STRIAE DISTENSAE

Striae distensae are linear atrophic scars and they are more common among adolescent and adult women.

They are caused by inheritance (not good skin elasticity) after pregnancy, use of cortisone, in Cushing syndrome or due to sudden height increase or weight gain. Stretching of the predisposed skin leads to skin “cleavage”, resulting in the development of lesions showing similar characteristics with those of atrophic scars.

They are usually symmetric and they tend to occur on the thighs, buttocks, abdomen and breasts. They first appear as pink marks and gradually they become whiter. The target of treatment is to significantly improve their appearance so that they are not visible.

 

Treatment of Striae Distensae Using Fractional Radiofrequencies with Needling Therapy

Background: Striae distensae are dermal scars characterised by flattening and atrophy of the epidermis. Although many treatment modalities have been attempted with variable results, there is no criterion standard treatment modality for striae distensae.

Patients should receive three treatment sessions at 4-week intervals. Clinical response to treatment is assessed through the comparison of clinical photographs, and patient satisfaction scores before and after treatment.

Striae distensae are dermal atrophic scars with overlying epidermal flattening and atrophy.

Although striae distensae are common, satisfactory therapeutic interventions have been disappointing. Fractional RF microneedling system is an effective way to treat scars and wrinkles. Treatment with the Fractional RF microneedling system was developed for transdermal drug delivery, skin needling also improves scar condition. Treatment with fractional RF microneedling might be able to promote the removal of old damaged collagen and induce more collagen growth beneath the epidermis. Puncturing the skin multiple times in acne scars increases the amount of collagen and elastin deposition. As far as acne scars are concerned, skin puncturing many times increases the quantity of collagen and elastin deposition. Thus, it has been hypothesised that fractional RF microneedling may be also useful in striae distensae because these seem to be dermal scars with epidermal atrophy.

In one study photographs using identical camera settings, lighting, and positioning were taken before and after each visit and 3 months after the last treatment. Two independent dermatologists evaluated and compared the photographs using a quartile grading system (0 = no change [0%], 1 = minimal improvement [<25%], 2 = moderate improvement [26–50%], 3 = marked improvement [51–75%], 4 = excellent improvement [76–100%]).

Marked to excellent improvement was noted in all patients in terms of skin texture, tightening and colour three months following the last treatment.

Striae distensae, also known as stretch marks, are a common skin problem. Striae distensae are dermal scars with epidermal atrophy. Histologic findings show thinner thickness and fewer collagen components in the upper dermis. The collagen bundles are thinned and lie parallel to the epidermis, and dermal elastin can be fragmented and markedly decreased.

Striae distensae have no medical consequences, but they are frequently distressing to those affected. A variety of treatment modalities have been used for the treatment of striae distensae, but there is no simple and definitive treatment. Topical treatments such as tretinoin cream, a combination of tretinoin and glycolic acid or ascorbic acid and glycolic acid9 have some effect in the early stages. Recently, several light and laser modalities such as intense pulsed light, pulsed dye laser, copper bromide laser, fractional laser, radiofrequency device, and excimer laser have been demonstrated to achieve some effect in treating striae distensae.

Treatment with fractional RF microneedling uses microneedles that penetrate to a maximum of 1.5 mm, and it causes virtually no bruising and minimal swelling. It produces hundreds of tiny dermal injuries that produce dermal collagen and elastin. A needle therapy system has been introduced to treat wrinkles and depressed scars. When a needle penetrates the skin, the injury causes localized damage and minor bleeding by rupturing fine blood vessels. A day after needling therapy, keratinocytes begin to proliferate and release growth factors to promote collagen deposition by the fibroblasts. Needling therapy modulates the expression of several genes in the skin (vascular endothelial growth factor, fibroblast growth factor, epidermal growth factor, collagen type I and III) that promote extracellular matrix remodeling.6,16,17 Needling therapy can be safely performed on all skin colours and types without the risk of dyspigmentation, which is the major safety feature distinguishing it from other invasive procedures used to treat wrinkles and depressed scars, such as laser resurfacing, deep chemical peels, and dermabrasion. A recent study found a marked increase in collagen and elastin deposition 6 months after needling therapy, and 40% thickening of the stratum spinosum and normal rete ridges was noted 1 year after treatment. Another study showed that a microneedle therapy system induced larger increases in collagen deposition than intense pulsed light, although both treatments were effective.

In another study with the participation of 16 patients aged 19 to 44 who were treated in three sessions the results were promising. More specifically, the assessment of the results revealed better skin texture, tightness, and colour. The treatment was well tolerated, and no serious side effects were observed. Therefore, fractional RF microneedling therapies are easily accessible to patients, because of their simplicity, low cost, and ease of use.

Treatment Of Striae Distensae

Erythematous Striae Distensae

  1. Special preparation is needed if skin shows hyperpigmentation.
  2. LASER Long pulse PULSED-DYE and Long pulse Nd:YAG (4 SESSIONS in the majority of cases) to achieve discolouration and stabilisation and/or reduction of the skin lesion.

With this treatment method, apart from the correction of skin colour, fiberblasts are also activated, resulting in the production of more elastin and collagen, that makes the lesions appear thinner.

White Striae Distensae

  1. MICRODERMABRASION treatment sessions (6 – 12). As the treatment progresses higher intensities can be used. Treatment is conducted with the use of topical anaesthesia.
  2. Depending on severity 1-3 sessions with the FRACTIONAL CO2 LASER are conducted

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