New Progress in Therapeutic Modalities of Striae Distensae

Figures & data

Table 1 Clinical Trials of Single Treatment Modalities

Study Method	Treatment Protocol	Striae Type	Sample Size (Fitzpatrick Skin Type)	Results Measurement	Results
FrCO2 laser vs blank control	10600 nm 80, 90, 100 and 110 mJ/MTZ 4 sessions 30 days intervals	SG	13 (NM)	The width of largest striae Skin biopsy (stains: NM) Patient satisfaction assessment Epidermis thickness	Treated region 1. Reduction in the striae width 2. Increase in the amount of collagen fibers, no significant changes in the number of mature intermediate and recent elastic fibers 3. 92% patients considered results “good” or “very good” 4. Increase in the thickness of the epidermis
Er:YAG laser	2940 nm 2.3 J/cm2 3 Hz 0.3 milliseconds 6 sessions 50 um 30 days intervals	SD	20 (I–IV)	Skin elasticity and dermis thickness Patient satisfaction scale: very good; moderate; slight Patient and observer scar assessment scale (POSAS) scores	1. Significantly improved skin elasticity and increased average the dermal thickness 2. 70% participants reported good improvements in SD scarring; 15% very good; 10% moderate; 5% slight 3. Significantly decreased POSAS Score, reflecting improved skin quality
Erbium: glass laser	1540 nm 2–3 passes 35–55 mJ/mb (10-mm) or 12–14 mJ/mb (15-mm) 4–6 weeks intervals	SA & SR	51 (II–IV)	Clinical improvements: 5 = 100%; 4 = 76–99%; 3 = 51–75%; 2 = 26–50%; 1 = 1–25%; 0 = 0% Histologic analysis (stains: collagen fiber analysis with hematoxylin and eosin staining, elastic fiber analysis with Orcein-Giemsa staining)	1. Nonblinded clinical assessment: 50% improvement or more 2. Blinded evaluators assessment: 51–75% improvement 3. Thickening of neocollagenesis, dermis and epidermis, increased of elastin deposition
Picosecond laser	1064 nm 0.6 J/cm2 750 ps pulse width 10 Hz 8 mm 4 sessions 4 weeks intervals	SA	20 (IV–V)	Skin texture Average melanin index (MI) and melanin variation score Clinical improvement (no improvement, less than 25%= minimal, 25–50% = moderate, 51–75% = marked, more than 75% = excellent improvement) Patient’s satisfaction	Significantly improvement of skin texture Average MI increased significantly and the melanin variation score decreased 90% subjects: moderate to marked improvement in striae distensae appearance 85% patients: 25–50% improvement; 5% patients: over 75% improvement
PDL	585 nm 3 J/cm2 0.45 ms PD 10 mm spot 1 passe 2 sessions 42 days intervals	SA & SR	20 (II–VI)	Visual analog scale 0 to 5: 0 = normal, 1 = light pink, 2 = pink, 3 = light brown, 4 = brown, and 5 = white hydroxyproline assay (collagen changes)	Striae rubra: Moderately beneficial for reducing erythema; striae alba: no apparent clinical improvement Total collagen per gram of dry weight increased (one striae alba and one striae rubra)
IPL	650 nm vs 590 nm 13.0–15.5 J/cm2 6 ms PD Two pulses, 20 ms delay 10 × 50 mm 5 sessions 2 weeks intervals	SR	20 (III–IV)	Sum of striae length and width Degree of erythema: 7–10 severe; 4–7 moderate; 1–4 mild; 0–1 white Patient’s satisfaction: weak, partial, very good	1. The length and width of both sides significantly reduced 2. 590-nm wavelength erythema significantly reduced with high patient’s satisfaction scores
Nd:YAG laser	1064 nm 75 vs100 J/cm2 5 mm spot size 15 ms pulse duration 1 Hz 2 sessions 3 weeks intervals	SD	45 (III–IV)	Global Aesthetic improvement scale (GAIS): 1 = very much improved to 5 = no change Patient satisfaction score: 1= very satisfied to 5 = very unsatisfied Histological analysis: (stains: hematoxylin and eosin, orecin and Masson’s trichrome)	Both doctors and patients are satisfied with clinical improvement. Striae alba: significant improvement with 100 J/cm2; striae rubra: improved more with 75 J/cm2. Both collagen and elastin fibres increased
RF	1.bipolar RF potentiated with IR light: five passes 100 J/cm2 20–30% overlap 2.fractional bipolar RF: two passes 50% overlap 50–65 mJ/ pin 3 sessions of two types	SD	22 (II–V)	Width and depth of the striae distensae Scale of global assessments: −1 = worsening of lesion; 0 = no change; 1 = slight improvement; 2 = moderate improvement; 3 = marked improvement; 4 = complete clearance Histological analysis (stains: hematoxylin, eosin, safran, orcein and Verhoeff) Reflectance Confocal Microscopy Pain: 0 = no pain to 4 =maximum pain	1. Striae distensae depth decreased by 21.64% in the combination group and increase by 1.73% in control group 2. No significant differences in striae distensae width 3. Global assessment showing greater progress in combination therapy compared to control areas 4. Dermal papilla becoming more roundish and collagen fibers more reticulated pattern in combination treated and fractional bipolar RF-treated areas 5. Thicker collagen fibers in all treated areas 6. The median pain score = 3 in combination treated and fractional bipolar RF-treated areas
Micro-needling	1.5–3 mm needle depths 4–10 passes 30 days intervals	SD	25 (I–V)	Clinical improvement of a 5-point scale (4 = 76–100% improvement, 3 = 51–75% improvement, 2 = 26–50% improvement, 1 = 1–25% improvement, 0 = no change) Global assessment score (GAS)	Clinical improvement of at least 50% for all striae and more than 75% for 28% of patients No significant differences in clinical responses to different skin phototypes of patients Striae in thicker skin regions showed comparable clinical Different Different skin thickness for the same treatment regimen with same cinical improvement
PRP vs Tretinoin	1.PRP: every month for 3 sessions 2.Tretinoin (0.05%): every night for 3 months	SD	30 (NM)	Clinical improvement (digital photographs pre and after treatment) Patient’s satisfaction Histological analysis (stains: collagen with hematoxylin, eosin, Masson Trichrome and elastic fibers with Van Gieson stain)	Significantly improvement in both sides and PRP-treated side had 86.6% of patient improvement, tretinoin-treated side had 60% Patient’s satisfaction: more improvement in the PRP-treated side Collagen and elastic fibers increased in both sides
Dermabrasion vs Tretinoin	1.Superficial dermabrasion: 16 weekly sessions 2.Tretinoin (0.05%): daily for 16 weeks	SR	32 (I–IV)	Length and width of the striae distensae Histological analysis (NM) Patient’s satisfaction: very unsatisfied, unsatisfied, neither satisfied nor unsatisfied, satisfied, very satisfied Global aesthetic improvement scale: very much improved, much improved, improved, no change, worse	1. The length and width of striae distensae decreased significantly in two treated areas but no significant difference between two treatments 2. Dermabrasion group:Improvement of dermal and epidermal layers 3. Satisfaction scores in two treated areas but no significant difference between two treatments 4. Global aesthetic improvement scale (Dermabrasion vs Tretinoin): Very much improved 7.7% vs 33.3%, Much improved 38.5% vs 55.6%, Improved 53.8% vs 11.1%
Carboxytherapy vs FrCO2 laser	1. Carboxytherapy: 50 to 80 mL/min. 45° needle 3–5 cm apart repeated once every 2 weeks 2. FrCO2 laser 10,600 nm 8 W pitch 600 μm 3000 microseconds Micro-diameter 120 µm 6 sessions 4 weeks intervals	SD	40 (III–IV)	Length and width of the striae distensae Clinical improvement (Digital photography of striae): −1 = worse, 0 = no change, 1 = weak (1–24% improvement), 2 = moderate (25–49%), 3 = good (50–74%) 4 = excellent (75–100%) Patients’ satisfaction	Significant improvement in both the width and length in both group and no statistically difference between them No statistical significance difference in clinical improvement between both groups but 2 patients became worse in fractional CO2 group only Patients’ satisfaction between the two groups was comparable

Abbreviations: FrCO₂ laser, fractional ablative CO₂ laser; SG, striae gravidarum; SA, striae albae; SR, striae rubrae; PDL, pulsed dye laser; IPL, intense pulsed light; RF, radiofrequency; PRP, platelet-rich plasma; NM, not mention; PIH, post-inflammatory hyperpigmentation; SD, striae distensae; MTZ, microscopic treatment zone; NM, not mention.

Table 2 Clinical Trials of Combined Treatment Modalities

Study Method	Striae Type	Sample Size (Fitzpatrick Skin Type)	Results Measurement	Results	Adverse Effects	Limitations	References
MRF vs FrCO2 laser	SD	14 (III–IV)	Global aesthetic improvement scale: very much improved (76–100%) = 4, much improved (51–75%) = 3, improved (25–50%) = 2, no change (improvement of <25%) = 1, worse = 0 Width of striae Patients’ satisfaction: 4 = extremely satisfied, 3 = very satisfied, 2 = satisfied, 1 = slightly satisfied, 0 = not satisfied	1. Global aesthetic improvement scale score showing a significant improvement and without a significant difference between the two groups 2. Significantly decreased of width in both groups 3. Patients’ satisfaction: MFR = 3.3, FrCO2 = 2.5	Both groups: PIH, pain mean pain score: MRF = 5.35, FrCO2 = 2.35 (MRF-treated side had a higher score than the FrCO2, which was a significant difference)	1.Small sample size 2. Lack of histologic assessment	[40]
MRF vs FrCO2 laser	SD	19 (III–IV)	Reduce width of the largest striae; blinded physician evaluation; skin texture; patient satisfaction; overall appearance and all of them with the same scale: No improvement = 0, < 25% minimal improvement = 1, 25–50%good improvement =2, 50–75% very good improvement =3, > 75% excellent improvement =4	1. Both techniques effective, but MRF had a slight better efficacy and the difference was not statistically significant 2. MRF and FrCO2 laser equally effective in the treatment of striae rubra and striae alba	PIH was more evident in FrCO2 compared to FMR, and the difference was statistically significant	1. Small sample size and all participants were female 2. Lack of skin biopsy	[41]
MRF vs Er:YAG laser	SA	20 (NM)	Width of the largest striae Epidermal thickness Physician Scar Improvement Scale (PSIS) Self‐Assessed Scar Improvement Scale (SASIS) Clinician Global Aesthetic Improvement Scale (CGAIS) All the scales above using Likert scale: 0 = no improvement, 1 = minimal (1–25% improvement), 2 = good (25–50% improvement), 3 = very good (50–75% improvement), and = for excellent (>75% improvement)	1. In both groups, the width of the largest striae decreased significantly and no significant difference between them 2. The average epidermal thickness increased significantly in all patients Significantly better results in FMR group 3.Scar improvements in both groups did not associate with duration, skin type, or site of the striae distensae	PIH	NM	[43]
Group1 (FrCO2 laser plus PRP) vs Group2 (PDL laser plus PRP)	SD	30 (V–IV)	Clinical assessment (including width of largest striae, improvement of skin texture) using Quartile Grading Scale: No improvement, Mild: < 25% improvement, Moderate: 26–50% improvement, Marked: 51–75% improvement, Excellent: >75% improvement Patient satisfaction: very satisfied, satisfied, slightly satisfied, unsatisfied Histological analysis (stains: hematoxylin, eosin stain and Masson’s trichrome stain)	1. Both treatment groups: significant improvement of skin texture and reduction of width of striae lesions 2. Significantly higher clinical improvements in combined FrCO2 laser with PRP group than the other group so does patient satisfaction 3. Improvement of epidermal thickness and dermal thickness in both treatment groups and more significant improvement of combined PRP with FrCO2 laser group	Mild PIH (100%)	NM	[48]
Group1 (FrCO2 laser plus rhEGF) Vs Group2 (FrCO2 laser plus Aloe vera)	SA	24 (NM)	Melanin variation Average melanin Patient satisfaction Histological analysis (stains: hematoxylin and eosin, Masson trichrome, and Verhoeff–van Gieson)	1. Significant improvement in texture, without statistically significant difference in both groups 2. Participants satisfaction greater marked improvement in group 1 than group 2 3. Both groups improved melanin variation 4. Both groups showed statistically significant increases in epidermal thickness and decreases in elastic fragmentation	PIH (95.8%)	1.Small sample size. 2. The effect of FrCO2 laser treatment alone was not evaluated.	[47]

Abbreviations: MRF, micro-needling radiofrequency; FrCO₂ laser, fractional ablative CO₂ laser; SD, striae distensae; SA, striae albae; rh EGF, recombinant human epidermal growth factor; NM, not mention; PIH, post-inflammatory hyperpigmentation; PRP, platelet-rich plasma; PDL, pulsed dye laser.

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