Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae

Comparing fractional microneedle radiofrequency and fractional CO2 laser for striae distensae treatment: a systematic review and meta-analysis

Striae distensae (SD) are a prevalent dermatological concern of women and approximately 90% of pregnant women experience these stretch marks. Fractional microneedle radiofrequency (FMR) and fractional CO2 laser (FCL) have gained substantial attention in the treatment of SD. In clinical studies, a clear superiority between FMR and FCL treatments is not found due to limited studies and sample sizes. In this systematic review and meta-analysis, a search of English-language articles was performed on PubMed, employing various combinations of keywords "fractional CO2 laser," "microneedle radiofrequency," and "striae". Studies that compared the treatments of FMR and FCL for SD and provided data regarding professional evaluation of improvement, patient self-assessment, and/or the presence of post-inflammatory hyperpigmentation (PIH) were included. We analyzed the incorporated studies utilizing both random and fixed-effects models to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Professional assessments of improvement showed no statistically significant difference between the FMR and FCL groups (OR: 1.27; 95% CI: 0.49-3.31). Similarly, patient self-assessments of improvement did not exhibit a significant difference (OR: 0.72; 95% CI: 0.13-3.90). However, the development of PIH was significantly less frequent in the FMR group when compared to the FCL group (OR: 0.24; 95% CI: 0.08-0.70). Both FMR and FCL demonstrate comparable performance in terms of improving lesions, as assessed by both healthcare professionals and patients. However, FCL is associated with a higher risk of developing PIH. This finding can guide clinicians especially who prefer a single treatment.

Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable.

OBJECTIVE

The aim of this review was to determine the most effective type of EBD for improving the appearance of striae.

MATERIALS AND METHODS

The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted.

RESULTS

Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width.

CONCLUSION

Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.

Microneedling in Dermatology: A Comprehensive Review of Applications, Techniques, and Outcomes

Microneedling, also known as collagen induction therapy, is a minimally invasive dermatological procedure that has gained widespread popularity for treating various skin conditions, including acne scars, wrinkles, hyperpigmentation, and stretch marks. By creating controlled micro-injuries in the skin, microneedling stimulates the body's natural healing processes, resulting in increased collagen and elastin production, essential for maintaining skin elasticity and firmness. Over the past few decades, microneedling has evolved significantly, with advancements such as automated devices, radiofrequency microneedling, and combination therapies enhancing its effectiveness and safety profile. This comprehensive review explores the mechanisms of action, various techniques, and clinical applications of microneedling, highlighting its advantages over other skin rejuvenation methods. The review also examines patient satisfaction, safety considerations, and potential complications, providing a balanced perspective on its clinical utility. Furthermore, the discussion includes future directions in microneedling technology and research, focusing on emerging innovations and potential new applications. As the field advances, microneedling is poised to play an increasingly important role in aesthetic medicine, offering a reliable and effective solution for skin rejuvenation and beyond. This review is a valuable resource for healthcare professionals, guiding the optimization of microneedling practices and informing future research efforts.

V-EMF therapy: A new painless and completely non-invasive treatment for striae gravidarum

BACKGROUND

The appearance of striae gravidarum (SG) during pregnancy is a common problem. The most common SG are abdominal striae, which can cause the greatest sequelae after pregnancy, and in the long term. There are several solutions to prevent and treat these striae, but not all are completely effective, and not without side effects.

AIMS

The aim of this study was to evaluate the effectiveness of a treatment that applies an electromagnetic field under vacuum (V-EMF therapy) on the abdominal SG.

METHODS

A retrospective analysis was conducted on the medical records of 26 women affected by abdominal SG and treated with V-EMF therapy. The results were evaluated using two different 5-point Likert Scales: one administered to the treated subjects to evaluate their satisfaction, and one to the doctors who performed the treatment, to evaluate the improvement of the striae. The presence of side effects, and the effects of sun exposure after treatment were also considered.

RESULTS

Only two treated subjects rated their level of satisfaction with a Score III on the Liker Scale. Everyone else expressed higher levels of satisfaction. Only one doctor rated the improvement of the striae with a Liker scale score of III. All the others reported greater improvements. No discomfort or side effects were noted either during the individual treatment sessions, or at the end of the treatment. The striae showed a newfound ability to tan.

CONCLUSIONS

V-EMF therapy proves to be a valid, safe, and effective treatment modality for SG.

Review of Fractional Nonablative Lasers for the Treatment of Dermatologic Conditions in Darker Skin Phototypes

BACKGROUND

Fractional nonablative lasers (NAFLs) have demonstrated efficacy and safety for treating dermatologic conditions in patients with darker skin phototypes. Nonablative lasers are preferred in darker skin tones due to lower risk of postinflammatory hyperpigmentation.

OBJECTIVE

This review aims to identify the ideal laser options and parameters for treating common dermatologic conditions in patients with skin types IV-VI.

MATERIALS AND METHODS

A comprehensive literature search was conducted on PubMed in May 2023. Of 1,065 articles were identified, and 40 articles met the inclusion criteria. The studies were classified based on design, dermatologic condition, and skin phototype of patients, and assigned levels of evidence according to the Modified Criteria of the Oxford Center of Evidence Based Medicine.

RESULTS

Strong level 1 evidence supports the treatment of melasma and atrophic scars using NAFL. Moderate level 2 evidence was found for using NAFL in acne vulgaris, striae, and skin rejuvenation; 45% of the studies examined skin types III-IV, 20% III-V, 7.5% II-IV, 5% II-V, 5% IV alone, and 2.5% I-IV.

CONCLUSION

Further research is needed to determine the optimal treatment modalities and parameters for skin types V and VI. Appropriate device selection and conservative treatment settings are crucial for optimizing outcomes and minimizing adverse events.

Efficacy and Safety of an Autologous Micrografting Procedure for Management of Striae Distensae in Women

INTRODUCTION

Striae distensae (SD), or stretch marks, are a common skin problem having a psychological impact and cosmetic concern, especially for women, in whom the prevalence is higher than in men. This study assessed the efficacy and safety of a single autologous micrografting treatment (AMT®) using Rigenera® technology for the management of SD.

METHODS

This single-centre study included 10 healthy women between 24 and 65 years of age, with Fitzpatrick-Goldman skin types I-IV, who had visible SD in glutes/thighs. Each subject acted as their own control. The treatment procedure (microneedling + AMT) and the control procedure (no treatment) were performed on contralateral sides of the glutes/thighs, targeting matched and paired SD. Microneedling was carried out using Dermapen®, equipped with 32 needle heads set at 1.5 mm needle length. The AMT procedure involved extracting biopsies from the mastoid hair zone with a 2.5-mm dermal punch, followed by disaggregation of the biopsies in a physiological saline solution using the Rigeneracons. The disaggregated micrografts were then intradermally injected using 30G 4-mm needles, maintaining a distance of 1 cm between injection points, covering the entire marked treatment region.

RESULTS

In the treated area, at 3 months post-procedure compared to pre-procedure, the following changes were observed, all with statistical significance (P ≤ 0.05): (a) significant reductions in skin roughness (Ra, - 15.9%; Rz, - 22.6%), skin luminance (- 2.0%), and blue-green color distribution (- 10.6%); (b) significant increases in skin microcirculation maximum value (+ 240.1%), skin hydration (+ 71.2%), skin elasticity (+ 216.5%), skin density (+ 34.3%), skin thickness (+ 26.0%), and hypodermis thickness (+ 29.9%). Furthermore, for each of the aforementioned parameters, there was a significantly greater improvement observed with the AMT procedure compared with microneedling at 3 months (all P ≤ 0.05).

CONCLUSION

The AMT procedure using Rigenera technology resulted in an noticeable improvement in the SD appearance after 3 months in healthy women.

Plants with cosmetic uses

The use of plants as a source of active principles for cosmetics has significantly increased in the last few years. Safety, compatibility with all types of skin, fewer side effects, and availability are among the advantages of herbal cosmetics above synthetic ingredients. The present review aims to explore the most important plants used in cosmetics. A literature search was carried out in several electronic databases with the following phrases: skincare and plants; cosmetics and plants; natural and cosmetics; and natural and skincare. Furthermore, more detailed filters such as clinical studies, meta-analyses, and systemic reviews were applied to positive results. Various plants and plant extracts currently used in skin care, scaring, whitening, and aging, as well as in sun protection, acne, eczema, and others, have been included in this review. The effectiveness of these plants is based mainly on preclinical research, and to a lesser extent on clinical studies. Some plant extracts or oils have been tested clinically, such as onions, aloe, and tea tree oil, more than other plant extracts. Despite many studies on natural products to improve dermal needs, proper clinical cosmeceutical trials are much fewer than expected. Therefore, more clinical trials are needed to evaluate appropriate efficacy. Furthermore, new formulation technologies might enhance the cosmeceutical benefits, but more work is warranted.

Evaluating the efficacy of microneedling technique in treating striae alba lesions

Striae alba, as an unsettling skin complication, has the potential to threaten the physical appearance and psychological health of individuals. So far, dermatologists' endeavors have been futile in finding an ideal treatment. This study evaluated microneedling as a novel treatment modality for striae alba scars. Microneedling was implemented in 1-3 sessions in 2-week intervals among patients with striae alba lesions. The lesions were photographed before and 3 months after the treatment, while all side effects were recorded. Two non-involved dermatologists and a patient self-report based on a visual analog score scale were utilized to evaluate the clinical improvement of striae scars. The complication rate among the 32 patients was 25%, which consisted of seven (21.9%) cases of post-inflammatory hyperpigmentation and one case (3.1%) of skin infection. The average improvement score among the patients in our study based on their self-report was 5.3 ± 1.3. (Range 4-8), while based on physician evaluation was 5.6 ± 1.2 (range 3.5-8). There was a significant association between lower age and higher self-report scores. Also, the improvement of lesions was more significant in skin type 3 compared to 2, based on physician assessment. In this study, MN was effective in ameliorating SA scars and was observed to induce better clinical satisfaction in younger patients and breast lesions. The studies concerning the use of MN in treating SA have yielded much attention lately, and they have denoted the relatively low cost of MN, its capability to be utilized over vast treatment areas, and its safety in that regard. Further research regarding the comparison of MN's efficacy in solo use versus implementing it as an adjuvant modality should be carried out.

Stretch marks: a visible expression of connective's involvement in autism spectrum disorders

In autism spectrum disorders (ASDs) in the pediatric population, skin manifestations are generally attributable to the concomitance of allergic forms or to accidental, self-inflicted or abusive lesions. However, clinical evidence has highlighted the presence of an increasing number of abdominal stretch marks, probably caused by the increase in the number of obesity cases in the pediatric population, in general, and therefore also among children with ASD. Stretch marks are often attributed to obesity, as they have an incidence of more than 50% in obese individuals. In the first part of this article we hypothesized that in addition to obesity there are other factors, such as a structural alteration on the skin in people with ASD, which can contribute/aggravate the phenomenon of stretch marks. Despite the high frequency with which stretch marks are found in children with ASD, this aspect has never been studied, the structure of the skin of children with ASD is not known. Furthermore, it is not known whether this structure is different from that of subjects without ASD. In the second part of the article, we hypothesized the mechanisms of the negative impact of simple abdominal stretch marks on the symptomatic picture of children with ASD. The presence of stretch marks, altered tactile perception, altered sensitivity to clothing fabrics can be a combination that influences development and determines negative consequences in the neurological picture of a child with ASD, as it is already known that the altered sensory perception in children with ASD contributes to the deterioration of social behavior. Furthermore, the presence of stretch marks may play a role in the postural and motor defects of children with ASD.

Evaluation of the tissue repair process and immunomodulatory action of Platelet-Rich Plasma (PRP) in the treatment of abdominal stretch marks

The aims of this study were to characterize and to compare the structural alterations of collagen and elastic fibers in the abdominal stretch marks of patients submitted to intralesional and per quadrant (region close to stretch marks) Platelet-Rich Plasma (PRP) treatment, as well as, to establish the possible mechanisms of action of this treatment involving toll-like receptors (TLRs) signaling pathways and growth factors. Incisional biopsies were collected from abdominal stretch marks with a 2 mm diameter punch in female patients, at the beginning of treatment, after 6 and 12 weeks of treatment, and submitted to morphological analyzes of elastic and collagen fibers, and immunohistochemistry for TLRs signaling pathways and growth factors. Our results demonstrated PRP per quadrant treatment was most effective in reducing the area of the abdominal stretch marks, with consequent stimulation of the synthesis and remodeling of collagen and elastic fibers. Also, PRP per quadrant treatment promoted an increase in TLR2 and TLR4 immunoreactivities, with consequent increase in TNF-α, VEGF and IGF-1. Based on the current findings, PRP constitutes a promising therapeutic approach in patients with stretch marks, since it promoted modulation of inflammatory cytokines and growth factors, with consequent remodeling of extracellular matrix, culminating with tissue improvement.

Combined Fractional CO 2 Laser With Intradermal Platelet-Rich Plasma versus Fractional CO 2 Laser Alone in the Treatment of Striae Distensae

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.

Striae Distensae: Clinical Results and Evidence-Based Evaluation of a Novel 675 nm Laser Wavelength

Background: A current popular aesthetic problem, especially among younger women, is striae distensae (SD), also referred to as "stretch marks.". Aim: The potential use of the 675 nm laser has been investigated in the treatment of SD. Methods: Patients underwent three sessions of the 675 nm laser with a 1-month interval between sessions. A total of three sessions were performed. The Manchester Scar Scale was used to assess stretch mark changes, and the mean scores related to each parameter at baseline and 6M FU after the last treatment session were measured. A clinical photographic evaluation was performed to show the aesthetic improvement of SD. Results: The patients' treated areas were the abdomen, thighs, buttocks, and breasts. Mean scores related to each Manchester Scar Scale parameter, with their relative percentage change, at baseline and 6M FU after the last treatment session were significantly improved. The total mean Manchester Scar Scale score significantly diminished from 14.16 (±1.30) to 10.06 (±1.32) at 6M FU (p < 0.01). The clinical photographs showed promising aesthetic SD improvement. Conclusions: 675 nm laser therapy demonstrated a good tolerance for the treatment of stretch marks applied to various body areas preventing any discomfort for the patient and with a significant improvement in skin texture.

Treatment of striae albae with 1,550 nm Er: Glass vs. CO2 fractional laser: A self-controlled study

Objective

The objective of this study was to compare the efficacy and safety of fractional CO₂ laser and 1,550 nm Er: glass laser in the treatment for the patients with striae albae.

Methods

The female adults with striae albae in the abdomen for at least 12 months were recruited. After informed consent obtained, the patient received three treatments at 2-month intervals. The lesions on the left abdomen were treated with 10,600 nm CO₂ fractional laser and right side treated with 1,550 nm Er: glass fractional laser. The pictures were taken before each visit and 3 months after the final treatment. The criteria for the evaluations using a quartile grading scale were excellent (76-100%), good (51-75%), fair (26-50%), poor (1-25%), and no improvement (0%). The safety and efficacy of the two lasers were independently evaluated using before and after photographs by two dermatologists. In addition, the self-reports to investigate the pain and satisfaction from patients were also recorded.

Results

Totally, 27 cases were recruited, and 25 patients completed the treatments and follow-up. The excellent and good results (improvement of 51-100%) were achieved on the right abdomen in 84% of the patients, while 48% on the left site (p < 0.05). Hyper-pigmentation was seen in 20% of the patients assessed on the left abdomen and only in 8% on the right abdomen. During the treatments, average score of the pain on the right abdomen was 5.41 ± 2.13, which was higher than that on the left (4.19 ± 2.12) (p < 0.001). No permanent hyper-pigmentation was found on the both sides. Considering the whole treatments, the patients favored the modality used on the right side (80 vs. 68%, p < 0.05).

Conclusion

Compared with CO₂ fractional laser, 1,550 nm Er: glass fractional laser therapy provides the significantly better clinical outcomes and fewer side effects in the treatment of striae albae.

Limitations

The sample size and follow-up time were limited.

A Narrative Review of Current Striae Treatments

Striae (striae cutis distensae) are a common disfiguring skin condition, characterised by the appearance of linear bands on the skin, with an atrophic look. The striae development is still unknown, being more common in women than in men. The prevalence of this condition ranges from 50% to 90%. Regarding treatment, there are various treatment strategies currently available for stretch marks, including topical preparations such as tretinoin and glycolic acid, and also laser. The goal of this work is to discover the main treatments available for striae management. For that, a search was performed based on the definition of specific scientific keywords, by exploring PubMed, ScienceDirect and Biblioteca Virtual em Saúde (BVS). MeSH thesaurus (Medical Subject Headings) descriptors were used. The results indicate that, to date, no treatment is fully effective. More clinical trials are needed to validate the efficacy of these therapies and their long-term use in this type of skin lesion.

New Progress in Therapeutic Modalities of Striae Distensae

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.

Comparative Study Between the Efficacy of Fractional CO2 Laser/Radiofrequency, PRP and a Combination of Both in the Treatment of Striae Distensae: A Pilot Study

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.

Allantoin Inhibits Compound 48/80-Induced Pseudoallergic Reactions In Vitro and In Vivo

Pseudoallergic reactions are hypersensitivity reactions mediated by an IgE-independent mechanism. Since allantoin (AT)-mediated pseudoallergy has not been studied, in this study, our objective is to investigate the anti-pseudoallergy effect of AT and its underlying mechanism. In vitro, β-hexosaminidase (β-Hex) and histamine (HIS) release assays, inflammatory cytokine assays, toluidine blue staining, and F-actin microfilament staining were used to evaluate the inhibitory effect of AT in RBL-2H3 cells stimulated with Compound 48/80 (C48/80). Western blot analysis is further performed to investigate intracellular calcium fluctuation-related signaling pathways. In vivo, Evans Blue extraction, paw swelling, and the diameter of Evans Blue extravasation were evaluated, and skin tissues are examined for histopathological examination in mice with passive cutaneous anaphylaxis (PCA) induced by C48/80. Body temperature is measured, and the levels of cytokines are further determined by ELISA kits in mice with active systemic anaphylaxis (ASA) induced by C48/80. The results show that AT dose-dependently inhibited degranulation in C48/80-stimulated RBL-2H3 cells by inhibiting β-Hex and HIS release, reducing the levels of TNF-α, IL-8, and MCP-1, inhibiting shape changes due to degranulation and disassembling the F-actin cytoskeleton. Furthermore, AT dose-dependently inhibits the phosphorylation of PLCγ and IP3R. In vivo, AT decreased Evans Blue extravasation, paw swelling, and the diameter of Evans Blue extravasation and significantly ameliorate pathological changes and mast cell degranulation in C48/80-induced PCA. Furthermore, AT help the mice recover from the C48/80-induced decrease in body temperature and decreased the levels of cytokines in C48/80-treated ASA mice. Our results indicate that allantoin inhibits compound 48/80-induced pseudoallergic reactions. AT has the potential to be used in IgE-independent anti-allergic and anti-inflammatory therapies.

Improving the outcome of treating striae gravidarum by combined therapies using topical β-glucan and 1565-nm non-ablative fractional laser: A prospective randomized vehicle-controlled parallel group study

Striae gravidarum (SG) is a kind of dermal scar associated with psychosocial and therapeutic challenge. Topical reagents and non-invasive laser are more preferred than invasive procedures for less pain and shorter downtime. However, there are few studies on comparing and combining these two modalities. The aim of the present study was to evaluate the efficacy and tolerance of a topical regimen containing β-glucan, 1565-nm non-ablative fractional laser (NAFL; ResurFX), and combination of them for SG. A total of 128 unilateral abdomens from 64 subjects were randomly divided into four strategies and were followed up for 12 weeks: topical vehicle (Veh); topical β-glucan (B); 1565-nm NAFL combined topical vehicle (NAFL); 1565-nm NAFL combined topical β-glucan (B + NAFL). NAFL was applied three times with a 4-week interval. Topical reagent was applied b.i.d. for 12 weeks. Global Aesthetic Improvement Scale (GAIS) scores were assessed by blinded physician according to standard photograph, and by subjects at 12th week. The degree of SG atrophy was assessed by blinded physician before treatment and at the 12th week according to a standard 5-point scale. Collagen remodeling was evaluated by histological analysis and all adverse effects were recorded. A total of 56 women (112 unilateral abdomens) completed all study. The GAIS scores by blinded physician showed greater improvement in NAFL as compared with β-glucan, and by subjects showed greater improvement in β-glucan as compared with vehicle. In terms of striae atrophy scale, the improvement of SG atrophy was more prominent in NAFL compared to β-glucan, and in β-glucan + NAFL compared to Veh + NAFL. All treatments were well tolerated. Topical β-glucan regimen can mildly improve SG. NAFL showed better results than topical β-glucan regimen. The combined strategy may further improve the SG atrophy compared with single treatment strategy.

Striae distensae as a diagnostic indicator for eating disorder pathologies

OBJECTIVE

This manuscript provides a review of the relationship between patients with an underlying eating disorder (ED) and the presence of striae distensae (SD). Researchers and clinicians have recognized many different skin manifestations associated with EDs. According to the Diagnostic and Statistical Manual of Mental Disorders, EDs include, but are not limited to, anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). The presence of specific skin findings often helps clinicians conclude whether or not a patient may have an underlying ED and require further evaluation. One skin finding associated with an ED with little current literature focus is SD. SD arises from a combination of hormonal imbalances and stretching of the dermis, triggering a local inflammatory response. The presence of SD leaves patients with diminished quality of life. There is no single guideline treatment for SD; however, topical and/or light and laser therapies can be utilized.

METHOD

Using online medical literature databases and the PRISMA guidelines, 11 out of 574 articles met the acceptable criteria to be analyzed, emphasizing the lack of current literature on this subject.

RESULTS

Anxiety and depression were comorbidities demonstrated to be strongly related to AN and obesity, secondary to BED, in patients who developed SD. Higher degrees of suicidal ideation and insomnia, along with lower self-esteem levels, were more likely to be present in these patients.

CONCLUSION

Altogether, this review highlights the importance of continued evaluation of SD and its overall impact on patient's mental health, emphasizing an underlying ED.

Clinical Evaluation on the Performance and Safety of a Non-Ablative Fractional 1340 nm Laser for the Treatment of Stretch Marks in Adolescents and Young Adults: A Case Series

A large part of the world’s population suffers from Striae distensae (SD) or stretch marks, which create physical and psychological discomfort in people. We evaluate the SD clinical improvement by using a non-ablative fractional Nd:YAP 1340 nm laser. The research was performed on 25 patients of both sexes, with a mean age of 31 ± 13.09 years. Each patient underwent from a minimum of 3 to a maximum of 4 treatments, with an Nd:YAP (1340 nm) medical device, every four weeks, with 3- and 6-month follow-up, in these areas: back, abdomen, breast, flanks, lower limbs, buttocks, and thighs. Manchester Scar Scale assessed stretch marks improvement. Side effects, patient pain, and SD overall appearance improvement were also recorded for all patients. Digital photographs measured the aesthetic results. Treatment was well-tolerated (pain score 1.08 ± 0.76) by all patients. There were no long-term side effects, and 88% of patients revealed an SD excellent improvement showing good aesthetic results achieved by the treatment. The total mean pretreatment Manchester Scar Scale score decreased from 13.80 (±1.58) to 10.36 (±1.70) after 3 months (p < 0.01) and to 8.36 (±1.07) after 6 months (p < 0.01). An Nd:YAP (1340 nm) laser seems to be a safe and effective treatment, showing a higher security profile with no side effects.

Classification of Distinct Endotypes in Human Skin Scarring: S.C.A.R.-A Novel Perspective on Dermal Fibrosis

Significance: Skin scarring is a permanent, irreversible end point of cutaneous injury. However, not everyone will acquire the same exact scar type. Skin scarring is generally recognized as complex with significant variability in individuals' scar type and response to treatment. Despite these tangible differences in treatment response, to date there has been no simplified approach in defining spectrum of skin scarring in relation to prediction and outcome post-treatment. Thus, in this study we propose that skin scarring consists of distinct endotypes, which is characterized by their specific pathology. Four distinct scar endotypes can be observed: (1) Stretched (flat), (2) Contracted, (3) Atrophic (depressed), and (4) Raised scarring, which can be abbreviated to S.C.A.R. endotypes. Each of these endotypes can certainly include subphenotypes and each phenotype can be present in more than one endotype. To define these endotypes, we also present a structured approach in assessment of all relevant parameters in skin scar evaluation including clinical (scar symptoms and signs) and nonclinical parameters (device measurements of structural, mechanical, and physiological properties of scars as well as gene and protein laboratory studies). Recent Advances: Scars can be phenotypically characterized based on a multitude of parameters assessed; however, not all scar types will share all the same characteristics. This leads to the question of whether skin scarring is a single disease entity with varying phenotypic characteristics or should be classed as several disease entities that have certain similar parameters. We suggest the latter and propose distinct scarring phenotypes arise mainly owing to genetic and environmental susceptibilities associated with the development of each specific scar endotype. Characteristic features of skin scarring, however, can be objectively and quantitively evaluated and used as an aid in the theranostic goal-directed management of scarring. Critical Issues: The concept of identifying different endotypes is key in formulating personalized treatments with improved outcomes beyond what is achieved with current nonspecific approaches in scar management. This approach has gained interest and significant traction in several other medical conditions including asthma, rheumatoid arthritis, and atopic dermatitis. Future Directions: To begin identifying distinct endotypic features in skin scarring, it is important to have a better understanding of underlying pathological mechanisms leading to further insight into the heterogeneous nature of skin scarring endotypes. This approach may lead to improved theranostic outcomes and further understanding of the pathophysiology of the complex nature of human skin scarring.

The Alleviating Effect of Lagerstroemia indica Flower Extract on Stretch Marks through Regulation of Mast Cells

Striae distensae (SD) or stretch marks are common linear scars of atrophic skin with disintegrating extracellular matrix (ECM) structures. Although fibroblasts contribute to the construction of ECM structure in SD, some studies have reported that mast cell degranulation causes the disruption of ECM in early SD lesions. Lagerstroemia indica flower (LIF) has traditionally been used in India as a diuretic. However, little is known about the effect and molecular action of Lagerstroemia indica flower extract (LIFE) on alleviating SD. This study evaluated the effects of LIFE on mast cell degranulation and the synthesis of ECM components in fibroblasts. LIFE inhibits the adhesion of rat basophilic leukemia (RBL) cells, RBL-2H3 on fibronectin (FN) and the expression of integrin, a receptor for FN, thereby reducing focal adhesion kinase (FAK) phosphorylation. In addition, LIFE attenuated the allergen-induced granules and cytokine interleukin 3 (IL-3) through the adhesion with FN. Moreover, the conditioned medium (CM) of activated mast cells decreases the synthesis of ECM components, and LIFE restores the abnormal expressions induced by activated mast cells. These results demonstrate that LIFE suppresses FN-induced mast cell activation and promotes the synthesis of ECM components in fibroblast, which indicates that LIFE may be a useful cosmetic agent for SD treatment.

Comparison of the efficacy of microneedling versus CO2 fractional laser to treat striae alba: A randomized clinical trial

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.

Systematic review of single and combined treatments for different types of striae: a comparison of striae treatments

Striae distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost-effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by 20 May 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light-based devices and topical treatments are the most commonly applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side-effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.

Treatment of abdominal striae distensae in Fitzpatrick skin types IV to V using a 1064-nm picosecond laser with a fractionated microlens array

BACKGROUND

Striae distensae are atrophic dermal scars that can cause psychosocial distress among affected patients. Despite numerous available therapeutic modalities, no gold standard treatment has been established.

OBJECTIVE

To evaluate the long-term efficacy and safety of a fractional 1064-nm picosecond laser for the treatment of striae alba in individuals with dark skin types.

MATERIALS AND METHODS

Twenty volunteers with Fitzpatrick skin types IV-V who presented with striae alba were enrolled. Subjects were treated with a fractional 1064-nm picosecond laser for four sessions at 4-week intervals. The skin texture, average melanin index (MI), and melanin variation score were assessed using Antera 3D® before treatment, at 1 month after the second treatment, and at 1, 3, and 6 months after the last treatment. Two independent investigators evaluated clinical improvement by comparing pretreatment and posttreatment photographs. The patient satisfaction rates were likewise assessed. Adverse effects were recorded during the entire study period.

RESULTS

Significant improvement of skin texture was seen at 1 month after the final treatment (p < 0.001) and continuously improved until the 6-month follow-up visit (p = 0.003). The average MI significantly increased at 1 month after the final treatment (p < 0.001), whereas the melanin variation score decreased throughout the follow-up period. Investigator assessment at the 6-month follow-up revealed that 90% of subjects had moderate to marked improvement of striae appearance. Only two of 20 subjects (10%) developed transient postinflammatory hyperpigmentation (PIH) after laser treatment.

CONCLUSION

Fractional picosecond 1064-nm laser is effective and well-tolerated for the treatment of striae alba in dark-skinned individuals with a low incidence of PIH.

Imaging striae distensae: a comparison between PS-OCT and digital dermoscopy

Stretch marks or striae distensae (SD) cause emotional distress and negatively affect the psychological well-being of patients. We investigate and compare two methods for quantifying the severity of SD: visual scoring of images captured using a clinical visible-light dermatological camera (C-Cube, Pixience Inc) and measuring the local birefringence of skin using polarization-sensitive optical coherence tomography (PS-OCT). Data on skin visually affected by SD and visually normal skin were collected from 19 human volunteers. Our results show a weak correlation between visual scores of the C-Cube images and the birefringence values obtained from the PS-OCT system. SD datasets have a significantly larger birefringence values compared to visually normal datasets.

Fractional Carbon Dioxide Laser Versus Carboxytherapy in Treatment of Striae Distensae

BACKGROUND AND OBJECTIVES

The aim of this study was to compare the efficacy and safety of fractional carbon dioxide (CO₂ ) laser versus carboxytherapy in treatment of striae distensae.

STUDY DESIGN/MATERIALS AND METHODS

This study was conducted on forty female patients with striae distensae on the abdomen. Patients were selected and divided randomly into two matched groups; group I was treated with fractional CO₂ laser resurfacing and group II with carboxytherapy. Assessment and evaluation of the results were done by comparing photographs and the Global Aesthetic Improvement Scale (GAIS).

RESULTS

Pregnancy, obesity, and long-term steroid use were the most common causes of striae in both groups. Both groups showed a statistically significant improvement in both the width and length of striae with no statistically significant difference between them. Patients' satisfaction was comparable in both groups. Pain and post-inflammatory hyperpigmentation were the two most common side effects in group I while bruising at the injection site was the most common in group II.

CONCLUSIONS

Both modalities could be effective in management of striae distensae. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Topical oil formulation of plant extracts and vitamins as effective treatment for stretch marks and xerosis-An observational longitudinal study

Background

Stretch marks are linear scars that result from elastic fiber destruction. They usually occur as the consequence of rapid change in the body mass (weight gain and loss, pregnancy, weightlifting), long‐term steroid use, or endocrinopathies. Treatment is challenging and mainly based on topical and procedural therapies, although the standard of care is still under debate.

Purpose

To evaluate the efficacy and tolerance of a topical oil formulation of plant extracts and vitamins on the aesthetic improvement of stretch marks and xerosis.

Materials and methods

Fifty male and female patients, aged between 14 and 45 years, with stretch marks referring at the University Hospital Federico II, Naples, were enrolled between March and November 2019. Topical application of plant extracts and vitamin‐rich oil was performed twice daily on affected skin for 4 months. Patients were monitored at baseline (T0), and at two‐month (T1) and 4‐month (T2) follow‐ups, through clinical and dermoscopic assessment, confocal microscopy, cutaneous ultrasound, MoistureMeterEpiD, and X‐Rite spectrocolorimeter. Primary endpoints were as follows: 70% clinical improvement of stretch marks and 3‐point decrease in clinical score from baseline to T2. Secondary endpoints were as follows: change in the T0 parallel pattern of collagen fibers at confocal microscopy, cutaneous thickness increase at ultrasounds, cutaneous hydration increase at MoistureMeterEpiD, erythema reduction at X‐Rite spectrocolorimeter, and safety and adverse events (AEs).

Results

At 4‐month follow‐up, stretch marks improved objectively and subjectively in all patients (p < 0.001). In detail, there was a 29% and 71% improvement in clinical appearance of stretch marks at T1 and T2, respectively, as documented dermoscopically and by the 3‐point reduction in the assessor's mean clinical score at each follow‐up visits [from 8.1±0.7 at baseline to 5.7±1.0 at T1 and 2.3 ±0.5 at T2 (p < 0.001)]. Erythema decreased by 15% and 30% and in parallel hydration increased by 25% and 71%, at T1 and T2, respectively (p < 0.001). At T2 confocal microscopy of stretch marks, dermal collagenous fibers assumed casual disposition with reticular pattern and refractivity, as signs of collagen remodeling and neocollagenesis, and also the T2 cutaneous ultrasound revealed increased epidermal thickness and decreased dermal hypoechogenicity as for a higher skin hydration.

Conclusion

Our study showed that a topical oil formulation rich in plant extracts and vitamins appears to be effective and safe in treating stretch marks and xerosis.

Treating Striae Distensae Albae in Asians: Efficacy and Safety of Combined MFU-V and CaHA

This study evaluated the efficacy and safety of a single treatment combining microfocused ultrasound with visualization (MFU-V) and subdermal diluted calcium hydroxylapatite with lidocaine (CaHA+) for Striae Distensae Albae (SDA).

Carboxytherapy for striae distensae: A promising modality

BACKGROUND

Striae distensae (SD) is a very common skin problem. Although a lot of treatment modalities have been proposed, few of them are effective. Recently, carbon dioxide therapy (CDT) or carboxytherapy was used in many indications of cosmetic dermatology such as SD.

OBJECTIVES

To objectively evaluate the use and effectiveness of CDT for treatment of SD.

PATIENTS AND METHODS

Twenty patients were subjected to 8 sessions of CDT injection at 2-week intervals using carboxy-gun. Patients were photographed, and skin specimens were obtained from the treated area before and after 4 months of treatment. Using a computerized 3D camera, skin topography was objectively analyzed before and after treatment. Evaluation of collagen and elastic fibers by special histopathological staining, in addition to histometric analysis, was also done to evaluate treatment efficacy.

RESULTS

Clinically, SD was statistically significantly improved after CDT injection compared with baseline (mean percentage of improvement of length and width, 59.8 ± 15.9; P < .05). Meanwhile, the improvement observed by the 3D camera correlated with the clinical improvement. Histometric analysis showed an increase in epidermal thickness (P < .0001) in association with re-appearance of rete ridges following treatment. Histochemical evaluation of changes in elastic and collagen fibers after treatment showed better organization of curled and fragmented elastic fibers, which was accompanied by an increase in collagen content that became denser, arranged in bundles and parallel to the epidermis.

CONCLUSIONS

CDT is an effective, promising, and simple minimally invasive procedure for improving SD with few side effects and low downtime.

Tasmannia lanceolata leaf extract alleviates stretch mark appearance in a randomized, placebo-controlled clinical trial in women and stimulates extracellular matrix synthesis in ex vivo human skin explants

BACKGROUND

The leaves of Tasmannia lanceolata mainly contain polygodial that is known to exhibit a range of biological functions including anti-inflammatory effects.

AIMS

These studies aimed to assess the effects of Tasmannia lanceolata extract (TLE) on skin and more particularly on stretch marks in women.

PATIENTS/METHODS

A double-blind, randomized, placebo-controlled clinical study was carried out on 29 women, aged from 25 to 60 years, to investigate the effects of TLE on stabilized stretch marks. TLE and placebo products were topically applied daily for 8 weeks. Skin roughness and firmness of stretch marks were assessed by 2D and 3D photograph processing and analyses. Dermal density and thickness were evaluated using ultrasound, while stretch mark conditions (length, color, and depth) were determined by clinical scoring. Matricial proteins (pro-collagen I and elastin) and pro-matricial factors, like TGF-β concentrations, were quantified from cultures of human skin explants presenting stretch marks, treated with TLE or vehicle control.

RESULTS

Skin roughness of stretch marks was significantly reduced in the TLE group after 8 weeks of treatment. Skin firmness of stretch marks was significantly increased in the TLE group after 4 weeks of treatment, and this improved effect was maintained until the end of the study. Dermal density and thickness were significantly increased in the TLE group compared to the placebo group. Furthermore, TLE restored the dermal condition of the stretch mark skin, up to normal skin levels. In addition, pro-collagen I and elastin concentrations were found to be higher in the TLE-treated stretch mark skin explants compared to the untreated ones, associated with higher quantities of TGF-β production.

CONCLUSION

These results revealed that TLE could help improve the aspect of stabilized stretch marks in women by restoring the matricial environment.

Comparative effectiveness of different therapies for treating striae distensae: A systematic review and network meta-analysis

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.

Imaging analysis of Bartonella species in the skin using single-photon and multi-photon (second harmonic generation) laser scanning microscopy

We demonstrate Bartonella spp are abundant in skin lesions resembling striae distensae. These striae distensae-like lesions, coincidental with sudden onset of neuropsychiatric symptoms, indicate testing for suspected Bartonella spp. infection.

Combined microneedling with topical application of platelet-rich plasma versus microneedling alone in the treatment of stria distensae: clinicopathological analysis

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.

Consumer Preference of Products for the Prevention and Treatment of Stretch Marks: Systematic Product Search

Background

Striae distensae, or stretch marks, are a common and distressing condition affecting females two-and-a-half times more frequently than males. Despite the numerous products available for stretch mark prevention and treatment, there have been few studies that consider consumer product preference.

Objective

The aim of this study was to determine which products were preferred by consumers for the prevention and treatment of stretch marks based on product vehicle and product ingredients.

Methods

In January 2020, a search was conducted on internet retailer Amazon for products related to stretch marks. The top products were identified as those with 100 reviews or greater and a rating of 4 or higher. The products were classified as either stretch mark–specific or non stretch mark–specific. Price, rating, type of vehicle, and specific ingredients of both product groups were compared. Vehicle-type and ingredients in both product groups were compared with two-tailed two-sample proportion tests to determine if certain vehicles or ingredients were more likely to be found in stretch mark–specific products. P<.05 indicated statistical significance.

Results

Out of over 10,000 products, 184 were selected as the top products according to the review and rating criteria of which 117 (63.6%) were stretch mark–specific and 67 (36.4%) were non stretch mark–specific. Oil was the most common vehicle (131/184, 71.2%) while vitamin E was the most common ingredient (58/184, 31.5%). Oil, as a vehicle, was more likely to be found in stretch mark–specific products than in non stretch mark–specific products (P=.001). Olive oil (P=.02) and cocoa butter (P=.08), Centella asiatica (P=.01), and shea butter (P=.003) were the ingredients more likely to be found in stretch mark–specific products than in non stretch mark–specific products.

Conclusions

This study demonstrated that there are many products available for the prevention and treatment of stretch marks and identified specific ingredients in the products preferred by customers. There are few studies investigating the effectiveness of the major ingredients in the stretch mark products that are preferred by consumers. Future studies can focus on the effectiveness of the ingredients found in the products that are preferred by consumers.

Fractional Radiofrequency Microneedling Combined With Fractional Carbon Dioxide Laser Treatment for Striae Distensae

BACKGROUND AND OBJECTIVES

To evaluate the safety and effectiveness of combined fractional radiofrequency microneedling (FRM) and fractional carbon dioxide (FCO₂ ) laser treatment for striae distensae and to compare the results to those of FRM alone and those of FCO₂ alone.

STUDY DESIGN/MATERIALS AND METHODS

Adult women (Fitzpatrick skin types III-IV) with striae distensae on the abdomen or calf were enrolled in this study. Each lesion was divided into three regions, with each region assigned to one of the three treatments (FCO₂ , FRM, or combined FCO₂ and FRM). Global photographic assessments were performed by three dermatologists and by patients using a scored visual analog scale (VAS). Additionally, each lesion was evaluated using a skin imaging analyzer and a diagnostic ultrasound system.

RESULTS

All 19 female subjects had an average body mass index of 23.85 kg/m² . The global assessment by dermatologists indicated a significant improvement in the combined treatment group (6.1) compared with the other groups (4.3 and 5.1 in the FRM and FCO₂ groups, respectively; P < 0.05), and that by the patients indicated a significant improvement in the combined treatment group (6.3) compared with the FRM group (5.1; P = 0.02). Ultrasound results showed significantly increased skin thickness and dermal density (204.9 μm and 8.8%; both P < 0.05) in the combined treatment group. However, results of the skin imaging analysis showed a higher average level of melanin and redness indices in the combined treatment group than in the FRM group (P < 0.001, P < 0.01, respectively), but not in the FCO₂ group (P = 0.15, P = 0.11, respectively).

CONCLUSION

Combined FRM and FCO₂ treatments resulted in slightly better clinical outcomes than single treatments, and the side effects of the treatment, such as pigmentation and persistent erythema, did not result in more serious events to a level similar to that of FCO₂ alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Striae distensae in adolescents: A mini review

Striae distensae or stretch marks are mainly a cosmetic concern. They commonly occur in adolescence and in pregnant women. Although, generally more common in females; physiological striae atrophicae of adolescence are more common in males. The pathophysiology is multifactorial with mechanical stretching of the skin being the most important. Despite of an abundance of treatment modalities none is 100% effective. (www.actabiomedica.it)

Unraveling the molecular and cellular mechanisms of stretch marks

BACKGROUND

Striae distensae, commonly known as stretch marks, are cutaneous lesions that accompany the hormonal upheavals of the major stages of life: puberty and pregnancy. Stretch marks occur in 90% of women, and they appear as red or purple lines that slowly fade to pale lines on the skin. There have been few studies regarding stretch mark origins, and new preventive and corrective treatments are needed.

AIMS

The aim of this work was to understand the primary genes and proteins involved in the regulation of striae compared to normal skin and to identify the differentially expressed genes and biochemical aspects of SA and SR Importantly, this is the first published study to use a molecular high-throughput approach combined with in vivo evaluation.

METHODS

In this study, we analyzed the molecular differences between skin with and without stretch marks (rubra [SR] and alba [SA]) of female volunteers using DNA microarray (Whole Human Genome Microarray Kit, 4×44 K, Agilent Technologies) analyses of cutaneous biopsies (2 mm) and in vivo confocal Raman spectroscopy of selected buttock regions, a technique recently introduced as a noninvasive skin evaluation method.

RESULTS

We identified gene expression alterations related to ECM, cellular homeostasis, and hormones such as secretoglobulins. Spectral analyses of collagen, fibrillin, and glycosaminoglycans were conducted by Raman spectroscopy at different skin depths. The main differences observed when comparing skin with and without stretch marks were at depths between 75 and 95 μm, corresponding to the dermal-epidermal junction and dermis regions and showing differences between normal skin and stretched skin regarding collagen, collagen hydration, and elastin fibers.

CONCLUSION

The results obtained by RNA and protein analyses are complementary and show that significant changes occur in the skin affected by stretch marks. These results suggest new strategies and opportunities to treat this skin disorder and for the development of new and eficiente cosmetic products.

Microfocused Ultrasound with Visualization for the Treatment of Stretch Marks

Objective: Stretch marks (striae) can be distressing for many people, and currently available treatments are less than optimal. A previous study showed that the use of a calcium hydroxylapatite (CaHA) filler followed by the topical application of 20% ascorbic acid solution and microneedling significantly improved striae appearance. We sought to evaluate additional improvements in atrophy and color of striae following treatment with microfocused ultrasound with visualization (MFU-V) in subjects who received previous treatments using CaHA, 20% ascorbic acid, and microneedling. Participants: Subjects with remaining skin atrophy (N=20) were treated with MFU-V using transducers with a frequency of 7MHz and 10MHz and a focal depth of 3.0 mm and 1.5 mm, respectively, applied in a cross-hatch pattern. Measurements: Efficacy was based on changes in Manchester Scar Scale scores. Results: At Day 90 post-treatment, the mean (± standard deviation) baseline Manchester Scar Scale score decreased from 9.35 (±1.18) to 6.30 (±1.26) (p<0.001) and the mean Patient Satisfaction Scale score increased from 3.75 (±0.44) to 4.70 (±0.47) (p<0.001). Most subjects (70%) were very satisfied with their results. No adverse events were reported. Conclusion: The combined use of CaHA, 20% ascorbic acid, and microneedling appears to be effective in improving the appearance of striae. Additional esthetic improvements were seen with the application of MFU-V.

Striae Distensae Treatment Review and Update

Striae distansae (SD) or stretch marks are very common, asymptomatic, skin condition frequently seen among females between 5 to 50 years of ages. It often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late, with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for stretch marks treatment. However, despite several advances, no fully effective treatment has emerged. Unfortunately, there is paucity of the strong evidence in the literature for the effective treatment of striae. A literature search using the terms 'striae distansae (SD or stretch marks' was carried out in the PubMed, Google Scholar and Medline databases. Only articles related to the treatment were considered and analysed for their data. Commonly cited treatments include topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q-switched Nd:YAG, pulse dye and excimer laser. Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture have also been used with variable success. This article reviews all currently accepted modalities and their effectiveness in the treatment of stretch marks.

Biophysical properties of striae rubra and striae alba in human skin: Comparison with normal skin

BACKGROUND

Striae distensae are common dermal lesions that progress through two different stages: the striae rubra, which appears to be erythematous, and striae alba, which is characterized by a hypopigmented feature. The clinical characteristics between striae distensae stages and normal skin remain unknown.

OBJECTIVES

We aimed to investigate the clinical characteristics according to stages of striae distensae in terms of their biophysical properties, using objective noninvasive measurements in comparison with adjacent normal skin.

METHODS

Sixty-one healthy female subjects with striae distensae were included as follows: 30 with striae rubra and 31 with striae alba on the abdomen and thighs. Hydration of the epidermis and dermis, skin color brightness, and Erythema index were measured. Skin elasticity, roughness, and dermal echo-density of the skin with striae distensae and adjacent normal skin were also measured.

RESULTS

Hydration of the epidermis and dermis showed no significant difference between the skin with striae distensae and normal skin. Brightness of skin with striae alba and normal skin was significantly higher than that of skin with striae rubra. Erythema index of skin with striae rubra was significantly higher than that of skin with striae alba and normal skin. Skin with striae rubra and striae alba had a rougher surface than normal skin. Elasticity and dermal echo-density were significantly lower in striae distensae skin.

CONCLUSIONS

Striae rubra and striae alba had similar biophysical properties in terms of skin hydration, elasticity, roughness, and dermal density. Moreover, striae distensae have less elasticity, more roughness, and lower dermal density than normal skin.

Evaluation of a non-ablative, fractional 1565 nm laser for the improvement of striae distensae albae

BACKGROUND AND OBJECTIVE

Striae distensae (SD) represent therapeutically challenging forms of dermal atrophic scarring. In addition to topical ointments, medical needling and various energy-based devices, non-ablative fractional lasers have been suggested for their improvement. However, objective evaluations of their efficacy are widely missing. In this study, we aimed to assess the clinical improvement of SD albae after three treatments with a non-ablative fractional 1565 nm Er: glass laser by employing three-dimensional analysis and several questionnaires.

METHODS

A total of 16 Caucasians suffering from SD albae were included in this prospective study. Every patient received three treatments - one every 4 weeks - using a non-ablative, fractional 1565 nm laser (two passes: 300 μbeams/cm² , 40 mJ inside the SD; 150 μbeams/cm² , 50 mJ inside the SD and within the surrounding area). Questionnaires (DLQI, POSAS), digital photography and three-dimensional analysis employing PRIMOS^® software and VECTRA^® camera system were taken at baseline, 1 and 6 months after the last treatment.

RESULTS

Evaluation of objective measurements at 6-month follow-up (FU) showed a significant reduction in depth of atrophic lesions by 31.7% and less skin irregularities with S_max at baseline of 621.2 μm decreasing to 411.6 μm (P < 0.01, respectively). Improvement in objective measurements was supported by significant changes in patients' rating of skin appearance. POSAS patient total score declined from 33.5 points to 17.5 points throughout the study (P < 0.001). From baseline to 6-month FU, patients' life quality improved by 68.0% (DLQI score). Procedures showed no lasting negative side-effects and little to no down time.

CONCLUSION

The use of a fractional non-ablative 1565 nm laser represents a safe approach for the treatment of SD albae. Clinically observed improvements were supported by significant data from objective measurements. The results achieved at 1-month FU represented at 6-month FU, showing stable clinical improvements.

Treatment of striae distensae using fractional ablative CO2 laser in skin types II-IV: a retrospective case series study

Striae distensae (SD) are atrophic dermal scars often found on abdomen, breasts, thighs, and hips of pregnant women. The strias' self-healing without any intervention is a poor possibility. Till now, several lasers and light sources have been used for treatment of SD. However, there are no integrated therapeutic approaches determined for treatment of SD yet. So, in this study, the therapeutic effect of fractional ablative CO₂ laser in women with pregnancy was assessed. Twenty-four ethic Iranian women aged between 20 and 42 years with various severity of pregnancy SD enrolled in retrospective case series study. Participants with skin types II-IV were treated in four sessions with a one-month interval by fractional ablative CO₂ laser. The severity of striae was determined by Daveys scoring. Clinical improvement was assessed by comparing pretreatment and posttreatment clinical photographs based on global improvement scoring. The evaluation of clinical results showed that fractional ablative CO₂ laser was an effective treatment. Twenty of 24 (83.3%) patients showed improvement. Clinical improvement was affected by striae severity (P = 0.03). Also, there were no statistical differences between clinical improvements with skin types, striae scar severity, number of pregnancy, and striae location.

In vivo study of dermal collagen of striae distensae by confocal Raman spectroscopy

This research work mainly deals with studying qualitatively the changes in the dermal collagen of two forms of striae distensae (SD) namely striae rubrae (SR) and striae albae (SA) when compared to normal skin (NS) using confocal Raman spectroscopy. The methodology includes an in vivo human skin study for the comparison of confocal Raman spectra of dermis region of SR, SA, and NS by supervised multivariate analysis using partial least squares discriminant analysis (PLS-DA) to determine qualitatively the changes in dermal collagen. These groups are further analyzed for the extent of hydration of dermal collagen by studying the changes in the water content bound to it. PLS-DA score plot showed good separation of the confocal Raman spectra of dermis region into SR, SA, and NS data groups. Further analysis using loading plot and S-plot indicated the participation of various components of dermal collagen in the separation of these groups. Bound water content analysis showed that the extent of hydration of collagen is more in SD when compared to NS. Based on the results obtained, this study confirms the active involvement of dermal collagen in the formation of SD. It also emphasizes the need to study quantitatively the role of these various biochemical changes in the dermal collagen responsible for the variance between SR, SA, and NS.