Therapeutic Update on the Treatment of Striae Distensae

January 2015 | Volume 14 | Issue 1 | Features | 11 | Copyright © January 2015


Deborah S. Sarnoff MD FAAD FACP

Intense pulsed light (IPL), characterized by a noncoherent filtered flashlamp with a broadband spectrum (515-1200nm) has been shown to replace dermal elastosis with neocollagen, thus improving the appearance of mature SD after a series of treatments.
The long-pulse 1064 Nd:YAG, used for non-ablative treatment of facial wrinkles, has been shown to increase dermal collagen. It also has a strong affinity to vascular targets, making it a useful modality in the treatment of SR. In a published study using the long-pulse 1064 Nd:YAG on immature SD in 20 patients, investigators and patients identified the results as satisfactory.15 The 1064 Nd:YAG laser can be safely used, even in patients with dark skin types.
Non-ablative fractional photothermolysis using the 1550nm laser useful in treating hypopigmented scars, has also proved beneficial in the treatment of mature SD. In a 2007 Brazilian study, the Fraxel improved texture and appearance of mature SD in Fitzpatrick skin types I-IV.16
Ablative fractional lasers, such as the fractional CO2, were found to give unpredictable results in one study, where some patients demonstrated significant improvement, while others showed little change from baseline.17 Other investigators have found benefit in using fractional CO2 laser resurfacing for treatment of SA.18,19 Fractional CO2 lasers combined with fractional microneedle radiofrequency has been shown to be safe and effective in the treatment of SD.20
The 308-nm xenon-chloride excimer laser (XeCl) used in psoriasis, vitiligo and post-inflammatory hypopigmentation, has been used to repigment SA. Published studies have documented temporary repigmentation and improvement of leukoderma. Post-treatment biopsies showed increased melanin pigment, hypertrophy and increased number of melanocytes, however failed to demonstrate any improvement in skin atrophy.21,22

Conclusion

SD are a common cosmetic concern that affect a majority of the population. At this time, treatment to diminish the erythema of SR seems to be more effective than treatment to ameliorate mature SA. More research, clinical trials, and combination therapy should be encouraged to develop safe and effective treatment protocols.

References

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  16. Macedo OR, Macedo O, Bussade M, et al. Fractional photothermolysis for the treatment of striae distensae. JAAD 2007;56:204.
  17. Alexiades-Armenaka M, Sarnoff D, Gotkin R, Sadick N. Multi-center clinical study and review of fractional ablative CO2 laser resurfacing for the treatment of rhytides, photoaging, scars and striae. J Drugs Dermatol. Apr 2011;10(4):352-62
  18. Naein FF, Soghrati M. Fractional CO2 laser as an effective modality in treatment of striae alba in skin types III and IV. J Res Med Sci. Oct 2012;17(10):928-33
  19. Lee SE, Kim JH, Lee SJ, Lee JE, Kang JM, Kim YK. Treatment of striae distensae using an ablative 10,600-nm carbon dioxide fractional laser: a retrospective review of 27 participants. Dermatol Surg. Nov 2010;36(11):1683-90.
  20. Ryu HW, Kim SA, Jung HR, Ryoo YW, Lee KS, Cho JW. Clinical improvement of striae distensae in Korean patients using a combination of fractionated microneedle radiofrequency and fractional carbon dioxide laser. Dermatol Surg. Oct 2013;39(10):1452-8.
  21. Goldberg DJ, Marmur ES, Hussain M. 308 nm excimer laser treatment of mature hypopigmented striae. Dermatol Surg 2003;29:596–9.
  22. Goldberg DJ, Marmur ES, Schmults C, et al. Histologic and ultrastructural analysis of ultraviolet B laser and light source treatment of leukoderma in striae distensae. Dermatol Surg 2005;31:385–7.

AUTHOR CORRESPONDENCE

Deborah S. Sarnoff MD FAAD FACPdssarnoff@aol.com
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