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Fusano M, Galimberti MG, Bencini M, Guida S, Bencini PL. Picosecond Laser treatment of Striae Distensae: In vivo Evaluation of Results by 3D Analysis, Reflectance Confocal Microscopy, and Patient's Satisfaction. Lasers Surg Med 2021; 53:1180-1185. [PMID: 33764570 DOI: 10.1002/lsm.23401] [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: 10/22/2020] [Revised: 01/27/2021] [Accepted: 03/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The efficacy of picosecond laser (PSL) in the treatment of striae distensae (SD) has been recently reported; otherwise, the base for this improvement has not been clarified yet. The aim of this study is to treat long-lasting SD with PLS and to describe their in vivo morphological variations after treatment using three-dimensional (3D) imaging and reflectance confocal microscopy (RCM). STUDY DESIGN/MATERIALS AND METHODS A total of 27 patients asking for treatment for SD were treated with four monthly sessions of PLS. Clinical improvement was estimated through a blinded evaluation performed by two independent dermatologists, Global Assessment Improvement Scale (GAIS), patients' satisfaction, 3D imaging, and RCM assessments at baseline and 6 months after the last laser session. RESULTS Although a clinical improvement of SD was observed in 81.4% of patients according to physicians' GAIS, only 66.6% of patients reported subjective improvement and satisfaction after treatment (P = 0.04). 3D imaging revealed a significant improvement in terms of skin texture (P < 0.001) and mean SD depth (P < 0.001). Otherwise, RCM highlighted collagen remodeling and the appearance of new dermal papillae in all the treated SD compared with baseline. CONCLUSIONS The present study confirms that PLS represents a safe treatment option for SD; herein, we report morphological documentation of skin variations after PLS treatment. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Marta Fusano
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, 20121, Milan, Italy
| | - Michela G Galimberti
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, 20121, Milan, Italy
| | - Matelda Bencini
- Department of General Surgery, Università Degli Studi di Milano, 20157, Milan, Italy
| | - Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, via del Pozzo 71, 41125, Modena, Italy
| | - Pier Luca Bencini
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, 20121, Milan, Italy
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Brennan M, Clarke M, Newell J, Devane D. Prevention of striae gravidarum: study protocol for a pilot randomised controlled trial. Trials 2018; 19:553. [PMID: 30314504 PMCID: PMC6186113 DOI: 10.1186/s13063-018-2898-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Striae gravidarum (stretch marks) are considered the most common connective tissue/skin change in pregnancy. Though not a health issue they can affect women in different ways, for example, cause stress or be an aesthetic or cosmetic concern. Many women use one or more of the commercially available products to try and prevent their development during pregnancy despite the fact that that there is a lack of high-quality evidence to support their use. There is a dearth of studies on the prevention of striae gravidarum and large, robust trials are lacking. Until such time as more products are investigated, much of the knowledge remains anecdotal. This pilot study will evaluate the feasibility of conducting a study to evaluate the effectiveness of a commercially available moisturising oil compared to no treatment for the prevention and reduction in severity of striae gravidarum. Methods The definitive study will be a randomised controlled trial to evaluate the effectiveness of a moisturising oil (commercially available moisturising oil) compared to no treatment for the prevention and reduction in severity of striae gravidarum. This protocol is for a pilot randomised trial to evaluate the feasibility of conducting such a study. The pilot study will be a two-arm, unblinded, pragmatic parallel randomised trial with a 1:1 randomisation ratio between control and intervention groups. Women in the intervention group will be asked to apply a moisturising oil to their abdomen during pregnancy, while women in the control group will not use any treatment. It is proposed to recruit 20 primigravida, who are 12–16 weeks pregnant from an Irish Maternity Hospital, in each arm to assess the feasibility of running such a trial. Discussion This pilot trial will evaluate the feasibility of conducting the main study to evaluate the effectiveness of a moisturising oil (commercially available moisturising oil) compared to no treatment for the prevention and reduction in severity of striae gravidarum. It will potentially initiate the generation of high-quality evidence to guide women in their choice of anti-stretch mark product. Trial registration ISRCTN Registry, ISRCTN76992326. Registered on 14 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2898-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Brennan
- School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway, H91 TK33, Ireland.
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute for Health Sciences, Queen's University Belfast, Belfast, BT12 6BA, Northern Ireland
| | - John Newell
- School of Mathematics, Statistics, and Applied Mathematics, National University of Ireland Galway, Galway, H91 TK33, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway, H91 TK33, Ireland
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Kasielska-Trojan A, Pietrusiński M, Borowiec M, Antoszewski B. Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae. J Cosmet Dermatol 2018; 18:342-345. [PMID: 29498185 DOI: 10.1111/jocd.12522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem. OBJECTIVES The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD. METHODS Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation. RESULTS Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences. CONCLUSION In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Łódź, Poland
| | | | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Łódź, Łódź, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Łódź, Poland
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Kasielska-Trojan A, Antoszewski B. Do body build and composition influence striae distensae occurrence and visibility in women? J Cosmet Dermatol 2017; 17:1165-1169. [PMID: 29105985 DOI: 10.1111/jocd.12455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Striae have been reported to be one of the most common skin changes and a commonly encountered esthetic problem. OBJECTIVES To analyze risk factors of striae not associated with pregnancy and verify if body build and composition influence striae distensae (SD) occurrence and visibility. METHODS Eighty female students (40 with striae (the mean age 23.9 years, SD 2.05 years) and 40 without these lesions (24.7 years, SD 6.2 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors of SD. Body build and composition were examined using Tanita SC-331S Body Composition Analyzer. RESULTS Women without striae more often reported a history of intended weight loss (P < .0001), less frequently had a history of contraceptives intake (P < .001) and more often their family history of striae was negative or unknown (P = .01). Multivariate analysis including body build and composition parameters indicated BMI as risk factor of SD (P = .021; OR =1.155, 95% CI 1.006; 1.325). CONCLUSIONS History of contraceptives intake and a family history of striae are risk factors of SD occurrence, while weight loss can reduce the risk of these lesions. BMI appeared to be the risk factor of striae visibility, especially in abdomen, but not on the buttocks. Further clinical researches are needed to examine the pathophysiology of this condition and to inform patients about the possibility to reduce the risk of striae occurrence.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
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Guida S, Galimberti MG, Bencini M, Pellacani G, Bencini PL. Treatment of striae distensae with non-ablative fractional laser: clinical and in vivo microscopic documentation of treatment efficacy. Lasers Med Sci 2017; 33:75-78. [DOI: 10.1007/s10103-017-2341-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
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DETTMER AMANDAM, ROSENBERG KENDRA, MENARD MARKT, EL-MALLAH SAIFN, WOODWARD RUTHA, SUOMI STEPHENJ, MEYER JERROLDS. Differential relationships between chronic hormone profiles in pregnancy and maternal investment in rhesus monkey mothers with hair loss in the neonatal period. Am J Primatol 2017; 79:1-8. [PMID: 26496532 PMCID: PMC6528798 DOI: 10.1002/ajp.22489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 01/12/2023]
Abstract
Hair loss is commonly used as an indicator of well being in primate facilities, yet it has been shown to also occur in otherwise healthy pregnant and postpartum females. There is significant variability in the incidence of hair loss during these important developmental periods, reasons for which remain unclear. We studied female rhesus monkeys (Macaca mulatta, n = 47) with and without hair loss in pregnancy/postpartum. We hypothesized that, similar to previously published reports, pregnancy would result in an increased likelihood of hair loss, and that hair loss would be correlated with higher hair cortisol concentrations (HCCs). We further hypothesized that hair loss among pregnant females is related to differential maternal investment. We studied a subset of monkeys (n = 26) from mid-to-late pregnancy through peak lactation, some of which exhibited hair loss in the perinatal period (n = 15), and some of which did not (n = 11). We examined fetal measurements, infant birth weight, infant growth rate, and milk yield volume (MYV) in the first 30 days as indices of investment. We found that pregnant monkeys showed a greater incidence of hair loss across the study year (χ2(2) = 6.55, P = 0.038), and that mothers with hair loss had significantly higher HCCs in pregnancy than those without (F(2,28) = 3.8, P = 0.017, ηp2 = 0.21). HCCs in pregnancy were correlated with severity of hair loss in the neonatal period (r(37) = 0.42, P = 0.008). Moreover, HCCs in pregnancy were positively correlated with infant birth weight (r(12) = 0.56, P = 0.038), infant growth rate (r(12) = 0.64, P = 0.014), and MYV (r(11) = 0.85, P < 0.001) for alopecic but not non-alopecic mothers. These mothers did not differ in fetal measurements, infant birth weight/growth rate, or MYV. Our results suggest that hair loss in some monkeys, especially during the birthing season, may be a signal of greater physiological stress during pregnancy and differential investment by mothers to their offspring. Am. J. Primatol. 79:e22489, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- AMANDA M. DETTMER
- Laboratory of Comparative Ethology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Poolesville, Maryland
| | - KENDRA ROSENBERG
- Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - MARK T. MENARD
- Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - SAIF N. EL-MALLAH
- Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - RUTH A. WOODWARD
- Research Animal Management Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Poolesville, Maryland
| | - STEPHEN J. SUOMI
- Laboratory of Comparative Ethology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Poolesville, Maryland
| | - JERROLD S. MEYER
- Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts
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Brennan M, Clarke M, Devane D. The use of anti stretch marks' products by women in pregnancy: a descriptive, cross-sectional survey. BMC Pregnancy Childbirth 2016; 16:276. [PMID: 27654661 PMCID: PMC5031338 DOI: 10.1186/s12884-016-1075-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/07/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stretch marks (Striae gravidarum) are a cutaneous change occurring commonly during pregnancy. A variety of products are available and promoted as ways to prevent or reduce their development, but it is not clear what products are used most commonly. The objective of this study was to identify topical products used during pregnancy to prevent or reduce the development of striae gravidarum. We also explored issues around application of the product, cost incurred and influences on women's decisions to use a product. METHODS In this cross sectional, descriptive survey we collected data from 773 women, via a paper (n = 707) or online (n = 66) questionnaire. Due to missing data in the online survey, 753 women at 36 weeks gestation or more were included in the analyses. Descriptive and inferential statistical analyses were undertaken. RESULTS Most respondents (n = 589, 78.2 %) indicated that they used a product to prevent or reduce the development of stretch marks during their current pregnancy. A large range of products were used and more than one third of women (n = 210, 36.5 %) had used two or more products. Bio-oil was the most frequently used product (n = 351, 60.9 %) and it was also the most frequently used product among women who used only one product (n = 189, 32.8 %). CONCLUSIONS Many women apply one of the many products available to prevent or reduce the development of striae gravidarum. Bio-oil was the most commonly used product identified in this study. There is a need for high-quality evidence on the effectiveness of Bio-oil and other products.
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Affiliation(s)
- Miriam Brennan
- School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway, Ireland
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Block B, Queen’s University Belfast, Royal Hospital, Grosvenor Road, Belfast, BT12 6BA Northern Ireland
| | - Declan Devane
- School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway, Ireland
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Kasielska-Trojan A, Sobczak M, Antoszewski B. Risk factors of striae gravidarum. Int J Cosmet Sci 2015; 37:236-40. [DOI: 10.1111/ics.12188] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A. Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic Medical University of Lodz Kopcinskiego 22; Lodz 90-153 Poland
| | - M. Sobczak
- Obstetrics Out-patient Department; Polish Mother's Memorial Hospital- Research Institute; Rzgowska 281/289 Lodz 93-338 Poland
| | - B. Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic Medical University of Lodz Kopcinskiego 22; Lodz 90-153 Poland
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Kar S, Krishnan A, Shivkumar PV. Pregnancy and skin. J Obstet Gynaecol India 2012; 62:268-75. [PMID: 23730028 DOI: 10.1007/s13224-012-0179-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/08/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Skin changes occur in about 90 % pregnant women in one form or the other. The various skin changes maybe either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy-specific dermatoses. All of these dermatoses can be attributed to the profound hormonal, vascular, metabolic, and immunological changes occurring during pregnancy. CLASSIFICATION Pregnancy-specific dermatoses have now been classified into dermatoses which are definitively associated and dermatoses with uncertain association with pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. CONCLUSION Careful history taking and examination will help us to identify each condition clinically and appropriate management can be instituted for the well-being of the mother and the fetus.
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Affiliation(s)
- Sumit Kar
- Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra 442012 India
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Gilmore SJ, Vaughan BL, Madzvamuse A, Maini PK. A mechanochemical model of striae distensae. Math Biosci 2012; 240:141-7. [PMID: 22796062 DOI: 10.1016/j.mbs.2012.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 11/16/2022]
Abstract
Striae distensae, otherwise known as stretch marks, are common skin lesions found in a variety of clinical settings. They occur frequently during adolescence or pregnancy where there is rapid tissue expansion and in clinical situations associated with corticosteroid excess. Heralding their onset is the appearance of parallel inflammatory streaks aligned perpendicular to the direction of skin tension. Despite a considerable amount of investigative research, the pathogenesis of striae remains obscure. The interpretation of histologic samples - the major investigative tool - demonstrates an association between dermal lymphocytic inflammation, elastolysis, and a scarring response. Yet the primary causal factor in their aetiology is mechanical; either skin stretching due to underlying tissue expansion or, less frequently, a compromised dermis affected by normal loads. In this paper, we investigate the pathogenesis of striae by addressing the coupling between mechanical forces and dermal pathology. We develop a mathematical model that incorporates the mechanical properties of cutaneous fibroblasts and dermal extracellular matrix. By using linear stability analysis and numerical simulations of our governing nonlinear equations, we show that this quantitative approach may provide a realistic framework that may account for the initiating events.
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Affiliation(s)
- Stephen J Gilmore
- Dermatology Research Centre, University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
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Rolfe H, Wurm E, Gilmore S. An investigation of striae distensae using reflectance confocal microscopy. Australas J Dermatol 2012; 53:181-5. [PMID: 22458385 DOI: 10.1111/j.1440-0960.2012.00884.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Striae distensae, otherwise known as stretch marks, are white or red scar-like streaks on the skin. Although they are not associated with adverse health outcomes, striae are associated with significant cosmetic morbidity. While they have been well characterised histopathologically, a non-invasive method of microscopic lesion assessment of striae would be welcome. METHODS To gain insight into the small-scale morphological features associated with striae we undertook an in vivo investigation of nine patients with striae alba and one with striae rubra utilising reflectance confocal microscopy (RCM). RESULTS Here we demonstrate that features known to be present using light microscopy, such as parallel collagen bundles in the dermis, and some features that are not well recognised by light microscopy, including distortion of dermal papillae, are demonstrable using RCM. CONCLUSIONS Characterising the features of early and established striae distensae with confocal microscopy is an important foundation for future work. The potential ability to reliably identify the earliest pathological changes in skin in early lesions or before clinically manifest striae develop--a task facilitated by our findings--will increase the understanding of their pathogenesis and will have significant practical utility in monitoring the impact of future preventative interventions.
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Affiliation(s)
- Heidi Rolfe
- Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, QLD 4102, Australia
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12
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[Physiologic skin changes in pregnancy]. Presse Med 2010; 40:e17-21. [PMID: 20843649 DOI: 10.1016/j.lpm.2010.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/08/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Pregnancy is a period of hormonal, immunological, metabolic and vascular changes. Some of them are considered to be physiologic, but others are real diseases specific or not of pregnancy. The aim of our study is to present the epidemiological and clinical physiologic dermatological changes of pregnancy. METHODS We present a transversal monocentric study. One hundred pregnant women attending the department of dermatology of the La Rabta hospital were enrolled. Systematic detailed cutaneous examination was performed by a dermatologist to look for a physiologic skin changes. RESULTS The mean age was 29 years [20-46 years]. Pigmentary changes were the most preponderant (93%), dominated by the areolar region pigmentation (77%). The glandular changes were noted in 75% of cases. The vascular modifications were observed in 77% of pregnant women. Of these, gingival hyperemia was the most common (46%). Others cutaneous changes were less frequent (stria distensae 45%, nevi changes 35%, molluscum gravidarum 10%). DISCUSSION The physiologic cutaneous changes during pregnancy are numerous. Our study confirms the frequency and the variability of these modifications. The pigmentary changes were the most common finding.
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Abstract
BACKGROUND Striae distensae are widely known to occur in pregnancy and aesthetically they can be a cause of great concern for many women. Various factors have been reported to be associated with the development of striae but the results are conflicting. OBJECTIVES To observe the prevalence of striae gravidarum in primiparae and identify independent associated risk factors. METHODS An observational analysis of 324 primiparae was conducted within 48 h of delivery. Data was collected in the form of a questionnaire and physical examination. Seventy-two primiparae participated in a pilot study in 1999 and the remaining were assessed over a 4-month period in 2000. Seventeen variables were recorded, and striae graded according to quantity and severity. Fifteen primiparae were excluded prior to analysis. RESULTS Fifty-two per cent (161 of 309) of primiparous white women had striae of which 12% (20 of 161) were classified as severe. The most significant risk factor was low maternal age (P < 0.0001). Twenty per cent (14 of 71) of teenagers had severe striae, a finding not seen in women over 30 years of age. Other significant risk factors included maternal body mass index greater than 26 (P = 0.0003), maternal weight gain of more than 15 kg (P = 0.0121) and high neonatal birth weight (P = 0.0135). CONCLUSIONS Logistic regression analysis demonstrated that maternal age, body mass index, weight gain and neonatal birth weight were independently associated with the occurrence of striae. It appears that the group at highest risk of developing severe striae are teenagers. This finding is important and may provide impetus to explore the pathomechanisms of striae.
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Affiliation(s)
- G S S Atwal
- Department of Obstetrics and Gynaecology, Hope Hospital, Stott Lane, Salford, Manchester, M6 8HD, U.K
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Abstract
BACKGROUND Physiologic skin changes are common during pregnancy due to a temporary shift in hormonal, metabolic, and immunologic factors. Physicians may mistake normal skin changes in pregnancy as pathologic change within the skin, and so an appreciation of the common and less common skin manifestations will assist in appropriate patient care. OBJECTIVE This review highlights the normal physiologic skin changes in pregnancy, which include pigmentary changes, changes to the hair and nails, alterations in glandular activity, vascular and hematological changes, cutaneous tumors, and mucous membrane changes. CONCLUSION Physiologic changes to the skin in pregnancy can be complex and confusing. Pregnancy can be a stressful time for women so it is imperative that physicians be aware of the normal skin changes during pregnancy in order to prevent unnecessary investigations and treatments.
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Affiliation(s)
- Benjamin Barankin
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
UNLABELLED Pregnancy is associated with immunological, endocrine, metabolic and vascular changes that may adversely affect the skin. The specific dermatoses of pregnancy are disease entities almost exclusively related to the pregnancy or the puerperium. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be aware of the main entities of the specific pregnancy dermatoses, their clinical presentations, the main diagnostic criteria and therapeutic options.
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Affiliation(s)
- S I Al-Fares
- Department of Dermatological Immunopathology, St John's Institute of Dermatology, Guy's King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK
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Abstract
OBJECTIVE To determine whether there are effective treatments for postpartum alopecia. DATA SOURCES Clinical literature identified through MEDLINE (January 1966-May 2000), EMBASE (June 1980-March 2000), and International Pharmaceutical Abstracts (January 1970-March 2000). Key search terms included alopecia, puerperium, and postpartum. DATA SYNTHESIS Postpartum alopecia is a diffuse shedding of scalp hair that can begin two to five months following parturition. Few articles examine the treatment of this condition. Treatments in the form of thyroid supplementation, topical progesterone and estradiol lotions, and an oral contraceptive have been studied. All available studies on this subject have significant limitations, such as small sample size, absence of a control group, or subjective measurement of treatment response. Nondrug therapy for a related type of hair loss has been recommended and includes education about hair cycles and reassurance to minimize anxiety. CONCLUSIONS From the available studies, no specific treatment has been studied well enough with sufficient treatment justify recommendation or to be termed effective.
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Affiliation(s)
- J H Eastham
- Department of Pharmacy, Naval Medical Center San Diego, CA 92134-1005, USA.
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Abstract
Awareness of pregnancy-related skin changes can facilitate improved care of women during pregnancy by identifying those skin changes that require further evaluation. Women experience significant endocrine and metabolic changes during pregnancy that can cause both physiologic and pathologic alterations in the skin, nails, and hair. This review discusses the physiologic changes and pruritic dermatoses that are specifically associated with pregnancy. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided.
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Affiliation(s)
- L Fuhrman
- Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Abstract
Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and IIBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.
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Affiliation(s)
- S Shanmugam
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
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19
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Abstract
BACKGROUND The endocrine, metabolic, and immunologic changes during pregnancy give rise to a number of physiologic cutaneous changes. OBJECTIVE We evaluated 140 pregnant women to determine the pattern of pregnancy-induced physiologic skin changes in our community. RESULTS The various changes observed include: increased pigmentation (90.7%), striae (77.1%), edema (48.5), melasma (46.4%), vascular changes (34.2%), and others. CONCLUSIONS Pigmentary changes were the most common finding, whereas the incidence of vascular changes was quite low (p < 0.01).
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Affiliation(s)
- F Muzaffar
- Department of Dermatology, King Edward Medical College/Mayo Hospital, Lahore, Pakistan
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20
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Wallace ML, Smoller BR. Estrogen and progesterone receptors in androgenic alopecia versus alopecia areata. Am J Dermatopathol 1998; 20:160-3. [PMID: 9557785 DOI: 10.1097/00000372-199804000-00010] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In some situations, hair growth is under hormonal control. Androgenic alopecia is characterized as hormonally driven hair loss in the genetically susceptible individual. During pregnancy, hair growth is increased, as estrogen appears to prolong the anagen phase. However, postpartum hair loss is common, and thus may be related to a decrease in estrogen and or progesterone levels. In contrast, alopecia areata is not considered to be under hormonal control. We compared the immunohistochemical staining characteristics of nine cases of androgenic alopecia with those of 13 cases of alopecia areata using estrogen receptor (ER) and progesterone receptor (PR) markers. Estrogen receptor positivity in the dermal papilla was found in only two of 13 cases of alopecia areata, and in one case of androgenic alopecia. Six of 13 cases of alopecia areata demonstrated focal reactivity with the progesterone marker in a similar location, while only three cases of androgenic alopecia showed positivity with this antibody. Examination of the perifollicular fibroblasts for the ER marker showed positivity in one of 13 cases of alopecia areata and in one case of androgenic alopecia. Two cases of alopecia areata revealed focal staining in this location for the PR marker, while the androgenic alopecia cases failed to stain. These results indicate that estrogen and progesterone receptor expression is not significantly increased or decreased in the pilosebaceous units or surrounding mesenchymal cells in androgenic alopecia vs. alopecia areata. Therefore, an indirectly mediated process of estrogen/progesterone control on hair growth and development must be presumed for cases of androgenic alopecia.
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Affiliation(s)
- M L Wallace
- Department of Pathology and Dermatology, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA
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21
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Affiliation(s)
- S V Elling
- Regional Centre of Dermatology, Mater Hospital, Dublin, Ireland
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22
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Affiliation(s)
- S Brenner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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23
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Affiliation(s)
- J M Fryer
- Department of Dermatology, University of Pennsylvania, Philadelphia 19104
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