxide laser for stria alba in phototype III-IV: a randomized controlled study. Lasers Med Sci 2024; 39:159. [PMID: 38890186 PMCID: PMC11189306 DOI: 10.1007/s10103-024-04107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Abstract
Striae distensae are common dermatological complaint. Cold laser using low-level light/laser therapy (LLLT) offers healing and analgesic effects and was not yet compared to 'hot lasers' efficacy. Study objective: to assess the efficacy and safety of LLLT in the management of stria alba compared to fractional carbon dioxide (FCO2) laser alone and to the combined use of both devices. Thirty patients with stria alba were randomized to receive either LLLT using diode 808 nm; 8-12 sessions, 2-3 sessions weekly (Group A) or FCO2 laser; 2 monthly sessions (Group B) or combined both devices simultaneously (Group C). Follow up was at 1 month and 3 months after last session. The efficacy of LLLT was statistically comparable to FCO2, despite numerical superiority of the latter. The combined group had the least numerical values in all efficacy outcomes. Patients in LLLT group did not experience any downtime. LLLT is effective in the management of stria alba comparable to the FCO2 laser. The lack of downtime with LLLT is reflected positively on patient's satisfaction. However, this is counterbalanced by the frequent weekly visits. Although adding LLLT to FCO2 laser palliates the laser side effects but it offers the least efficacy. Trial registration number NCT04165226 (clinicaltrials.gov).
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Affiliation(s)
- Vanessa Hafez
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Doaa Mahgoub
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mona El-Kalioby
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Sun X, Jia X, Huang L. Microneedling Therapy for Striae Distensae: Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03954-x. [PMID: 38509316 DOI: 10.1007/s00266-024-03954-x] [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: 11/07/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Striae distensae (SD), linear scars of derma, caused by disproportionate skin stretching, which indicates a cosmetic problem and even endangers individuals' psychosocial health. Microneedling, representing a relatively new procedural therapy, has shown brightening but diverse results in the remedy of SD. Our study systematically investigates and further evaluates the efficacy of microneedling for SD. METHOD This study was conducted following the PRISMA guidelines. According to the preplanned search strategy, four electronic databases were comprehensively searched for eligible clinical controlled studies. Standardized mean difference (SMD) and odd ratio (OR) with 95% confidence intervals were calculated for continuous data and dichotomous data, respectively. RESULTS According to the predetermined criteria, eleven eligible articles of six RCTs and five non-RCTs were included. Concerning clinical improvement, a significant difference was observed in the microneedle radiofrequency treatment subgroup (SMD: 0.57, 95% CI 0.20-0.94, P = 0.003). The pooled result of the second subgroup revealed that microneedling and lasers producing almost comparable effectiveness for treating SD with no significant difference (P = 0.35). The analysis result of the third subgroup of microneedling versus non-laser therapy indicated significant difference at the 5% significance level (SMD:1.01, 95% CI 0.51-1.51, P < 0.0001). With regard to patient satisfaction, the pooled estimate concluded that participants' satisfaction with therapeutic effect between MRF and laser group was comparable (P = 0.26), whereas microneedling exhibited significant superiority than both laser (P = 0.04) and non-laser treatments (SMD: 0.95, 95% CI 0.52-1.38, P < 0.0001). Occurrence of post-inflammatory hyperpigmentation (PIH) was not obvious in microneedling therapy compared to other treatments, and a statistically difference was observed (P = 0.0003). Microneedling treatment caused significant pain compared with laser therapy (P < 0.00001). CONCLUSION This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Xiaochen Sun
- Laser Aesthetic Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ximeng Jia
- Laser Aesthetic Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lvping Huang
- Laser Aesthetic Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kneiber D, Amin M, Nguyen TA, Gharavi NM. Review of radiofrequency microneedling: history, devices and uses. J COSMET LASER THER 2023; 25:59-64. [PMID: 37844087 DOI: 10.1080/14764172.2023.2268308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.
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Affiliation(s)
- Diana Kneiber
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Mina Amin
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Tuyet A Nguyen
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Nima M Gharavi
- Department of Dermatologic Surgery & Mohs Micrographic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA, USA
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Madegowda SB, Rajegowda HM, Kalegowda D, Nagaraju PH, Naidu HM. Efficacy of Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Platelet-Rich Plasma in Treatment of Striae Distensae in a Tertiary Care Center: A Comparative Study. J Cutan Aesthet Surg 2023; 16:178-185. [PMID: 38189063 PMCID: PMC10768952 DOI: 10.4103/jcas.jcas_65_22] [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] [Indexed: 01/09/2024] Open
Abstract
Background Striae distensae are atrophic scars that are often cosmetically distressing. The efficacy of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) in treating striae individually has been evaluated previously. However, not many studies described the combined efficacy of both. Aims and Objectives The aim of this study was to compare the efficacy and safety of fractional CO2 laser alone and in combination with PRP. Materials and Methods Twenty-four patients with striae presenting bilaterally in the abdomen, upper limbs, and lower limbs were included. PRP was prepared by double-spin method and cell count was done to ensure at least fourfold concentration of platelets. The patients were treated CO2 laser on both sides and PRP on the left side along with laser, every month for three sessions. Digital photography and dermoscopy were done at baseline, every treatment session, and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient satisfaction before and after treatment. Results All patients showed improvement on both sides. In CO2-laser-treated patients, responses in 6 patients (25%) were moderate, 14 (56%) were good, and 4 (16.6%) were excellent. In CO2-laser and PRP-treated patients, responses in 5 patients (20.8%) were moderate, 11 (45.8%) were good, and 8 (33.3%) were excellent. Hyperpigmentation was the most common side-effect seen (19 patients) on both sides, which resolved spontaneously by 6 months. Conclusion These results support the use of ablative CO2 fractional laser as effective and safe treatment modalities for striae. However, slightly better efficacy was noted with the addition of PRP.
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Affiliation(s)
| | | | - Deepadarshan Kalegowda
- Department of Dermatology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India
| | - Phani Halevoor Nagaraju
- Department of Dermatology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India
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Sayed DS, Badary DM, Ali RA, Abou-Taleb DAE. Combined Fractional CO 2 Laser With Intradermal Platelet-Rich Plasma versus Fractional CO 2 Laser Alone in the Treatment of Striae Distensae. Dermatol Surg 2023; 49:552-558. [PMID: 36946771 DOI: 10.1097/dss.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Striae distensae (SD) or stretch marks are common cutaneous conditions that occur because of the stretching of the dermis.OBJECTIVE To evaluate and compare the efficacy of fractional carbon dioxide (CO 2 ) laser alone versus combined fractional CO 2 laser with platelet-rich plasma (PRP) in SD treatment. METHODS AND MATERIALS Thirty adult female patients with SD (SR and SA) were enrolled. In each patient, a split-lesion design was conducted as follows: pairs of SD on both sides of the midline were selected and allocated to groups A and B. Group A: was treated with combined fractional CO 2 laser with intradermal PRP. Group B: was treated with fractional CO 2 laser alone. Skin biopsies were taken from the lesions before and after treatment for histopathologic evaluation. RESULTS In group A, a significant excellent improvement of the SD was achieved more than in group B ( p = .007) and the mean of improvement was significantly higher (60.33 ± 26.49) than that in group B (43.80 ± 27.43) ( p -value = .001). Group A was also associated with a more significant dermal deposition of collagen and elastic fibers. CONCLUSION Combined fractional CO 2 laser with PRP was more effective than fractional CO 2 laser alone for the treatment of SD.
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Affiliation(s)
- Doaa S Sayed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Daila M Badary
- Department of pathology, Faculty of Medicine, Assiut University, Egypt
| | | | - Doaa A E Abou-Taleb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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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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Nobari NN, Tabavar A, Sadeghi S, Dehghani A, Kalantari Y, Ghassemi M, Atefi N, Goodarzi A. A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO 2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers Med Sci 2023; 38:67. [PMID: 36749436 DOI: 10.1007/s10103-022-03694-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/08/2022] [Indexed: 02/08/2023]
Abstract
The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.
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Affiliation(s)
- Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Anahita Tabavar
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Sadeghi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Division of Dermatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Abbas Dehghani
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghassemi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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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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Tawfic SO, Hassan AS, El-Zahraa Sh Aly F, Elbendary A, Shaker OG, AlOrbani AM. Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars. Lasers Surg Med 2022; 54:1089-1098. [PMID: 35900305 DOI: 10.1002/lsm.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO2 ) laser in the treatment of postburn hypertrophic scars. PATIENTS AND METHODS Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO2 laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFβ1 ) levels were measured for biochemical evaluation. RESULTS Both fractional CO2 and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFβ1 levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively). CONCLUSION Our results demonstrate the value of FMR as an effective alternative to fractional CO2 in the treatment of hypertrophic scars, with a potentially favorable safety profile.
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Affiliation(s)
- Shereen O Tawfic
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Akmal S Hassan
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Amira Elbendary
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Olfat G Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aya M AlOrbani
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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11
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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: 1] [Impact Index Per Article: 0.5] [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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Sany I, Mohamed Sobhi R, Badawi A, Mohamed Elmaadawi Z, Mostafa PIN. Comparative Study Between the Efficacy of Fractional CO 2 Laser/Radiofrequency, PRP and a Combination of Both in the Treatment of Striae Distensae: A Pilot Study. Clin Cosmet Investig Dermatol 2022; 15:1687-1694. [PMID: 36017418 PMCID: PMC9398515 DOI: 10.2147/ccid.s365952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
Abstract
Purpose The work aims to compare the effect of platelet-rich plasma versus fractional CO22 laser/radiofrequency versus both methods combined in treating striae distensae. Patients & Methods The study included ten female patients with striae alba with Fitzpatrick IV skin. Three sites of striae were chosen; one was treated with platelet-rich plasma, another with fractional CO2 /radiofrequency (CO2/RF), and the third received both treatments. Every patient received three treatment sessions one month apart. Patients were photographed, and a skin biopsy was taken from each area before and one month after treatment. Results Assessment of the clinical photos showed that fractional CO2/radiofrequency gave a mild improvement in 22%, moderate improvement in 55.5% and marked improvement in 22.5%. Clinically, the combined treatment showed mild improvement in 44% of patients, moderate results in 33% and marked improvement in 23% of patients. The PRP as an only mode of treatment showed poor improvement in 22%, mild improvement in 23% and moderate improvement in 55% of patients. Biopsy results showed a decrease in collagen and elastin after treatment with the solitary methods, while the combined approach resulted in an increase in collagen and a reduction in elastin. Conclusion Fractional CO2 laser/radiofrequency combined with PRP or either of them showed clinical improvement to variable degrees with superior results clinically and histologically with the combined method.
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Affiliation(s)
- Iman Sany
- Department of Dermatology, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - Rehab Mohamed Sobhi
- Department of Dermatology, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - Ashraf Badawi
- Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt.,Department of Dermatology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zeinab Mohamed Elmaadawi
- Department of Histology & Cell Biology, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
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Saki N, Rahimi F, Pezeshkian FS, Parvar SY. Comparison of the efficacy of microneedling versus CO 2 fractional laser to treat striae alba: A randomized clinical trial. Dermatol Ther 2021; 35:e15212. [PMID: 34796595 DOI: 10.1111/dth.15212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
Striae distensae (SD) are common skin conditions that have posed a significant challenge regarding their assessment and treatment. The present study aimed to evaluate the efficacy of microneedling in comparison to fractional CO2 laser therapy. Similar striae were selected and photographed. Each side was randomly assigned to be treated with CO2 fractional laser or microneedling four times at monthly intervals and followed up for 10 months. Outcome measures including the length and width of the largest striae, dermatologist assessed improvement, patients' satisfaction, and visual analog scale (VAS) were assessed. Wilcoxon signed-rank test and Mann-Whitney U test were used to assess the efficacy of treatments. Forty patients with a mean age of 28.1 years were included. The median cross-section of the largest striae decreased significantly in both groups (P-value <0.001), without statistically significant differences between the two groups before and 6 months after treatment. VAS also improved significantly in both groups, and there were no statistically significant differences between the two treatments in all visits. No clinically significant adverse effects were observed. Fractional CO2 laser and microneedling are both efficient treatments to resolve SD. A new light should be shed on the microneedling modality as it is more economical than the other treatment options.
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Affiliation(s)
- Nasrin Saki
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Rahimi
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Abstract
BACKGROUND Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear. OBJECTIVE To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in. MATERIALS AND METHODS A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded. RESULTS Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia. CONCLUSION Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.
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15
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Gad SES, Neinaa YMEH, Rizk OK, Ghaly NESR. Efficacy of platelet-poor plasma gel in combination with fractional CO 2 laser in striae distensae: A clinical, histological, and immunohistochemical study. J Cosmet Dermatol 2021; 20:3236-3244. [PMID: 33764613 DOI: 10.1111/jocd.14102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Platelet-poor plasma gel is a semi-solid plasma formulation that recently recommended as autologous bio-filler for treatment of atrophic dermal scars. AIM To compare the therapeutic efficacy and safety of intradermal injection of plasma gel in combination with fractional CO2 laser versus fractional CO2 laser alone in striae distensae (SD). PATIENTS AND METHODS This study included 36 SD patients treated by three sessions (one session/1.5 months) of fractional CO2 laser on all SD lesions following intradermal injection of plasma gel on one side and saline (as placebo) on the other side. RESULTS Significant clinical improvements associated with remarkable narrowing of SD lesions and prominent enhancement of skin texture were observed on both treatment sides. Obviously, higher degrees of clinical improvements of SD lesions were reported following combined therapy with fractional CO2 laser and plasma gel rather than fractional CO2 laser monotherapy. However, post-inflammatory hyperpigmentation (PIH) was reported more frequently with fractional CO2 laser monotherapy. Histopathological and immunohistochemical examinations revealed significant epidermal improvement, and homogenization, and orientation of dermal collagen bundles as a result of both therapeutic procedures. CONCLUSION Plasma gel in combination with fractional CO2 laser could be considered a promising novel treatment modality for SD. Plasma gel not only improves the efficacy of fractional CO2 laser but also decreases the frequency of PIH.
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Affiliation(s)
- Samar El-Sayed Gad
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Yomna Mazid El-Hamd Neinaa
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Dermatopathology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Omnia Kamel Rizk
- Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Lou W, Chen F, Xu T, Fan Q, Shi H, Kang J, Shi X, Zhu L. A randomized controlled study of vaginal fractional CO 2 laser therapy for female sexual dysfunction. Lasers Med Sci 2021; 37:359-367. [PMID: 33723687 DOI: 10.1007/s10103-021-03260-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to evaluate the efficacy and safety of vaginal fractional CO2 laser therapy for female sexual dysfunction (FSD). A total of 84 women at high risk of sexual dysfunction were randomly divided into two groups. Women in the laser group received vaginal fractional CO2 laser therapy. Others in the Kegel group were advised to participate in Kegel exercise training. Sexual distress and sexual function were evaluated by using the Female Sexual Distress Scale-Revised (FSDS-R) and the Chinese version Female Sexual Function Index (CVFSFI), respectively. Adverse events were recorded during the 12-month follow-up. At the end of the 6th and 12th months, the lubrication scores of the CVFSFI in the laser group (4.55±0.05, 4.58±0.09) were significantly higher than those in the Kegel group (4.19±0.15, 4.20±0.14) (P<0.05). The satisfaction scores in the laser group (4.43±0.08) were higher than those in the Kegel group (4.20±0.16) at the end of the 6th month (P<0.05). The self-contrast test in the laser group showed significant improvement in lubrication, pain, satisfaction and total scores after CO2 laser therapy (p<0.05). These improvements were maintained for 1 year. The improvement of FSDS-R in the laser group (10.0±0.2) was more evident than in the Kegel group (11.1±0.4) at the end of the 12th month. There were no major adverse events reported during laser therapy. Vaginal fractional CO2 laser therapy can effectively improve sexual function without any serious adverse events. It might be an effective and relatively safe treatment option for improving vaginal mucosa status in sexually active women with sexual dysfunction.
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Affiliation(s)
- Wenjia Lou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Qingbo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xinwen Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
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Neinaa YMEH, Gheida SF, Mohamed DAEA. Synergistic effect of platelet-rich plasma in combination with fractional carbon dioxide laser versus its combination with pulsed dye laser in striae distensae: A comparative study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:214-223. [PMID: 33289155 DOI: 10.1111/phpp.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Striae distensae (SD) are very common atrophic cutaneous scarring that are therapeutically challenging. Various kinds of laser had been suggested as effective treatment modalities for SD. In addition, platelet-rich plasma (PRP) was recently recommended for its therapy. OBJECTIVE To evaluate the synergistic role of PRP injection as a combined modality to fractional CO2 laser (Fr CO2 ) versus its combination with pulsed dye laser (PDL) in SD. PATIENTS AND METHODS Thirty SD patients were included in this study and treated by intradermal injection of autologous PRP on both sides, followed by laser therapy (Fr CO2 laser on right side and PDL on left side). They received 3 treatment sessions at 6 weeks interval. RESULTS Both treatment sides reported significant clinical improvements of SD lesions, evidenced by significant reduction of width of striae lesions and significant improvement of skin texture. Furthermore, significantly higher degree of clinical improvements were observed in response to treatment sessions by combined PRP with Fr CO2 laser rather than combined PRP with PDL. Generally, post-inflammatory hyperpigmentation (PIH) were mild in all patients. Histopathologically, SD lesions showed improvement of epidermal thickness, and more homogenization and regular orientation of dermal collagen fibers in both treatment sides, with more significant improvement on the side treated by combined PRP with Fr CO2 laser sessions rather than the other side. CONCLUSIONS PRP injection in combination with Fr CO2 laser or PDL is considered safe and effective therapeutic regimens for SD. However, its combination with Fr CO2 laser is more promising with better outcome and fewer side effects.
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18
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de Freitas VMP, Miot HA, Miot LDB, Nogueira MADS, Yarak S, Ranulfo RT, Nunes GJDB, Sanches JA, Bagatin E. Development of a clinical scale to assess the severity of striae distensae. Skin Res Technol 2020; 27:627-631. [PMID: 33368720 DOI: 10.1111/srt.12995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/31/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale. MATERIAL AND METHODS After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested. RESULTS Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90). CONCLUSION An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.
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Affiliation(s)
| | | | | | | | - Samira Yarak
- Department of Dermatology, UNIFESP, São Paulo, Brazil
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Nada HA, Sallam MA, Mohamed MN, Elsaie ML. Optical Coherence Tomography-Assisted Evaluation of Fractional Er:YAG Laser Versus Fractional Microneedling Radiofrequency in Treating Striae Alba. Lasers Surg Med 2020; 53:798-805. [PMID: 33185927 DOI: 10.1002/lsm.23349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Striae distensae (SD) is a challenging skin condition. Striae alba (SA) represents the chronic late atrophic stage of SD. Fractional laser technology is among the modalities used for treating SD. Lately, fractional microneedling radiofrequency (FMR) is gaining increased popularity in treating SD. The aim of our study was to assess and compare the efficacy of FMR and fractional Er:YAG laser in the treatment of SA. STUDY DESIGN/MATERIALS AND METHODS Twenty female patients were enrolled in the study fulfilling all inclusion and exclusion criteria. On a randomly selected half side of the body, the patients were treated with 2940 nm fractional Er:YAG laser while the other half side was treated with the FMR. RESULTS Both modalities showed a significant reduction in the width of the widest striae (P < 0.005); however, there was no significant difference between them. Using optical coherence tomography, all patients demonstrated a mean significant increase in epidermal thickness; however, the FMR-treated sites showed significantly better results when compared with the ER:YAG-treated sides (P = 0.029). Scar improvements in both modalities did not correlate to skin type, duration, or site of the striae. CONCLUSION Er:YAG and FMR represent two safe, effective, tolerable modalities for treating SA and are associated with minimal side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Hesham A Nada
- Department of Dermatology, Suez Canal University, Ismailia, 11371, Egypt
| | - Moataz A Sallam
- Department of Ophthalmology, Suez Canal University, Ismailia, 11371, Egypt
| | - Marwa N Mohamed
- Department of Dermatology, Suez Canal University, Ismailia, 11371, Egypt
| | - Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Giza, 11371, Egypt
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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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21
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Lu H, Guo J, Hong X, Chen A, Zhang X, Shen S. Comparative effectiveness of different therapies for treating striae distensae: A systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22256. [PMID: 32991422 PMCID: PMC7523784 DOI: 10.1097/md.0000000000022256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis. METHODS A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework. RESULTS Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively). CONCLUSION Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.
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Yan D, Huang Z, Zhang A, Li S, Xiao Y. Application effect of lattice laser in facial rejuvenation: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21814. [PMID: 32846820 PMCID: PMC7447505 DOI: 10.1097/md.0000000000021814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Various techniques have been applied in facial rejuvenation and lattice laser is the most accepted. However, the application effect of lattice laser in facial rejuvenation is unclear. This study aims to evaluate the application effect of lattice laser in facial rejuvenation. METHODS Randomized controlled trials of lattice laser in facial rejuvenation will be searched in PubMed, EMbase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database from inception to July 2020. And Baidu Scholar, International Clinical Trials Registry Platform, Google Scholar, and Chinese Clinical Trials Registry will be searched to obtain more relevant studies comprehensively. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS This study will sum up the present evidence so far by exploring the application effect of lattice laser in facial rejuvenation. CONCLUSIONS The findings of the study will provide helpful evidence for the application effect of lattice laser in facial rejuvenation, promoting clinical practice, and further scientific research. ETHICS AND DISSEMINATION The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/QF6H5.
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23
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Rossi AM, Hibler BP, Navarrete-Dechent C, Lacouture ME. Restorative oncodermatology: Diagnosis and management of dermatologic sequelae from cancer therapies. J Am Acad Dermatol 2020; 85:693-707. [PMID: 32781177 DOI: 10.1016/j.jaad.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
Abstract
The long-term survival of patients with cancer has risen dramatically during the last few decades. Despite this remarkable success, the same treatments that have enabled cure or remission often secondarily affect the skin, hair, and nails. Conditions including scarring, striae distensae, persistent alopecia, pigmentary changes, nail alterations, chronic radiation dermatitis, and radiation fibrosis have been associated with anxiety, depression, decreased quality of life, and impaired function. These dermatologic changes are cosmetically disfiguring, may limit activities, and are a visual reminder of past illness. Interventions toward improving these untoward sequelae and restoring the appearance and function of skin and appendages are critical for normalization and may contribute to improved quality of life in cancer survivors. Here, we outline dermatologic sequelae of cancer therapies with a review of medical and procedural treatment strategies to restore dermatologic health in the survivorship population.
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Affiliation(s)
- Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Brian P Hibler
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario E Lacouture
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
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Abdallah M, Fahmy H, Abdel Hameed S, Mostafa AE. Ablative fractional CO 2 laser vs lyophilized growth factor intralesional injection vs combination of both modalities for striae distensae treatment. J Cosmet Dermatol 2020; 20:472-480. [PMID: 32640118 DOI: 10.1111/jocd.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/26/2020] [Accepted: 06/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Different studies had evaluated the efficacy of fractional CO2 laser and platelet-rich plasma (PRP) in treating striae distensae (SD). Lyophilized growth factors (LGF) represent another form of delivering growth factors similar to PRP with a more standardized method. To the best of our knowledge, no previous trials have been reported using LGF in SD. AIMS We aimed to compare the efficacy of ablative fractional CO2 laser vs intralesional injection of LGF vs combination of both modalities for SD treatment. METHODS This study included 20 female patients with SD. All patients received three modalities of treatment in separate three areas: area A: received fractional CO2 laser, area B: received combination of fractional CO2 laser and intradermal injection of LGF, and area C: received intradermal injection of LGF. Each area received three sessions with 6-week intervals. The outcome was evaluated clinically and histopathologically before treatment and six weeks after the last session. RESULTS There was a statistically significant clinical and histopathological improvement of SD both in areas A and B after treatment. Area C exhibited nonsignificant clinical and histopathological improvement. Area B showed the best improvement results as compared to areas A and C. CONCLUSION We reported that fractional CO2 laser combined with LGF injection was more effective than fractional CO2 laser alone in SD treatment based on clinical and histopathological assessment. We do not advocate LGF as a monotherapy for SD treatment; instead, LGF can be used as a combined therapy with fractional CO2 laser to improve its outcome.
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Affiliation(s)
- Mahmoud Abdallah
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
| | - Hossam Fahmy
- Clinical Pathology Department, Ain Shams University, Cairo, Egypt
| | - Shawkat Abdel Hameed
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
| | - Azza E Mostafa
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
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Abdel-Motaleb AA, Zedan H, Mostafa MM, Abu-Dief EE, Gebril SM, Abdelwahed Hussein MR. Combined microneedling with topical application of platelet-rich plasma versus microneedling alone in the treatment of stria distensae: clinicopathological analysis. J DERMATOL TREAT 2020; 33:836-847. [PMID: 32538219 DOI: 10.1080/09546634.2020.1782323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Striae distensae (SD) are common skin conditions.Objectives: This study was done to test the hypothesis that 'the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.'Patients and methods: Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes.Results: As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis.Conclusions: This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.
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Affiliation(s)
- Amira A Abdel-Motaleb
- Faculty of Medicine, Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Hatem Zedan
- Faculty of Medicine, Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | | | - Eman E Abu-Dief
- Faculty of Medicine, Department Histology, Sohag University, Sohag, Egypt
| | - Sahar M Gebril
- Faculty of Medicine, Department Histology, Sohag University, Sohag, Egypt
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Afify AA, Fawzy HM, Ali Al-Rubaiay NH, Abdallah M. Fractional microneedling radiofrequency in striae alba: Do growth factors add value? J Cosmet Dermatol 2020; 19:2583-2590. [PMID: 32323904 DOI: 10.1111/jocd.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various treatment modalities have been applied to treat striae alba (SA) with low satisfaction rate. Fractional microneedling radiofrequency (FMR) provides deep dermal coagulation, thereby inducing collagen synthesis and tissue tightening. The addition of platelet-derived lyophilized growth factors may add to the effect of FMR. OBJECTIVES To evaluate and compare the efficacy and safety of FMR alone or combined with lyophilized growth factors in the treatment of SA. METHODS In this left-right comparative study, 25 patients suffering from SA on the abdomen received four sessions of FMR with lyophilized growth factors on one side and with saline (as placebo) on the other side at 4 weeks interval. Photographic and biopsy documentation of the progress of the SA was carried out before the start of the treatment and 4 weeks after the last session. Calculation of the width of SA before treatment and after 4 sessions was done by Adobe Photoshop CS6. RESULTS There was a significant improvement in SA width after treatment in both the lyophilized growth factors (P = <.0001) and placebo sides (P = <.0001), the lyophilized growth factors being superior (P = .002). Patient satisfaction was more on the lyophilized growth factors (LGF) side (P = .034). Erythema and hyperpigmentation were less on the lyophilized growth factors side. Histopathologically, both showed improvement with no difference between LGF and placebo (epidermal thickness (P = .456), collagen content (P = .297), elastin content (P = .239)). CONCLUSION The combination of FMR and lyophilized growth factors improves SA outcome.
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Affiliation(s)
- Ahmed Abdelfattah Afify
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba M Fawzy
- Histology and Cell Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Marwa Abdallah
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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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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