Treatment of striae distensae using an ablative Erbium: YAG fractional laser versus a 585-nm pulsed-dye laser

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.

Comparative study between the effectiveness of plasma skin regeneration versus micro-needling in the treatment of striae distensae

BACKGROUND

Striae distensae (SD) or stretch marks, a common condition causing significant cosmetic concern and distress, are linear dermal scars associated with epidermal atrophy that occur due to overstretching. Recently, micro-needling with dermapen is considered as one of the therapeutic modalities for SD. Also, plasma skin regeneration with plasma jet has been recommended as an effective method for the treatment of SD.

AIM

The aim was to compare between the efficacy of both methods in the treatment of SD.

METHODS

This study included 30 patients with striae distensae. Body was divided into two halves; one was treated with plasma jet for two sessions with 1 month interval and follow-up one month after the last session and the other half was treated with dermapen for four sessions with two weeks interval and follow-up one month after.

RESULTS

There was no statistically significant difference (p- value >0.05) between dermapen and plasma jet procedures as regard to width, Total Atwal Score, Atwal score component, score of erythema, and skin texture after treatment. There was high statistically significant difference (p value <0.01) between dermapen and plasma jet as regards pain with higher values with plasma jet while there were statistical higher values concerning hyperpigmentation and erythema with dermapen. There was high statistically significant difference (p value <0.001) between width of striae before and after treatment with dermapen.

CONCLUSIONS

Both lines of treatments are effective and promising therapeutic modalities for striae distensae with minimal side effects.

Optical Coherence Tomography-Assisted Evaluation of Fractional Er:YAG Laser Versus Fractional Microneedling Radiofrequency in Treating Striae Alba

BACKGROUND AND OBJECTIVES

Striae distensae (SD) is a challenging skin condition. Striae alba (SA) represents the chronic late atrophic stage of SD. Fractional laser technology is among the modalities used for treating SD. Lately, fractional microneedling radiofrequency (FMR) is gaining increased popularity in treating SD. The aim of our study was to assess and compare the efficacy of FMR and fractional Er:YAG laser in the treatment of SA.

STUDY DESIGN/MATERIALS AND METHODS

Twenty female patients were enrolled in the study fulfilling all inclusion and exclusion criteria. On a randomly selected half side of the body, the patients were treated with 2940 nm fractional Er:YAG laser while the other half side was treated with the FMR.

RESULTS

Both modalities showed a significant reduction in the width of the widest striae (P < 0.005); however, there was no significant difference between them. Using optical coherence tomography, all patients demonstrated a mean significant increase in epidermal thickness; however, the FMR-treated sites showed significantly better results when compared with the ER:YAG-treated sides (P = 0.029). Scar improvements in both modalities did not correlate to skin type, duration, or site of the striae.

CONCLUSION

Er:YAG and FMR represent two safe, effective, tolerable modalities for treating SA and are associated with minimal side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Restorative oncodermatology: Diagnosis and management of dermatologic sequelae from cancer therapies

The long-term survival of patients with cancer has risen dramatically during the last few decades. Despite this remarkable success, the same treatments that have enabled cure or remission often secondarily affect the skin, hair, and nails. Conditions including scarring, striae distensae, persistent alopecia, pigmentary changes, nail alterations, chronic radiation dermatitis, and radiation fibrosis have been associated with anxiety, depression, decreased quality of life, and impaired function. These dermatologic changes are cosmetically disfiguring, may limit activities, and are a visual reminder of past illness. Interventions toward improving these untoward sequelae and restoring the appearance and function of skin and appendages are critical for normalization and may contribute to improved quality of life in cancer survivors. Here, we outline dermatologic sequelae of cancer therapies with a review of medical and procedural treatment strategies to restore dermatologic health in the survivorship population.

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.

Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients

BACKGROUND AND OBJECTIVE

Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD.

STUDY DESIGN/MATERIALS AND METHODS

This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm² , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported.

RESULTS

Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported.

CONCLUSION

Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230-238, 2019. © 2018 Wiley Periodicals, Inc.

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.

[Therapy of scars with lasers]

Scar formation is the consequence of trauma to the skin that affects the deep parts of the dermis. Different scar types like immature, mature, atrophic, hypertrophic, or keloid scars can develop depending on factors like age, anatomic localization, cause of trauma, the course of the healing process, and individual predispositions. Keloids and hypertrophic scars are often associated with itching, pain, tautness of the skin, and functional impairments, thus, leading to significantly reduced quality of life in some patients. However, even seemingly physiologically healed scars can cause tremendous psychological strain as is the case with self-harm scars. Despite increased research efforts, the exact pathomechanisms of excessive scarring are still scarcely understood, and dependably effective treatment options are often lacking. However, through continually improving scientific progress, scar treatment paradigms for a variety of scar types, thus far often dominated by conventional treatment methods, are increasingly complemented by new laser technologies and wavelengths.

Therapeutic targets in the management of striae distensae: A systematic review

BACKGROUND

Striae distensae are permanent dermal lesions that can cause significant psychosocial distress. A detailed understanding of the numerous treatment modalities available is essential to ensuring optimal patient outcomes.

OBJECTIVE

Our objective was to evaluate and summarize the different treatment methods for striae distensae by linking their proposed modes of action with the histopathogenesis of the condition to guide patient treatment.

METHODS

A systematic review of the literature was performed with no limits placed on publication date. Relevant studies were assigned a level of evidence by the authors.

RESULTS

Ninety-two articles were identified, with 74 being eligible for quality assessment. The majority of treatments aim to increase collagen production. The use of vascular lasers can reduce erythema in striae rubrae by targeting hemoglobin, whereas increasing melanin through methods such as ultraviolet light is a major focus for treatment of striae albae. Despite some topical treatments being widely used, uncertainty regarding their mode of action remains. No treatment has proved to be completely effective.

LIMITATIONS

Limitations of the study include low-quality evidence, small sample sizes, and varying treatment protocols and outcome measures, along with concerns regarding publication bias.

CONCLUSIONS

Further randomized, controlled trials are needed before definitive conclusions and recommendations can be made.

Management of stretch marks (with a focus on striae rubrae)

Stretch marks are one of the most common benign cutaneous lesions and encountered esthetic problems. Striae rubrae and striae albae can be differentiated on the basis of clinical appearance. Histologically, disturbances of the dermal fiber network and local expression of receptors for sexual steroids have been detected. The epidermal changes are secondary. Prevention of stretch marks using topical ointments and oils is debatable. Treatment of striae rubrae by lasers and light devices improves appearance. Microneedling and non-ablative and fractionated lasers have been used. This review provides an overview on current treatment options with a special focus on laser treatments.

Laser and Light Treatments for Striae Distensae: A Comprehensive Review of the Literature

Striae distensae (SD) are common dermatologic lesions that often arise as a result of rapid weight change, certain endocrine conditions, or prolonged exposure to steroids. SD initially present as raised edematous plaques (striae rubra), after which they become white and atrophic (striae alba) owing to local breakdown and reorganization of collagen and elastin. There currently exists no reliable treatment option, though numerous topical applications have been attempted. Lasers and light represent emerging noninvasive therapies that have demonstrated some success targeting vascular chromophores in striae rubra and stimulating collagen and elastin production in striae alba. An extensive literature review was performed to gather all available articles studying laser and light treatments for SD. Lasers and light can significantly improve the appearance of both striae rubra and striae alba. Generally, striae rubra are more responsive to therapy and can be treated successfully with a variety of lasers without major adverse effects. Fractional lasers exhibit the strongest results for striae alba repigmentation and collagen induction, and several other lasers produce temporary repigmentation. Lasers in combination with other modalities such as topical agents and additional energy devices have also demonstrated promising preliminary results; however, large comparative studies are necessary to validate these outcomes.

Photoletter to the editor: Topical 0.5% brimonidine gel to camouflage redness of immature scars

Cutaneous scars develop as a result of a defective wound healing process. Scars are commonly visible as erythematous, sometimes disfiguring lesions which might be stigmatizing for the affected patient. Only a few therapies to improve the appearance of scars are available. Recently, brimonidine - a selective α2-receptor-agonist which causes vasoconstriction of small cutaneous vessels - was approved for the treatment of erythemato-telangiectatic rosacea. Topical brimonidine might also be helpful to improve redness of immature scars. Here we report on the effect of brimonidine 0.5% gel on a flat, erythematous scar in a 25-year-old female patient. Whitening of the scar could be observed immediately after application of brimonidine 0.5% gel and a good clinical result was observed within one hour. This effect lasted for up to three hours. We conclude that brimonidine 0.5% gel is a suitable topical therapy to reduce erythema in visible cutaneous scars.

A novel 1565 nm non-ablative fractional device for stretch marks: A preliminary report

BACKGROUND

Striae Distensae (SD) is a very common dermatologic condition. We evaluated the effectiveness and safety of a novel non-ablative fractional 1565 nm laser (ResurFX) on the appearance of SD.

MATERIALS AND METHODS

Twelve Caucasian subjects with various stages of SD received three non-ablative laser treatments. Each treatment consisted of two different laser settings, in order to achieve a demarcated dense impact together with a diffused deep impact. Three months after the last treatment, SD improvement was assessed by blinded and non-blinded reviewers using clinical images and 3D image analyses.

RESULTS

Good clinical improvement (between 51% and 75%) was observed in all patients. Most patients showed improvement of > 50% in the volume of depressions and in lesion color (91.7% and 83.3% of patients, respectively). The average pain during treatment was generally defined as tolerable and the average downtime was 4 days. Transient erythema and severe edema were noted immediately after the procedure, but long-lasting or severe adverse effects were not observed. All patients noted a good improvement and were satisfied with the treatment and the results.

CONCLUSIONS

The treatment with the 1565 nm ResurFX laser resulted in improved pigmentation, volume, and textural appearance of SD.