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Wu TJ, Huang YL, Kang YN, Chen KH, Chen C. Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Dermatol Surg 2024; 50:931-938. [PMID: 38820425 DOI: 10.1097/dss.0000000000004252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable. OBJECTIVE The aim of this review was to determine the most effective type of EBD for improving the appearance of striae. MATERIALS AND METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted. RESULTS Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width. CONCLUSION Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.
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Affiliation(s)
- Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Cathay General Hospital, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Hafez V, Mahgoub D, Satour EMA, Mikhail MMS, El-Kalioby M. Photobiomodulation versus fractional carbon dioxide laser for stria alba in phototype III-IV: a randomized controlled study. Lasers Med Sci 2024; 39:159. [PMID: 38890186 PMCID: PMC11189306 DOI: 10.1007/s10103-024-04107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Abstract
Striae distensae are common dermatological complaint. Cold laser using low-level light/laser therapy (LLLT) offers healing and analgesic effects and was not yet compared to 'hot lasers' efficacy. Study objective: to assess the efficacy and safety of LLLT in the management of stria alba compared to fractional carbon dioxide (FCO2) laser alone and to the combined use of both devices. Thirty patients with stria alba were randomized to receive either LLLT using diode 808 nm; 8-12 sessions, 2-3 sessions weekly (Group A) or FCO2 laser; 2 monthly sessions (Group B) or combined both devices simultaneously (Group C). Follow up was at 1 month and 3 months after last session. The efficacy of LLLT was statistically comparable to FCO2, despite numerical superiority of the latter. The combined group had the least numerical values in all efficacy outcomes. Patients in LLLT group did not experience any downtime. LLLT is effective in the management of stria alba comparable to the FCO2 laser. The lack of downtime with LLLT is reflected positively on patient's satisfaction. However, this is counterbalanced by the frequent weekly visits. Although adding LLLT to FCO2 laser palliates the laser side effects but it offers the least efficacy. Trial registration number NCT04165226 (clinicaltrials.gov).
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Affiliation(s)
- Vanessa Hafez
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Doaa Mahgoub
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mona El-Kalioby
- Department of Dermatology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Madegowda SB, Rajegowda HM, Kalegowda D, Nagaraju PH, Naidu HM. Efficacy of Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Platelet-Rich Plasma in Treatment of Striae Distensae in a Tertiary Care Center: A Comparative Study. J Cutan Aesthet Surg 2023; 16:178-185. [PMID: 38189063 PMCID: PMC10768952 DOI: 10.4103/jcas.jcas_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Striae distensae are atrophic scars that are often cosmetically distressing. The efficacy of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) in treating striae individually has been evaluated previously. However, not many studies described the combined efficacy of both. Aims and Objectives The aim of this study was to compare the efficacy and safety of fractional CO2 laser alone and in combination with PRP. Materials and Methods Twenty-four patients with striae presenting bilaterally in the abdomen, upper limbs, and lower limbs were included. PRP was prepared by double-spin method and cell count was done to ensure at least fourfold concentration of platelets. The patients were treated CO2 laser on both sides and PRP on the left side along with laser, every month for three sessions. Digital photography and dermoscopy were done at baseline, every treatment session, and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient satisfaction before and after treatment. Results All patients showed improvement on both sides. In CO2-laser-treated patients, responses in 6 patients (25%) were moderate, 14 (56%) were good, and 4 (16.6%) were excellent. In CO2-laser and PRP-treated patients, responses in 5 patients (20.8%) were moderate, 11 (45.8%) were good, and 8 (33.3%) were excellent. Hyperpigmentation was the most common side-effect seen (19 patients) on both sides, which resolved spontaneously by 6 months. Conclusion These results support the use of ablative CO2 fractional laser as effective and safe treatment modalities for striae. However, slightly better efficacy was noted with the addition of PRP.
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Affiliation(s)
| | | | - Deepadarshan Kalegowda
- Department of Dermatology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India
| | - Phani Halevoor Nagaraju
- Department of Dermatology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India
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Sayed DS, Badary DM, Ali RA, Abou-Taleb DAE. Combined Fractional CO 2 Laser With Intradermal Platelet-Rich Plasma versus Fractional CO 2 Laser Alone in the Treatment of Striae Distensae. Dermatol Surg 2023; 49:552-558. [PMID: 36946771 DOI: 10.1097/dss.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Striae distensae (SD) or stretch marks are common cutaneous conditions that occur because of the stretching of the dermis.OBJECTIVE To evaluate and compare the efficacy of fractional carbon dioxide (CO 2 ) laser alone versus combined fractional CO 2 laser with platelet-rich plasma (PRP) in SD treatment. METHODS AND MATERIALS Thirty adult female patients with SD (SR and SA) were enrolled. In each patient, a split-lesion design was conducted as follows: pairs of SD on both sides of the midline were selected and allocated to groups A and B. Group A: was treated with combined fractional CO 2 laser with intradermal PRP. Group B: was treated with fractional CO 2 laser alone. Skin biopsies were taken from the lesions before and after treatment for histopathologic evaluation. RESULTS In group A, a significant excellent improvement of the SD was achieved more than in group B ( p = .007) and the mean of improvement was significantly higher (60.33 ± 26.49) than that in group B (43.80 ± 27.43) ( p -value = .001). Group A was also associated with a more significant dermal deposition of collagen and elastic fibers. CONCLUSION Combined fractional CO 2 laser with PRP was more effective than fractional CO 2 laser alone for the treatment of SD.
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Affiliation(s)
- Doaa S Sayed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Daila M Badary
- Department of pathology, Faculty of Medicine, Assiut University, Egypt
| | | | - Doaa A E Abou-Taleb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Luo Y, Lin Y, Wang M, Gao X, Liu X, Liu H. Treatment of striae albae with 1,550 nm Er: Glass vs. CO 2 fractional laser: A self-controlled study. Front Med (Lausanne) 2023; 9:1060815. [PMID: 36703883 PMCID: PMC9871643 DOI: 10.3389/fmed.2022.1060815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Yanfei Luo
- Department of Dermatology, Hainan General Hospital, Haikou, Hainan, China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Meiling Wang
- Department of Plastic Surgery, Third People’s Hospital of Guizhou, Guiyang, Guizhou, China
| | - Xiaoyuan Gao
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaodong Liu
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Huaxu Liu
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Huaxu Liu,
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Wang Y, Song Y. Efficacy of Combined Treatment with Intense Pulsed Light and Erbium Fractional Laser in Striae Gravidarum. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2817-2824. [PMID: 36569421 PMCID: PMC9783832 DOI: 10.2147/ccid.s387970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/30/2022] [Indexed: 12/23/2022]
Abstract
Purpose Laser and intense pulsed light (IPL) treatments are preferred over invasive procedures due to less pain. This study looked at the efficacy and safety of IPL and Erbium fractional laser for patients with striae gravidarum (SG). Patients and Methods All 60 patients with SG were successfully enrolled in the study. IPL treatment was followed by Erbium fractional laser (wavelength 2940 nm) treatment at 4-week intervals for a total of three treatments. SG elasticity was assessed with a SEM575 custom instrument and patients were scored for SG span with an Antera 3D multifunctional skin imaging analyzer. A 3D skin impact system was used to assess patients' epidermal thickness. A visual analog scale (VAS) was used to assess patients' pain scores during the treatment period. Improvement in stretch marks was assessed with the Global Aesthetic Improvement Scale (GAIS). The occurrence of adverse events was recorded at a follow-up of 3 months. Patient satisfaction with the outcome of the treatment was also recorded. Results Area of stretch marks decreased from 7.89 ± 0.49 cm2 pre-treatment to 4.94 ± 1.16 cm2 post-treatment (P < 0.001). The grayness values and atrophy of stretch marks were reduced after treatment. Furthermore, skin elasticity and thickness at the lesions of patients increased significantly after the treatment (P < 0.001), while the width of the stretch marks significantly decreased (P < 0.001). The VAS score was 5.45 ± 1.31, the incidence of adverse events was 25%, and patient satisfaction with the efficacy was 96.67%. Conclusion IPL combined with Erbium fractional laser improves the area and atrophy of SG, lightens the color, and increases the elasticity and thickness of the skin, with high treatment safety and remarkable clinical results.
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Affiliation(s)
- Yi Wang
- Department of Plastic Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People’s Republic of China
| | - Yong Song
- Department of Plastic Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People’s Republic of China,Correspondence: Yong Song, Department of Plastic Surgery, Fujian Maternity and Child Health Hospital, No. 18, Daoshan Road, Gulou District, Fuzhou, Fujian, 350000, People’s Republic of China, Tel +86-0591-87514834, Email
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Farouk S, Afify Mahmoud W, Hafiz HSA, Maghraby HM. Split body comparative clinical and radiological study of fractional CO 2 laser versus carboxytherapy in treatment of striae distensae. Dermatol Ther 2022; 35:e15668. [PMID: 35762297 DOI: 10.1111/dth.15668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Striae Distensae (SD) are quite common complaint in dermatology practice. They are linear lesions of variable length and width according to the site and the causative condition. Several treatment modalities have been tried. To achieve satisfactory results, a combination therapy is often needed. OBJECTIVES To evaluate the efficacy and safety of fractional CO2 laser versus carboxytherapy in the treatment of Striae Distensae clinically and radiologically. METHODS Thirty Egyptian patients with striae distensae, received a split body therapy: the left side was treated by fractional CO2 laser and the right side was treated by carboxytherapy in the same session. Six sessions were done with 4 weeks apart. Clinical evaluation by measurement of the width of widest striae on both sides, global aesthetic improvement scale (GAIS) and Likert satisfaction scale. Radiological evaluation by measurement of cutaneous thickness of widest striae on both sides by ultrasonography. RESULTS There was a highly statistically significant decrease in the median width of the widest striae distensae on both sides after the last session (P < 0.01). Regarding GAIS, satisfaction scale and ultrasound, there was highly statistically significant improvement on laser side than carboxytherapy side (P < 0.01) after last session. CONCLUSION Both fractional CO2 laser and carboxytherapy may be considered as safe and effective lines of treatment for striae distensae, but fractional CO2 laser showed excellent improvement clinically, radiologically when compared with carboxytherapy which made it a promising module in treatment of striae distensae. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shaimaa Farouk
- Dermatology and venereology, Al Houd Al Marsoud Hospital, Egyptian Ministry of Health
| | - Wafaa Afify Mahmoud
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al- Azhar University, Cairo, Egypt
| | - Hala S A Hafiz
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al- Azhar University, Cairo, Egypt
| | - Hala M Maghraby
- Radiodiagnosis Department, Faculty of Medicine for Girls, Al- Azhar University, Cairo, Egypt
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8
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Saki N, Rahimi F, Pezeshkian FS, Parvar SY. Comparison of the efficacy of microneedling versus CO 2 fractional laser to treat striae alba: A randomized clinical trial. Dermatol Ther 2021; 35:e15212. [PMID: 34796595 DOI: 10.1111/dth.15212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
Striae distensae (SD) are common skin conditions that have posed a significant challenge regarding their assessment and treatment. The present study aimed to evaluate the efficacy of microneedling in comparison to fractional CO2 laser therapy. Similar striae were selected and photographed. Each side was randomly assigned to be treated with CO2 fractional laser or microneedling four times at monthly intervals and followed up for 10 months. Outcome measures including the length and width of the largest striae, dermatologist assessed improvement, patients' satisfaction, and visual analog scale (VAS) were assessed. Wilcoxon signed-rank test and Mann-Whitney U test were used to assess the efficacy of treatments. Forty patients with a mean age of 28.1 years were included. The median cross-section of the largest striae decreased significantly in both groups (P-value <0.001), without statistically significant differences between the two groups before and 6 months after treatment. VAS also improved significantly in both groups, and there were no statistically significant differences between the two treatments in all visits. No clinically significant adverse effects were observed. Fractional CO2 laser and microneedling are both efficient treatments to resolve SD. A new light should be shed on the microneedling modality as it is more economical than the other treatment options.
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Affiliation(s)
- Nasrin Saki
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Rahimi
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Seirafianpour F, Sodagar S, Mozafarpoor S, Baradaran HR, Panahi P, Hassanlouei B, Goodarzi A. Systematic review of single and combined treatments for different types of striae: a comparison of striae treatments. J Eur Acad Dermatol Venereol 2021; 35:2185-2198. [PMID: 34021922 DOI: 10.1111/jdv.17374] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
Striae distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost-effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by 20 May 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light-based devices and topical treatments are the most commonly applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side-effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.
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Affiliation(s)
- F Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - S Sodagar
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - S Mozafarpoor
- Department of Dermatology, Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H R Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - P Panahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - B Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - A Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
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Hendawy AF, Aly DG, Shokeir HA, Samy NA. Comparative Study Between the efficacy of Long-Pulsed Neodymium- YAG Laser and Fractional Co2 Laser in the Treatment of Striae Distensae. J Lasers Med Sci 2021; 12:e57. [PMID: 35155142 PMCID: PMC8837835 DOI: 10.34172/jlms.2021.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/07/2021] [Indexed: 08/28/2024]
Abstract
Introduction: Stretch marks, or striae distensae (SD), are the lesions of the dermis caused by its linear atrophy at the sites of stretching. They occur in more than 70% of pregnant women and adolescents as a result of cutaneous stretching. This study aimed at evaluating and comparing the clinical and histological efficacy of the fractional CO2 laser versus the long pulsed (LP) Nd: YAG laser in the treatment of striae alba. Methods: Thirty female subjects having bilateral symmetrical stretch marks were managed by the LP Nd: YAG laser on the right side and the fractional CO2 laser on the left side. The laser treatment course consisted of 3 sessions with an interval of 3 weeks. The patient satisfaction score and the Global Aesthetic Improvement Scale (GAIS) were employed in the study in order to assess the improvement 3 months after therapy. Punch biopsies measuring 4 mm were extracted from one lesion on each side at baseline and after the last treatment session by 3 months to evaluate the thickness of both collagen and epidermis Results: Clinical improvement was more significant in the lesions treated by the LP Nd:YAG laser than those treated with the fractional CO2 laser. The patient satisfaction score and the GAIS were higher with a statistically significant value in the side treated by the LP Nd:YAG laser. Collagen and epidermal thickness increased more in the LP Nd: YAG laser-treated lesions in comparison to their thickness in the fractional CO2 laser-managed lesions, but this difference did not have a statistical significance. Conclusion: The clinical efficacy of the LP Nd-YAG laser exceeded that of the fractional CO2 laser in the treatment of striae alba without severe side effects in spite of the insignificant histological difference between the two lasers.
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Affiliation(s)
- Alyaa Farouk Hendawy
- Department of Dermatology and Venereology, National Research Centre, Giza, Egypt
| | - Dalia Gamal Aly
- Department of Dermatology and Venereology, National Research Centre, Giza, Egypt
| | - Hisham Aly Shokeir
- Department of Medical Applications of Laser in Dermatology, NILES, Cairo, Egypt
| | - Nevien Ahmed Samy
- Department of Medical Applications of Laser in Dermatology, NILES, Cairo, Egypt
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11
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Abstract
SUMMARY Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.
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12
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Listiawan MY, Prakoeswa CRS, Astari L, Zulkarnain I, Sawitri, Rahmadewi, Wardhani PH, Harnanti DV. A comparison study of the 0.1% tretinoin cream versus fractional microneedle radiofrequency combination with fractional CO 2 laser for the treatment of striae alba in Indonesian patients. J COSMET LASER THER 2021; 23:81-86. [PMID: 34519226 DOI: 10.1080/14764172.2021.1975757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Striae distensae (SD) are linear scar tissue in the dermis that arises from stretching the skin. There are two types of SD, striae rubrae and striae albae (SA) which is marked with a line hypopigmentation that cause a psychological problem, especially in the high skin type. The standard therapy is a 0.1% tretinoin cream, but it takes a long time to reach the collagen so it needs invasive measures to reach these targets. This study was comparing 0.1% tretinoin cream with combination therapy of fractional microneedle radiofrequency (FMR) and fractional CO2 laser for SA. The number of subjects in this study was 11 patients each group with Fitzpatrick skin types IV or V. Biopsy was taken before and after therapy. The clinical changes in SA lesions in this study were represented by measurements of the length and width. The percentage of collagen area is the amount of collagen fibers with Masson's trichrome staining. The clinical changes of lesion in the combination therapy decreased. The percentage change in collagen area in the combination therapy group had a higher increase. The side effect experienced by all combination group subjects was postinflammatory hyperpigmentation, two subjects in 0.1% tretinoin cream group experienced irritation.
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Affiliation(s)
- M Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Linda Astari
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Iskandar Zulkarnain
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Sawitri
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Rahmadewi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Putri Hendria Wardhani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Densy Violina Harnanti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
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Elmorsy EH, Elgarem YF, Sallam ES, Taha AAA. Fractional Carbon Dioxide Laser Versus Carboxytherapy in Treatment of Striae Distensae. Lasers Surg Med 2021; 53:1173-1179. [PMID: 33998005 DOI: 10.1002/lsm.23418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Eman H Elmorsy
- Dermatology, Venereology and Andrology, Faculty of Medicine, University of Alexandria, Alexandria, 21131, Egypt
| | - Yehia F Elgarem
- Dermatology, Venereology and Andrology, Faculty of Medicine, University of Alexandria, Alexandria, 21131, Egypt
| | - Eman S Sallam
- Dermatology, Venereology and Andrology, Faculty of Medicine, University of Alexandria, Alexandria, 21131, Egypt
| | - Alsayeda A A Taha
- Dermatology, Venereology and Andrology, Faculty of Medicine, University of Alexandria, Alexandria, 21131, Egypt
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Neinaa YMEH, Gheida SF, Mohamed DAEA. Synergistic effect of platelet-rich plasma in combination with fractional carbon dioxide laser versus its combination with pulsed dye laser in striae distensae: A comparative study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:214-223. [PMID: 33289155 DOI: 10.1111/phpp.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Striae distensae (SD) are very common atrophic cutaneous scarring that are therapeutically challenging. Various kinds of laser had been suggested as effective treatment modalities for SD. In addition, platelet-rich plasma (PRP) was recently recommended for its therapy. OBJECTIVE To evaluate the synergistic role of PRP injection as a combined modality to fractional CO2 laser (Fr CO2 ) versus its combination with pulsed dye laser (PDL) in SD. PATIENTS AND METHODS Thirty SD patients were included in this study and treated by intradermal injection of autologous PRP on both sides, followed by laser therapy (Fr CO2 laser on right side and PDL on left side). They received 3 treatment sessions at 6 weeks interval. RESULTS Both treatment sides reported significant clinical improvements of SD lesions, evidenced by significant reduction of width of striae lesions and significant improvement of skin texture. Furthermore, significantly higher degree of clinical improvements were observed in response to treatment sessions by combined PRP with Fr CO2 laser rather than combined PRP with PDL. Generally, post-inflammatory hyperpigmentation (PIH) were mild in all patients. Histopathologically, SD lesions showed improvement of epidermal thickness, and more homogenization and regular orientation of dermal collagen fibers in both treatment sides, with more significant improvement on the side treated by combined PRP with Fr CO2 laser sessions rather than the other side. CONCLUSIONS PRP injection in combination with Fr CO2 laser or PDL is considered safe and effective therapeutic regimens for SD. However, its combination with Fr CO2 laser is more promising with better outcome and fewer side effects.
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El-Domyati M, Hosam El-Din W, Medhat W, Ibrahim MR, Khaled Y. Carboxytherapy for striae distensae: A promising modality. J Cosmet Dermatol 2020; 20:546-553. [PMID: 33205585 DOI: 10.1111/jocd.13844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Moetaz El-Domyati
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
| | - Wael Hosam El-Din
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
| | - Walid Medhat
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
| | - Michel R Ibrahim
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
| | - Yasmin Khaled
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al Minya, Egypt
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Yu Y, Wu H, Yin H, Lu Q. Striae gravidarum and different modalities of therapy: a review and update. J DERMATOL TREAT 2020; 33:1243-1251. [PMID: 33003983 DOI: 10.1080/09546634.2020.1825614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The term striae gravidarum (SG) refers to a kind of striae distensae (SD) that develops particularly during pregnancy. According to the level of maturity of the lesions, SG is divided into striae rubra (SR) and striae alba (SA). The pathogenesis remains unclear; recent studies have implicated abnormalities in elastic fibers, collagen fibrils, and other extracellular matrix (ECM) components. Changes in the expression of hormone receptors and hormone levels have also been hypothesized. Considering this new information, we reviewed successful treatments of SG and listed them in two tables. Our review found that topical treatments were relatively weak compared with laser and light treatment, with which the appearance of SR and SA can be significantly improved. Lasers combined with other modalities, such as additional energy devices and topical agents, were also proven effective, but more large-scale trials are necessary.
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Affiliation(s)
- Yangyiyi Yu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Haijing Wu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Heng Yin
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, PR China
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Lu H, Guo J, Hong X, Chen A, Zhang X, Shen S. Comparative effectiveness of different therapies for treating striae distensae: A systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22256. [PMID: 32991422 PMCID: PMC7523784 DOI: 10.1097/md.0000000000022256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis. METHODS A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework. RESULTS Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively). CONCLUSION Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.
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Rossi AM, Hibler BP, Navarrete-Dechent C, Lacouture ME. Restorative oncodermatology: Diagnosis and management of dermatologic sequelae from cancer therapies. J Am Acad Dermatol 2020; 85:693-707. [PMID: 32781177 DOI: 10.1016/j.jaad.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
Abstract
The long-term survival of patients with cancer has risen dramatically during the last few decades. Despite this remarkable success, the same treatments that have enabled cure or remission often secondarily affect the skin, hair, and nails. Conditions including scarring, striae distensae, persistent alopecia, pigmentary changes, nail alterations, chronic radiation dermatitis, and radiation fibrosis have been associated with anxiety, depression, decreased quality of life, and impaired function. These dermatologic changes are cosmetically disfiguring, may limit activities, and are a visual reminder of past illness. Interventions toward improving these untoward sequelae and restoring the appearance and function of skin and appendages are critical for normalization and may contribute to improved quality of life in cancer survivors. Here, we outline dermatologic sequelae of cancer therapies with a review of medical and procedural treatment strategies to restore dermatologic health in the survivorship population.
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Affiliation(s)
- Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Brian P Hibler
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario E Lacouture
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
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Abdallah M, Fahmy H, Abdel Hameed S, Mostafa AE. Ablative fractional CO 2 laser vs lyophilized growth factor intralesional injection vs combination of both modalities for striae distensae treatment. J Cosmet Dermatol 2020; 20:472-480. [PMID: 32640118 DOI: 10.1111/jocd.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/26/2020] [Accepted: 06/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Different studies had evaluated the efficacy of fractional CO2 laser and platelet-rich plasma (PRP) in treating striae distensae (SD). Lyophilized growth factors (LGF) represent another form of delivering growth factors similar to PRP with a more standardized method. To the best of our knowledge, no previous trials have been reported using LGF in SD. AIMS We aimed to compare the efficacy of ablative fractional CO2 laser vs intralesional injection of LGF vs combination of both modalities for SD treatment. METHODS This study included 20 female patients with SD. All patients received three modalities of treatment in separate three areas: area A: received fractional CO2 laser, area B: received combination of fractional CO2 laser and intradermal injection of LGF, and area C: received intradermal injection of LGF. Each area received three sessions with 6-week intervals. The outcome was evaluated clinically and histopathologically before treatment and six weeks after the last session. RESULTS There was a statistically significant clinical and histopathological improvement of SD both in areas A and B after treatment. Area C exhibited nonsignificant clinical and histopathological improvement. Area B showed the best improvement results as compared to areas A and C. CONCLUSION We reported that fractional CO2 laser combined with LGF injection was more effective than fractional CO2 laser alone in SD treatment based on clinical and histopathological assessment. We do not advocate LGF as a monotherapy for SD treatment; instead, LGF can be used as a combined therapy with fractional CO2 laser to improve its outcome.
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Affiliation(s)
- Mahmoud Abdallah
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
| | - Hossam Fahmy
- Clinical Pathology Department, Ain Shams University, Cairo, Egypt
| | - Shawkat Abdel Hameed
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
| | - Azza E Mostafa
- Department of Dermatology, Venereology and Andrology, Ain Shams University, Cairo, Egypt
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Afify AA, Fawzy HM, Ali Al-Rubaiay NH, Abdallah M. Fractional microneedling radiofrequency in striae alba: Do growth factors add value? J Cosmet Dermatol 2020; 19:2583-2590. [PMID: 32323904 DOI: 10.1111/jocd.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various treatment modalities have been applied to treat striae alba (SA) with low satisfaction rate. Fractional microneedling radiofrequency (FMR) provides deep dermal coagulation, thereby inducing collagen synthesis and tissue tightening. The addition of platelet-derived lyophilized growth factors may add to the effect of FMR. OBJECTIVES To evaluate and compare the efficacy and safety of FMR alone or combined with lyophilized growth factors in the treatment of SA. METHODS In this left-right comparative study, 25 patients suffering from SA on the abdomen received four sessions of FMR with lyophilized growth factors on one side and with saline (as placebo) on the other side at 4 weeks interval. Photographic and biopsy documentation of the progress of the SA was carried out before the start of the treatment and 4 weeks after the last session. Calculation of the width of SA before treatment and after 4 sessions was done by Adobe Photoshop CS6. RESULTS There was a significant improvement in SA width after treatment in both the lyophilized growth factors (P = <.0001) and placebo sides (P = <.0001), the lyophilized growth factors being superior (P = .002). Patient satisfaction was more on the lyophilized growth factors (LGF) side (P = .034). Erythema and hyperpigmentation were less on the lyophilized growth factors side. Histopathologically, both showed improvement with no difference between LGF and placebo (epidermal thickness (P = .456), collagen content (P = .297), elastin content (P = .239)). CONCLUSION The combination of FMR and lyophilized growth factors improves SA outcome.
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Affiliation(s)
- Ahmed Abdelfattah Afify
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba M Fawzy
- Histology and Cell Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Marwa Abdallah
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Al-Muriesh M, Huang CZ, Ye Z, Yang J. Dermoscopy and VISIA imager evaluations of non-insulated microneedle radiofrequency versus fractional CO 2 laser treatments of striae distensae. J Eur Acad Dermatol Venereol 2020; 34:1859-1866. [PMID: 32030833 DOI: 10.1111/jdv.16266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUNDS Striae distensae (SD) has a known psychological impact due to the resulting cosmetic disfigurement. Many treatment modalities have been used over the years, but no standard interventions or evaluation methods have been proposed to date. OBJECTIVE We compared the efficacy and safety of non-insulated microneedle radiofrequency (NIMRF) and fractional CO2 laser treatments of SD by objective measurements with dermoscopy and VISIA. METHODS Fourteen females with severe SD were enrolled. These subjects had been treated three sessions of NIMRF and fractional CO2 laser for the right and left abdomen, respectively. Dermoscopy and VISIA imaging data, and photographs were collected at baseline and 2 months after the last treatment session. The global aesthetic improvement scale (GIAS) was scored by patients, and blinded investigators, pain score and satisfaction score were also documented. Any side effects were recorded. RESULTS Ten patients completed the study. The GIAS from investigators and patients showed an overall improvement but without a significant difference (P = 0.18, P = 0.17, respectively). The decreased width measured by dermoscopy was between 5% and 32% (right side) and 6-31% (left side). There was no significant difference between both sides in either the per-protocol or intention to treat analyses (P = 0.149, P = 0.161, respectively). The mean pain score was 5.35 and 2.35 on the right side and left side, respectively, which was significant (P = 0.0016). Post-inflammatory hyperpigmentation (PIH) manifested in six patients on their left sides and four patients on their right sides. In most cases, this had resolved by the 3-month follow-up. CONCLUSION Non-insulated microneedle radiofrequency and fractional CO2 laser are both effective and safe treatment options for SD. PIH is a possible side effect but is more likely with fractional CO2 laser treatment. However, it clears up in most cases. Dermoscopy and VISIA are both convenient, digitalized methods of tracking subtle changes and monitoring the efficacy of SD treatments.
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Affiliation(s)
- M Al-Muriesh
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - C-Z Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Z Ye
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - J Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Comparative study between the efficacy of fractional micro-needle radiofrequency and fractional CO2 laser in the treatment of striae distensae. Lasers Med Sci 2019; 34:1295-1304. [DOI: 10.1007/s10103-019-02792-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
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Casabona G. Microfocused Ultrasound with Visualization for the Treatment of Stretch Marks. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:20-24. [PMID: 30881579 PMCID: PMC6415706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Gabriela Casabona
- Dr. Casabona is Scientific Director at Ocean Clinic in MarbelIa, Spain
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Abstract
Striae distansae (SD) or stretch marks are very common, asymptomatic, skin condition frequently seen among females between 5 to 50 years of ages. It often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late, with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for stretch marks treatment. However, despite several advances, no fully effective treatment has emerged. Unfortunately, there is paucity of the strong evidence in the literature for the effective treatment of striae. A literature search using the terms 'striae distansae (SD or stretch marks' was carried out in the PubMed, Google Scholar and Medline databases. Only articles related to the treatment were considered and analysed for their data. Commonly cited treatments include topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q-switched Nd:YAG, pulse dye and excimer laser. Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture have also been used with variable success. This article reviews all currently accepted modalities and their effectiveness in the treatment of stretch marks.
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Affiliation(s)
- Archana J Lokhande
- Department Of Dermatology, ESIC PGIMSR, Model Hospital, Basaidarapur, New Delhi, India
| | - Venkataram Mysore
- Venkat Charmalaya Centre for Advanced Dermatology and Postgraduate Training, Bangalore, Karnataka, India
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Kravvas G, Veitch D, Al-Niaimi F. The use of energy devices in the treatment of striae: a systematic literature review. J DERMATOL TREAT 2018; 30:294-302. [DOI: 10.1080/09546634.2018.1506078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - David Veitch
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK
| | - Firas Al-Niaimi
- Department of Dermatologic Surgery and Laser Unit, St. John’s Institute of Dermatology, St. Thomas’ Hospital, London, UK
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Ferreira ACR, Guida ACP, Piccini AA, Parisi JR, Sousa LD. Galvano-puncture and dermabrasion for striae distensae: a randomized controlled trial. J COSMET LASER THER 2018; 21:39-43. [PMID: 29547019 DOI: 10.1080/14764172.2018.1444777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the effects of galvano-puncture (GG) and dermabrasion (DG) in reducing striae distensae in the gluteal region of women. METHODS This randomized, controlled, single-blind clinical trial was conducted at the UNIFAL-MG. Participants were 48 female who had striae distensae alba in the gluteal region. They were randomly divided in GG; DG; and Control Group (CG). The length and width of the largest striae were measured (in millimeters) using a caliper. The same striae were assessed before and after treatment. Infrared thermography was performed in the gluteal region to assess local microcirculation. RESULTS Intragroup analysis showed a significant reduction in the dimension of the striae between baseline and treatment session 10 in the GG and DG groups. Between-group analysis revealed a reduction in the width and length of the striae for both the GG and DG groups, but there were no significant differences between the two groups. When compared to the CG and the DG group, the GG group had significant improvements, as shown by thermography. CONCLUSION Both GG and DG are effective in reducing striae length and width. However, only the thermography results showed significant differences between GG and control, and between GG and DG.
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Affiliation(s)
| | - Ana Cláudia Pereira Guida
- a Graduate in Physical Therapy , Federal University of Alfenas - UNIFAL-MG , Alfenas , Minas Gerais , Brazil
| | - Adriana Arruda Piccini
- a Graduate in Physical Therapy , Federal University of Alfenas - UNIFAL-MG , Alfenas , Minas Gerais , Brazil
| | - Júlia Risso Parisi
- b Master , Postgraduate Program in Physiotherapy - UFSCAR, São Carlos , São Paulo , Brazil
| | - Ligia de Sousa
- c Doctor , Post-Graduate Program in Rehabilitation Sciences - UNIFAL-MG , Alfenas , Minas Gerais , Brazil
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Abstract
Striae distensae (SD), otherwise known as "stretchmarks," are a common presenting complaint, particularly in young healthy women. SD are hypothesized to form in a patient when the cross-linked collagen is "overstretched" and rupture of this collagen matrix causes the striae. Thus, many treatments work by increasing collagen synthesis. This review critically appraises the evidence to date for the treatment of SD, including both energy-based devices and topical treatments.
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Affiliation(s)
- Emily Forbat
- a Department of General medicine, Chelsea and Westminster Hospital , London , UK
| | - Firas Al-Niaimi
- b Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre , Guy's and St Thomas' NHS Foundation Trust , London , UK
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Bielfeldt S, Blaak J, Staib P, Simon I, Wohlfart R, Manger C, Wilhelm KP. Observer-blind randomized controlled study of a cosmetic blend of safflower, olive and other plant oils in the improvement of scar and striae appearance. Int J Cosmet Sci 2017; 40:81-86. [DOI: 10.1111/ics.12438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
- S. Bielfeldt
- proDERM; Institute for Applied Dermatological Research GmbH; Kiebitzweg 2 Schenefeld/Hamburg DE 22869 Germany
| | - J. Blaak
- Kneipp GmbH, Research & Development; Winterhäuser Str. 85 Würzburg DE 97084 Germany
| | - P. Staib
- Kneipp GmbH, Research & Development; Winterhäuser Str. 85 Würzburg DE 97084 Germany
| | - I. Simon
- Kneipp GmbH, Research & Development; Winterhäuser Str. 85 Würzburg DE 97084 Germany
| | - R. Wohlfart
- Kneipp GmbH, Research & Development; Winterhäuser Str. 85 Würzburg DE 97084 Germany
| | - C. Manger
- proDERM; Institute for Applied Dermatological Research GmbH; Kiebitzweg 2 Schenefeld/Hamburg DE 22869 Germany
| | - K. P. Wilhelm
- proDERM; Institute for Applied Dermatological Research GmbH; Kiebitzweg 2 Schenefeld/Hamburg DE 22869 Germany
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Shen J, Lu XG, Jin JJ, Wang HW. Combination of a 2940 nm Er:YAG laser with recombinant bovine basic fibroblast growth factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for the treatment of striae alba: A pilot study. J Cosmet Dermatol 2017; 17:176-183. [PMID: 28755402 DOI: 10.1111/jocd.12376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jie Shen
- Department of Dermatology; Huadong Hospital, Fudan University; Shanghai China
| | - Xin-Gang Lu
- Department of Traditional Chinese Medicine; Huadong Hospital, Fudan University; Shanghai China
| | - Jing-Jing Jin
- Department of Pathology; Huadong Hospital, Fudan University; Shanghai China
| | - Hong-Wei Wang
- Department of Dermatology; Huadong Hospital, Fudan University; Shanghai China
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30
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Gokalp H. Long-term results of the treatment of pregnancy-induced striae distensae using a 1550-nm non-ablative fractional laser. J COSMET LASER THER 2017; 19:378-382. [DOI: 10.1080/14764172.2017.1342040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hilal Gokalp
- Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
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Hague A, Bayat A. Therapeutic targets in the management of striae distensae: A systematic review. J Am Acad Dermatol 2017; 77:559-568.e18. [PMID: 28551068 DOI: 10.1016/j.jaad.2017.02.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/14/2017] [Accepted: 02/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Striae distensae are permanent dermal lesions that can cause significant psychosocial distress. A detailed understanding of the numerous treatment modalities available is essential to ensuring optimal patient outcomes. OBJECTIVE Our objective was to evaluate and summarize the different treatment methods for striae distensae by linking their proposed modes of action with the histopathogenesis of the condition to guide patient treatment. METHODS A systematic review of the literature was performed with no limits placed on publication date. Relevant studies were assigned a level of evidence by the authors. RESULTS Ninety-two articles were identified, with 74 being eligible for quality assessment. The majority of treatments aim to increase collagen production. The use of vascular lasers can reduce erythema in striae rubrae by targeting hemoglobin, whereas increasing melanin through methods such as ultraviolet light is a major focus for treatment of striae albae. Despite some topical treatments being widely used, uncertainty regarding their mode of action remains. No treatment has proved to be completely effective. LIMITATIONS Limitations of the study include low-quality evidence, small sample sizes, and varying treatment protocols and outcome measures, along with concerns regarding publication bias. CONCLUSIONS Further randomized, controlled trials are needed before definitive conclusions and recommendations can be made.
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Affiliation(s)
- Adam Hague
- Centre for Dermatological Research, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Centre for Dermatological Research, University of Manchester, Manchester, United Kingdom.
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Striae Distensae: Preventative and Therapeutic Modalities to Improve Aesthetic Appearance. Dermatol Surg 2017; 43:635-648. [DOI: 10.1097/dss.0000000000001079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Stretch marks are one of the most common benign cutaneous lesions and encountered esthetic problems. Striae rubrae and striae albae can be differentiated on the basis of clinical appearance. Histologically, disturbances of the dermal fiber network and local expression of receptors for sexual steroids have been detected. The epidermal changes are secondary. Prevention of stretch marks using topical ointments and oils is debatable. Treatment of striae rubrae by lasers and light devices improves appearance. Microneedling and non-ablative and fractionated lasers have been used. This review provides an overview on current treatment options with a special focus on laser treatments.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
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