Fractional CO2 Laser Versus Intense Pulsed Light in Treating Striae Distensae

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Abstract

Context:

Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried.

Aims:

To evaluate and compare the efficacy of fractional CO ₂ laser with intense pulse light in treating striae distensae.

Subjects and Methods:

Forty patients with striae distensae were recruited. Twenty of them were treated by fractional CO ₂ laser and 20 were treated with intense pulse light. Length and width of the largest striae were measured pre- and post-treatment. Patient satisfaction was also evaluated and graded. Patients were photographed after each treatment session and photos were examined by a blinded physician who had no knowledge about the cases.

Results:

Both groups showed significant improvement after treatments ( P < 0.05). Patients treated with fractional CO ₂ laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light ( P < 0.05) in all parameters except in the length of striae ( P > 0.05).

Conclusions:

The current study has provided supportive evidence to the effectiveness of both fractional CO ₂ laser and intense pulse light as treatments for striae distensae. Fractional CO ₂ laser was found to be more effective in the treatment of striae distensae compared with intense pulse light.

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Most cited references 34

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Striae gravidarum in primiparae.

Christopher Griffiths, L K Manku, S Atwal … (2006)

Striae distensae are widely known to occur in pregnancy and aesthetically they can be a cause of great concern for many women. Various factors have been reported to be associated with the development of striae but the results are conflicting. To observe the prevalence of striae gravidarum in primiparae and identify independent associated risk factors. An observational analysis of 324 primiparae was conducted within 48 h of delivery. Data was collected in the form of a questionnaire and physical examination. Seventy-two primiparae participated in a pilot study in 1999 and the remaining were assessed over a 4-month period in 2000. Seventeen variables were recorded, and striae graded according to quantity and severity. Fifteen primiparae were excluded prior to analysis. Fifty-two per cent (161 of 309) of primiparous white women had striae of which 12% (20 of 161) were classified as severe. The most significant risk factor was low maternal age (P < 0.0001). Twenty per cent (14 of 71) of teenagers had severe striae, a finding not seen in women over 30 years of age. Other significant risk factors included maternal body mass index greater than 26 (P = 0.0003), maternal weight gain of more than 15 kg (P = 0.0121) and high neonatal birth weight (P = 0.0135). Logistic regression analysis demonstrated that maternal age, body mass index, weight gain and neonatal birth weight were independently associated with the occurrence of striae. It appears that the group at highest risk of developing severe striae are teenagers. This finding is important and may provide impetus to explore the pathomechanisms of striae.

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Fibrillin microfibrils are reduced in skin exhibiting striae distensae.

D Polson, Andrew Watson, Howell E Parry … (1998)

Striae distensae (striae: stretch marks) are a common disfiguring condition associated with continuous and progressive stretching of the skin--as occurs during pregnancy. The pathogenesis of striae is unknown but probably relates to changes in those structures that provide skin with its tensile strength and elasticity. Such structures are components of the extracellular matrix, including fibrillin, elastin and collagens. Using a variety of histological techniques, we assessed the distribution of these extracellular matrix components in skin affected by striae. Pregnant women were assessed for the presence of striae, and punch biopsies were obtained from lesional striae and adjacent normal skin. Biopsies were processed for electron microscopy, light microscopy and immunohistochemistry. For histological examination, 7 microns frozen sections were stained so as to identify the elastic fibre network and glycosaminoglycans. Biopsies were also examined with a panel of polyclonal antibodies against collagens I and III, and fibrillin and elastin. Ultrastructural analysis revealed alterations in the appearance of skin affected by striae compared with that of normal skin in that the dermal matrix of striae was looser and more floccular. Light microscopy revealed an increase in glycosaminoglycan content in striae. Furthermore, the number of vertical fibrillin fibres subjacent to the dermal-epidermal junction (DEJ) and elastin fibres in the papillary dermis was significantly reduced in striae compared with normal skin. The orientation of elastin and fibrillin fibres in the deep dermis showed realignment in that the fibres ran parallel to the DEJ. However, no significant alterations were observed in any other extracellular matrix components. This study identifies a reorganization and diminution of the elastic fibre network of skin affected by striae. Continuous strain on the dermal extracellular matrix, as occurs during pregnancy, may remodel the elastic fibre network in susceptible individuals and manifest clinically as striae distensae.

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Fractional nonablative 1540-nm laser treatment of striae distensae in Fitzpatrick skin types II to IV: clinical and histological results.

Larissa Kolesnikova, GIUSEPPINA LIGUORI, Franco Renato … (2011)

Current striae treatments are limited in their ability to deliver long-lasting improvements for all skin types. The success of fractional nonablative lasers for surgical scars has been attributed to the controlled wound-healing response stimulated by microscopic columns of epidermal and dermal thermal damage. The authors describe the safety and efficacy results of treatment with a fractional nonablative 1540-nm erbium:glass laser in patients with Fitzpatrick skin types II to IV for both striae rubra and striae alba. A 51-person clinical study was conducted on striae ranging in duration from one to 40 years. Nine different anatomical locations were treated, including the breasts, hips, and abdomen. Treatment parameters included two to three passes with the 1540-nm laser, with energy settings from 35 to 55 mJ/mb with the 10-mm optical tip or 12 to 14 mJ/mb with the 15-mm optical tip. Two to four total treatments were performed at four- to six-week intervals. Nonblinded efficacy evaluations were performed on all 51 patients; blinded evaluations were conducted by three independent clinicians on 14 randomized sets of pre- and posttreatment images on a 0% to 100% quartile improvement scale. Skin reactions were assessed by the treating physician and recorded at multiple time points, and histology was conducted with hemotoxylin and eosin as well as Orcein-Giemsa staining. Nonblinded clinical assessments rated overall improvement as 50% or greater for all patients at six months or longer after the last treatment. Blinded evaluators reported an overall mean improvement score of 51% to 75% on properly selected images taken at least three months after treatment (n = 11). In all patients examined at either 18 or 24 months after treatment, there was no recurrence of striae. Typical side effects included transient erythema and edema. A small minority of patients experienced transient cases of trace postinflammatory hyperpigmentation (PIH), which all resolved. Histologic observations showed thickening of the epidermis and dermis, neocollagenesis, and increased elastin deposition one month after the last treatment. Positive safety and efficacy results with the fractional nonablative 1540-nm erbium:glass laser for the treatment of striae rubra and striae alba ranging in maturation age from one to 40 years was demonstrated in Fitzpatrick skin types II to IV.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Dermatol

Journal ID (iso-abbrev): Indian J Dermatol

Journal ID (publisher-id): IJD

Title: Indian Journal of Dermatology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0019-5154

ISSN (Electronic): 1998-3611

Publication date (Print): Mar-Apr 2016

Volume: 61

Issue: 2

Pages: 174-180

Affiliations

[1] From the Department of Dermatology, Venereology and Andrology, Qina Faculty of Medicine, South Valley University, Qena, Egypt

[1 ] Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Asyut, Egypt

Author notes

Address for correspondence: Dr. Moustafa Adam El Taieb, Department of Dermatology, Venereology and Andrology, Qina Faculty of Medicine, South Valley University, Qena, Egypt. E-mail: musmus22@ 123456yahoo.co.uk

Article

Publisher ID: IJD-61-174

DOI: 10.4103/0019-5154.177774

PMC ID: 4817442

PubMed ID: 27057017

SO-VID: 14818790-4096-4862-a08e-02e6d593f7ec

License:

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