Clinical efficacy of stromal vascular fraction gel in the treatment of mature striae distensae.

BACKGROUND: Striae Distensae (SD) is a common dermatological lesion. The mechanism of formation is unclear, the prevailing theory is mechanical pulling of the skin and hormonal changes. Traditional SD treatment methods include topical drugs, photoelectric therapy, stripping and others, but each has limitations. Stromal vascular fraction gel (SVF-gel) is a filler physically prepared from granular fat, enriched with adipose-derived stem cells (ADSCs) and extracellular matrix (ECM). A good effect in the treatment of neck lines, wounds, acne, and other aspects. SD formation and treatment goals are comparable to those of neck lines. In this study, SVF-gel filling will be used to treat mature SD, and its effectiveness and safety will be discussed in detail. METHODS: From December 2019 to June 2022, recruit patients who want to treat SD caused by obesity or pregnancy among those who have "autologous fat aspiration" to change their body shape. Preoperatively, the area to be treated for SD was marked, autologous fat aspiration was performed, and the aspirated fat was prepared as SVF-gel and filled into the preoperatively marked SD. All patients had preoperative and postoperative follow-up with planar photographs and VISIA skin analyzer photographs to assess surgical results and safety from subjective and objective perspectives. RESULTS: A total of 36 patients were enrolled, with 31 of them successfully followed up on. The mean Global Aesthetic Improvement Scale (GAIS) score six months after surgery was 1.87 ± 0.03. At six months postoperatively, the overall patient satisfaction rate was 90%. The depth, area, and color of SD improved six months after surgery, and no serious complications occurred in any of the patients. CONCLUSIONS: SVF-gel is a safe and effective method of improving mature SD and can be used as a clinical treatment option.

Evaluating the efficacy of microneedling technique in treating striae alba lesions.

Striae alba, as an unsettling skin complication, has the potential to threaten the physical appearance and psychological health of individuals. So far, dermatologists' endeavors have been futile in finding an ideal treatment. This study evaluated microneedling as a novel treatment modality for striae alba scars. Microneedling was implemented in 1-3 sessions in 2-week intervals among patients with striae alba lesions. The lesions were photographed before and 3 months after the treatment, while all side effects were recorded. Two non-involved dermatologists and a patient self-report based on a visual analog score scale were utilized to evaluate the clinical improvement of striae scars. The complication rate among the 32 patients was 25%, which consisted of seven (21.9%) cases of post-inflammatory hyperpigmentation and one case (3.1%) of skin infection. The average improvement score among the patients in our study based on their self-report was 5.3 ± 1.3. (Range 4-8), while based on physician evaluation was 5.6 ± 1.2 (range 3.5-8). There was a significant association between lower age and higher self-report scores. Also, the improvement of lesions was more significant in skin type 3 compared to 2, based on physician assessment. In this study, MN was effective in ameliorating SA scars and was observed to induce better clinical satisfaction in younger patients and breast lesions. The studies concerning the use of MN in treating SA have yielded much attention lately, and they have denoted the relatively low cost of MN, its capability to be utilized over vast treatment areas, and its safety in that regard. Further research regarding the comparison of MN's efficacy in solo use versus implementing it as an adjuvant modality should be carried out.

Clinical evaluation of the efficacy of fractional radiofrequency for the treatment and reduction of stretch marks: A prospective study.

BACKGROUND/OBJECTIVES: Skin resurfacing with fractional radiofrequency results in reepithelization, collagen shrinkage, fibroblast stimulation, and neocollagenesis which may be beneficial for the improvement of various skin lesions. This clinical study was conducted to evaluate the safety and efficacy of fractional radiofrequency device (FRF) for the treatment of striae. METHODS: Seventeen subjects, totaling 67 treatment zones were evaluated. Subjects had 4 FRF treatment sessions to the striae areas, at 4-weeks interval. 3D-standardized photographs of the treatment area with a 3D camera were used to evaluate striae volumetric improvement from baseline to follow up (FU) visits at 12 and 16 weeks post-final treatment. A satisfaction questionnaire was completed by subjects at each of the follow-up visits. Additionally, the mean scores of the live investigator assessments of Global Aesthetic Improvement Scale (GAIS), Subject Satisfaction Scale, Pain Visual Analog Scale and Tolerability Score were calculated. RESULTS: A total of 15 subjects completed the study (Fitzpatrick skin type I-III, average age 36.2 years) received 4 FRF treatments on multiple different body zones with multiple passes over stretch marks on the abdomen, inner arms, lower buttocks, inner thighs, and/or flanks. Analysis of 3D photographs of the striae affected zones at 16-week FU revealed an average reduction in the striae volume of 19.1%, a reduction of redness of 14.3%, a reduction of pigmentation of 11.2%, and a reduction of striae color of 8.82%. The GAIS improved by 1.7-points when compared to baseline. Treatments were well tolerated with subjects reporting a mean score of 3.8 out of 10 for pain and 3.1 out of 4 for tolerability (indicating the treatment was "tolerable"), with no occurrences of serious adverse events. The average subject satisfaction at 16-week follow-up was 3.1, out of a total of 4, which signified subjects were "satisfied" with their treatment. CONCLUSION: 3D Image analysis of the treated zones presented overall reductions in the color and texture of striae after four treatments with FRF. A combination of ablation and coagulation introduced by FRF treatment resulted in improvement to the appearance of the treated striae.

The efficacy and safety of the innovative cold atmospheric-pressure plasma technology in the treatment of striae distensae: A randomized controlled trial.

BACKGROUND: Available current therapeutics modalities for striae distensae (SD) provide inconsistently effective outcomes. There is ongoing research on innovative treatment modalities to find better treatment solutions. OBJECTIVES: To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of striae distensae. METHODS: This study includes twenty-three patients with striae distensae. The body was divided into two halves. One side was randomly treated with CAP biweekly on the same treated side for five sessions with 30 days follow-up after the last session. Another half was left untreated. Efficacy assessment was done using patient and observer scar assessment scale (POSAS), patient satisfaction scales, and Antera 3D® skin imaging system. Safety assessment was evaluated using the visual analog scale (VAS) and adverse effects monitoring. RESULTS: Patient and observer scar assessment scale, patient and observer overall opinion score, and patient and observer total score in a summary of all rated characteristics, comparing treated and untreated areas, showed a statistically significant reduction in all parameters after one treatment (*p-value <0.05). Patients rated satisfaction as a great improvement in 52.3%, moderate improvement in 39.1%, extreme improvement in 4.3%, and slight improvement in 4.3%. Adverse effects included small scabs, shallow wounds, and rash. CONCLUSION: Cold atmospheric plasma is a safe and effective, innovative treatment modality for striae distensae with minimal side effects.

Stretch Mark Treatment by Tattooing and Microneedling.

Stretch marks (striae distensae) are common dermal scarring associated with weight gain, overweight, and pregnancy. Scarring is caused by overstretching of the skin's dermis with permanent structural alteration of the collagen network fibers. Some individuals have naturally weak connective tissue and may develop major stretch marks without being overweight. Stretch marks can develop during puberty and after physical exercise with rapid muscle growth. Cortisone treatment and anabolic steroids often cause stretch marks. Stretch marks are of major cosmetic concern to many. They are red and swollen in the early sate and white and irregular in texture in the later stage. Many men and women suffer from poor self-esteem caused by stretch marks. Medical tattooing of stretch marks, also known as microneedling, can correct the skin pigmentation color in the normal direction, but not the actual textural change. However, abnormal texture may be modified by microneedling, by nonablative laser treatment, or by microdermabrasion. Treatments can also be combined, e.g., initial use of a method to flatten the skin, followed by tattooing to correct the color. Treatment options and strategies are reviewed.

Evaluation of anisotropic properties of striae distensae with regard to skin surface texture and viscoelasticity.

BACKGROUND: Striae distensae (SD) are skin lesions of parallel streaks, which mostly occur during rapid tissue expansion. Considering the etiological mechanism of SD, including dermal network ruptures and alignment to mechanical stretch, structural directionality or anisotropy could be expected. Non-invasive objective methods for measuring the anisotropy of SD have not been suggested yet. Therefore, we evaluated the anisotropic properties of SD with regard to skin surface texture and viscoelasticity, to verify them as new objective evaluation parameters of SD. METHODS: Thirty-two healthy subjects with SD on their body participated. Anisotropy of skin surface texture and biomechanical properties of SD-involved skin and adjacent normal skin was assessed and compared. RESULTS: Analysis of skin surface texture, based on the ×60 magnified images, revealed that SD have more disordered patterns compared to the regular honeycomb patterns seen in the normal surrounding skin. SD have bigger sizes of each blob than normal skin. The overall anisotropy of skin texture was significantly higher in SD. Skin biomechanical parameters, measured using Cutiscan® , indicated the less deformable, less recovered, and less viscoelastic properties of SD. When comparing viscoelastic properties over 360°, SD were more anisotropic than the adjacent normal skin as well. CONCLUSION: We observed that SD were significantly more anisotropic than adjacent normal skin with regard to skin surface texture and viscoelasticity. Therefore, anisotropy could be an objective evaluation parameter to represent the distinctive features of SD. It can be applied for evaluation of the SD severity and clinical efficacy of various treatments.

Unraveling the molecular and cellular mechanisms of stretch marks.

BACKGROUND: Striae distensae, commonly known as stretch marks, are cutaneous lesions that accompany the hormonal upheavals of the major stages of life: puberty and pregnancy. Stretch marks occur in 90% of women, and they appear as red or purple lines that slowly fade to pale lines on the skin. There have been few studies regarding stretch mark origins, and new preventive and corrective treatments are needed. AIMS: The aim of this work was to understand the primary genes and proteins involved in the regulation of striae compared to normal skin and to identify the differentially expressed genes and biochemical aspects of SA and SR Importantly, this is the first published study to use a molecular high-throughput approach combined with in vivo evaluation. METHODS: In this study, we analyzed the molecular differences between skin with and without stretch marks (rubra [SR] and alba [SA]) of female volunteers using DNA microarray (Whole Human Genome Microarray Kit, 4×44 K, Agilent Technologies) analyses of cutaneous biopsies (2 mm) and in vivo confocal Raman spectroscopy of selected buttock regions, a technique recently introduced as a noninvasive skin evaluation method. RESULTS: We identified gene expression alterations related to ECM, cellular homeostasis, and hormones such as secretoglobulins. Spectral analyses of collagen, fibrillin, and glycosaminoglycans were conducted by Raman spectroscopy at different skin depths. The main differences observed when comparing skin with and without stretch marks were at depths between 75 and 95 µm, corresponding to the dermal-epidermal junction and dermis regions and showing differences between normal skin and stretched skin regarding collagen, collagen hydration, and elastin fibers. CONCLUSION: The results obtained by RNA and protein analyses are complementary and show that significant changes occur in the skin affected by stretch marks. These results suggest new strategies and opportunities to treat this skin disorder and for the development of new and eficiente cosmetic products.

Prediction of pelvic adhesions at repeat cesarean delivery through assessment of striae gravidarum score: A cross-sectional study.

OBJECTIVE: To investigate the predictive value of the Davey Score for striae gravidarum (SG) on the presence of pelvic adhesions at repeat cesarean delivery (CD). MATERIALS AND METHODS: The current study was a cross-sectional study conducted in a tertiary university hospital between November 2016 and March 2018. All women scheduled for elective CD were included if they had at least previous one CD with pregnancy in term fetus (37-40 weeks gestation. Preoperative evaluation of SG severity using Davey score, which is a validated scoring system, was done on the examination bed. Patients with no/mild striae (score 0-2) were classified as group (I) and women with severe striae (score 3-8) were classified as group (II). During surgery, pelvic adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the difference in the rate of pelvic adhesions between both groups. RESULTS: The study included 300 women; group I included 114 women and group II included 186 women. About 90% of women with severe striae versus 82.5% of women with no/mild striae were found to have adhesions (p = 0.035). Dense adhesions were significantly present in severe striae group (57.4%) versus (41.5%) in no/mild striae group (p = 0.022). The mean Davey score in women in group (II) was significantly higher than group (I) (4.25 ± 3.36 vs. 3.09 ± 2.95, p = 0.03). Nair's score had a significant positive moderate correlation with Davey score (r = 0.541, p = 0.016). According to the results of multivariate regression analysis, Davey score >2 was the only variable associated with increased risk of pelvic adhesions (p = 0.010). CONCLUSION: Assessment of SG score in women with previous CD using Davey score might help to predict pelvic adhesions status before planning a new surgery.

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery.

OBJECTIVES: The aim of the present study has been to examine skin scar characteristics and striae gravidarum, considering the reliability of each for predicting adhesions in repeat Caesarean sections. MATERIAL AND METHODS: A cross-sectional study was done over a period of two years. One hundred pregnant women were invited to participate in the study. Preoperatively, abdominal scar features (according to the scar's appearance) and stria gravidarum were both recorded.Then, at the time of surgery, intraabdominal adhesions were graded according to the modified Nair's classification. RESULTS: Among the skin markers, abdominal scar width (p = 0.001), depressed scar (p = 0.002) and striae colour grading (p = 0.0183) were found to have significant associations with intraabdominal adhesions; yet all were of low validity. CONCLUSIONS: Despite growing interest in the use of skin markers in the prediction of intraabdominal adhesions at the time of repeat CS, the present study demonstrates that these markers may not be reliable.

Striae reconstructed, a full thickness skin model that recapitulates the pathology behind stretch marks.

OBJECTIVE: Stretch marks are disfiguring skin lesions that often cause problems of self-esteem, but little effort has been put to studying this pathology. We therefore analysed cell cultures of dermal fibroblasts isolated from a striae albae, to thereafter reconstruct a full thickness skin model. METHODS: Human Dermal Fibroblasts (HDF) were isolated from a striae distensae (SD) lesion and from the adjacent non-lesioned skin. The dermis of two full thickness skin models was reconstructed with either striae- or normal-HDF, while the epidermis was in both reconstructed with Normal Human Epidermal Keratinocytes. RESULTS: Main observations and pertinent data: Gene expression analysis of cell cultures revealed a generalized decomposition of the Extra Cellular Matrix (ECM), since collagens type I and III, lysyl oxidase (LOX), biglycan, lumican and fibronectin were downregulated, while MMP3 was increased together with a decrease of its natural inhibitors (TIMP1, TIMP2 and PAI-1). These findings were statistically corroborated for key ECM elements at the protein level (COL1, MMP1 and TGFB1). Interestingly, striae albae fibroblasts retained a pro-inflammatory phenotype, as suggested by increased gene expression of CXCL8, HAS1 and TNFA. We next reconstructed a full thickness skin model (Striae Reconstructed) with dermal fibroblasts from striae albae. Gene expression analysis showed that the Striae Reconstructed elicited not only ECM decomposition, but also skin ageing, as indicated by the upregulation of P16, PTGS2 and SOD2. Discussion points: Although the epidermis was constructed with normal human epidermal keratinocytes, the Striae Reconstructed presented epidermal atrophy and a dramatic increase of ß1-integrin at the epidermal-dermal junction providing, for the first time to our knowledge, a rationale showing that the key cell player behind stretch marks are dermal fibroblasts rather than epidermal keratinocytes. CONCLUSION: New knowledge: Taken together, our findings shed new light into the aetiology of stretch marks and indicate that the Striae Reconstructed, a new model for in vitro testing and drug screening, may open new avenues for the treatment of stretch marks.

OBJECTIFS: Les vergetures sont des lésions cutanées défigurantes qui posent souvent des problèmes d'estime de soi, mais peu d'efforts ont été consacrés dans l'étude de cette pathologie. Nous avons donc analysé des cultures cellulaires de fibroblastes dermiques isolés d'un stria alba, afin de reconstruire ensuite un modèle de peau avec une pleine épaisseur. METHODES: Des fibroblastes dermiques humains (FDH) ont été isolés d'une lésion de Stria distensae (SD) et d'une peau adjacente sans lésion. Le derme de deux modèles de peau de pleine épaisseur a été reconstruit avec du HDF striae- ou normal, tandis que l'épiderme était reconstruit avec des kératinocytes humains normaux. RESULTATS: Principales observations et données pertinentes: L'analyse de l'expression génique de cultures cellulaires a révélé une décomposition généralisée de la matrice extra-cellulaire (MEC) car les collagènes de types I et III, la lysyl oxydase, le biglycane, le lumican et la fibronectine étaient régulés négativement, tandis que la MMP3 augmentait ses inhibiteurs naturels diminuaient (TIMP1, TIMP2 et PAI-1). Ces résultats ont été corroborés statistiquement pour les éléments clés de la MEC au niveau de la protéine (COL1, MMP1 et TGFB1). Il est intéressant de noter que les fibroblastes de Striae albae ont conservé un phénotype proinflammatoire, comme le suggère l'augmentation de l'expression des gènes de CXCL8, HAS1 et TNFA. Nous avons ensuite reconstruit un modèle de peau de pleine épaisseur (Stria Reconstructed) avec des fibroblastes dermiques de Striae albae. L'analyse de l'expression génique a montré que la reconstruction de Striae induisait non seulement la décomposition de la MEC, mais également le vieillissement de la peau, comme l'indique la régulation à la hausse de P16, PTGS2 et SOD2. Points de discussion : Bien que l'épiderme ait été construit avec des kératinocytes humains normaux, les stries reconstruites présentaient une atrophie épidermique et une augmentation spectaculaire du taux de ß1-intégrine au niveau de la jonction épidermo-dermique, fournissant pour la première fois une explication rationnelle qui démontre que les cellules principales impliquées dans la pathologie de la Striae sont les fibroblastes et non les kératinocytes. CONCLUSION: Nouvelles connaissances: Ensemble, nos résultats donnent une nouvelle lumière sur l'étiologie des vergetures et indiquent que le Striae Reconstructed, un nouveau modèle de test in vitro et de dépistage du médicament, pourrait être une avancée pour le traitement des vergetures.

Lichen Sclerosus on the Sites of Striae Distensae and a Surgical Scar in a Patient with Coexistent Morphea.

Lichen sclerosus (LS), also known as lichen sclerosus et atrophicus, is a chronic inflammatory mucocutaneous disease affecting the genital and/or extragenital areas. Although LS usually occurs alone, its coexistence in morphea patients has been reported in 5.7% and 38.0% (genital LS) of cases, in two series (1). A 74-year-old woman presented with a 6-month history of multiple asymptomatic, shiny , indurated, brownish large flat plaques located on the abdomen (Figure 1, a-b) and back, intermingled with slightly atrophic, white-colored, guttate, and patchy areas (Figure 1, d-e). Both punch biopsies of the sclerotic plaques on the back and abdomen showed findings consistent with morphea (Figure 1, c, f). Furthermore, the punch biopsy of a well-demarcated white plaque on the back revealed findings compatible with LS (Figure 1, f). Remarkably, there were also multiple white-colored lesions on the sites of pregnancy-induced striae distensae (SD) (Figure 2, a-b) on the lower abdomen and an old appendectomy scar (Figure 2, c). There was no anogenital involvement. A diagnosis of morphea-LS overlap was established and white lesions located on the surgical scar and SD were clinically evaluated as LS. Methotrexate (15 mg/week) achieved a partial regression of morphea plaques in three months. However, white LS lesions remained unchanged. Our patient presented with coexistence of LS and morphea on different sites of the trunk and on the same lesion. Additionally, one of the isolated LS lesions was located on a surgical scar. Occurrence of LS on skin grafts, irradiated areas, injection sites, or burn/surgical scars has been attributed to the Koebner phenomenon, also called isomorphic response, defined as "the formation of the skin lesions in the same morphology of the existing disease on the areas of various cutaneous injuries" (2). LS is classified under the Koebner category-III (occasional lesions) (2). However, in a case of morphea with features of LS that developed in 1 month following a herpes zoster infection has been suggested to represent "Wolf's isotopic response" (3), which was originally defined as "the occurrence of a new skin disease at the site of another, unrelated and already healed skin disorder" with a time interval between the first and second diseases ranging from months to several years (4). Remarkably, typical morphea plaques in our patient did not involve the surgical scar, in contrast to a cohort in which 16% of 329 patients developed initial morphea lesions at sites of prior (surgery) or ongoing/repetitive (chronic friction) skin trauma (5). SD appear on skin as atrophic linear bands mostly due to rapid weight changes, pregnancy, Cushing syndrome, or prolonged use of corticosteroids (6). The mechanism underlying the occurrence of several diseases on striae is still elusive. Blunt trauma occurring during the development of striae has been suggested to cause the Koebner phenomenon in patients with vitiligo, psoriasis, and lichen planus (7), but it has been suggested that the occurrence of leukemia cutis on SD in a patient reflects Wolf's isotopic response (8). Although chronic graft-versus-host disease, urticarial vasculitis, keloid, lupus erythematosus, diffuse normolipemic plane xanthoma, and drug-induced cutaneous eruptions have been reported to occur on striae (6,9), such an association with LS as in our patient has not been previously documented in the literature. Concomitant occurrence of LS patches on different previous lesions such as a surgical scar and SD in our patient raises the possibility of a common underlying mechanism. As mentioned above, the terms "Koebner phenomenon" or "Wolf's isotopic response" have been used to designate the development of some diseases in injured areas. However, Happle and Kluger (10) claimed in a recent statement that "there is no clear-cut criterion to distinguish isotopic response from Koebner phenomenon and all reactions of this kind represent examples of Koebner phenomenon", which seems to be the best way to describe the site-specific occurrence of LS lesions in our patient.

Minimal Scar Formation After Orthopaedic Skin Incisions Along Main Folding Lines.

BACKGROUND: Patients, particularly those who are young, often develop noticeable orthopaedic scars. In order to achieve minimal scarring, surgeons should attempt to place incisions in skinfolds or skin creases. METHODS: Optimal incision lines can be determined from the direction of stretch marks (striae distensae), which develop perpendicular to lines of tension or main folding lines. A composite diagram of photographs of 213 individuals with striae distensae was created and compared with 276 images of incisions and scars derived from the Internet. RESULTS: Classically described Langer cleavage lines often run counter to real tension lines and poorly predict the optimal direction for skin incisions. CONCLUSIONS: Whenever possible, main folding lines should be utilized as a guide in planning surgical incisions for young patients as well as for correction of problem scars.

Efficacy of Microneedling Versus Fractional Non-ablative Laser to Treat Striae Alba: A Randomized Study.

BACKGROUND: Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women. OBJECTIVES: The aim of our study was to compare the efficacy of a neodymium:yttrium-aluminum-perovskite 1340 nm non-ablative fractional laser (NAFL) and the microneedling (MN) technique to treat striae alba (SA). MATERIALS AND METHODS: NAFL and MN were used to treat striae on the longitudinally divided abdominal surface of 20 women classified as Fitzpatrick skin type III or IV (five sessions at monthly intervals). Photographs and skin biopsies were obtained during pretreatment and after the third and fifth treatment sessions for all patients. Patients and two independent evaluators assessed the clinical response using the Global Aesthetic Improvement Scale. RESULTS: Patient-reported evaluation showed improvement of striae using both modalities, with no statistically significant difference between the groups. Collagen and elastic fibers were significantly increased (p < 0.01) after the third and fifth treatment sessions, with no significant difference between the modalities. In addition, Dermatology Life Quality Index scores showed significant improvement (p < 0.001) after the third and fifth treatment sessions compared with pretreatment values, with average values of 8.4 (standard error [SE] ± 1.21), 3.17 (SE ± 0.55), and 2.64 (SE ± 0.60), respectively. The mean pain score using the Visual Analog Scale in the MN group versus the NAFL group was 5.23 (SE ± 0.31) versus 2.39 (SE ± 0.22) [p < 0.001], and the mean duration of adverse events in the NAFL group versus the MN group was 4.03 days (SE ± 0.45) versus 3 days (SE ± 0.37) [p = 0.02]. CONCLUSION: NAFL and MN are safe for treating SD, particularly in individuals classified as phototype III or IV. MN is a useful non-technology-dependent, low-cost alternative therapy for SA. CLINICAL TRIAL REGISTRATION NUMBER: NCT03390439.

Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients.

BACKGROUND AND OBJECTIVE: Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD. STUDY DESIGN/MATERIALS AND METHODS: This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm2 , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 µm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported. RESULTS: Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported. CONCLUSION: Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230-238, 2019. © 2018 Wiley Periodicals, Inc.

Confocal microscopy can assess the efficacy of combined microneedling and skinbooster for striae rubrae.

Striae distensae or stretch marks are dermal scars characterized by flattening and atrophy of the epidermis. They develop particularly during adolescence but they can also appear in other situations such as pregnancy, the use of prolonged therapies with topical or systemic corticosteroids, Cushing's syndrome, Marfan's syndrome, prolonged use of lightening creams, cachexia, rapid weight loss or the use of androgenic and anabolic substances. Treatment options often take a long time, and the results are often disappointing, causing significant psychological distress in patients. We propose a completely innovative approach, combining the skinbooster technique with the microneedling technique. These minivasive methods work by inducing tissue remodeling and stimulating the synthesis of new collagen. Confocal microscopy can show and follow the skin changes made by these therapies, thus becoming an important and valid therapeutic monitoring tool for aesthetic dermatology.

Biophysical properties of striae rubra and striae alba in human skin: Comparison with normal skin.

BACKGROUND: Striae distensae are common dermal lesions that progress through two different stages: the striae rubra, which appears to be erythematous, and striae alba, which is characterized by a hypopigmented feature. The clinical characteristics between striae distensae stages and normal skin remain unknown. OBJECTIVES: We aimed to investigate the clinical characteristics according to stages of striae distensae in terms of their biophysical properties, using objective noninvasive measurements in comparison with adjacent normal skin. METHODS: Sixty-one healthy female subjects with striae distensae were included as follows: 30 with striae rubra and 31 with striae alba on the abdomen and thighs. Hydration of the epidermis and dermis, skin color brightness, and Erythema index were measured. Skin elasticity, roughness, and dermal echo-density of the skin with striae distensae and adjacent normal skin were also measured. RESULTS: Hydration of the epidermis and dermis showed no significant difference between the skin with striae distensae and normal skin. Brightness of skin with striae alba and normal skin was significantly higher than that of skin with striae rubra. Erythema index of skin with striae rubra was significantly higher than that of skin with striae alba and normal skin. Skin with striae rubra and striae alba had a rougher surface than normal skin. Elasticity and dermal echo-density were significantly lower in striae distensae skin. CONCLUSIONS: Striae rubra and striae alba had similar biophysical properties in terms of skin hydration, elasticity, roughness, and dermal density. Moreover, striae distensae have less elasticity, more roughness, and lower dermal density than normal skin.

Clindamycin-induced Maculopapular Exanthema with Preferential Involvement of Striae Distensae: A Koebner phenomenon?

Clindamycin is a lincomycin-derived antibiotic useful for the treatment of anaerobic and Gram-positive aerobic bacterial infections. Cutaneous adverse reactions are usually maculopapular exanthemas, although hypersensitivity syndrome, acute generalized exanthematous pustulosis, and Stevens-Johnson syndrome have also been reported (1). We report the case of a patient with a maculopapular rash triggered by clindamycin who developed cutaneous lesions on striae distensae (SD). A 47-year-old woman was referred to our clinic for pruritic cutaneous lesions which had started 6 days earlier. Her past clinical history included hypertension, hypothyroidism, hyperuricemia, cholecystectomy, caesarean section, and endometriosis-related abdominal surgery, and she was taking levothyroxine, allopurinol, imidapril, and omeprazole. The skin rash first developed on her neck and back on the 3rd day of clindamycin oral treatment (300 mg every 6 hours), which was prescribed as antibiotic prophylaxis for a tooth implant. General malaise (but not fever) was also reported. Physical examination revealed an erythematous maculopapular eruption symmetrically distributed on the neck, abdomen, and back (Figure 1, A), with isolated lesions involving the proximal upper and lower limbs (Figure 1, B). There was a striking vertical distribution of skin lesions along the SD on the lateral sides of the abdomen (Figure 1, C). No mucosal involvement was found, and laboratory studies showed no abnormalities. Clindamycin withdrawal was followed by prescription of a course of oral deflazacort, starting at 30 mg daily and tapering down during a 9-day period. On the 5th day of treatment, the rash had almost cleared with minimal desquamation (Figure 1, D). Eight weeks after clearance of the skin rash, informed consent was obtained in order to perform an allergological evaluation of clindamycin, including prick and intradermal (ID) tests on the forearm and patch tests on the upper back (2). For patch testing, powder of the commercial capsules (Dalacin®) was diluted in petrolatum (pet.) and water (aq.), resulting in a final 1% clindamycin dilution. Parenteral clindamycin preparations were used in therapeutic concentrations for prick tests (150 mg/mL) and dilutions in saline of 1/100 and 1/10 for the ID test. Other authors have reported that these concentrations do not seem to irritate the skin (3-6). Prick and ID tests were assessed after 20 min and 24 hours, respectively. Patch tests were removed after the 2nd day, and late reactions were evaluated on day 2 and day 4. Prick and ID test results after 20 min were negative. Late results of ID tests with clindamycin (1.5 and 15 mg/mL) were positive: erythematous infiltrated papules about 7×7 mm and 18×15 mm were observed at 24 hours and lasted until the 8th day. Patch tests with clindamycin 1% in pet. and 1% in aq. were also positive (+ on day 2 and day 4). Positive late skin tests suggested delayed-type non-IgE-mediated allergic clindamycin hypersensitivity. Oral challenge tests are considered to be the gold standard to establish or exclude drug hypersensitivity. Due to the positive result of late skin test to clindamycin, oral challenge was not performed in our patient (3,5). The Koebner isomorphic phenomenon has been described in cutaneous reactions induced by drugs, such as antibiotics and chemotherapy. Chronic pressure on the skin is probably involved in the onset of skin lesions in hand-foot eruptions induced by tyrosine kinase inhibitors (sorafenib and sutinib). Solar exposure and cutaneous trauma also seem to play a role in the location of papulopustular eruptions caused by endothelial growth factor receptor inhibitors (erlotinib) (7). More frequent involvement in traumatized skin and surgical scars has been reported in the context of linear IgA bullous dermatosis and leukocytoclastic vasculitis triggered by vancomycin and cefuroxime (8). SD are produced by non-penetrating physical trauma, similar to friction or pressure. Different dermatoses can develop along SD skin lesions (like plaque psoriasis, pustular psoriasis, lichen planus, vitiligo, discoid lupus erythematosus, lupus vasculitis, urticarial vasculitis, or chronic graft-versus-host disease) (9). Bevacizumab, etretinate, and corticosteroid-induced ulcers, hyperpigmentation caused by bleomycin, and urticariform lesions triggered by diclofenac are examples of different type of drug-induced abnormalities involving SD (10). In summary, we identified clindamycin as the cause of the cutaneous reactions that occurred in our patient on the basis of the results of the skin tests and clinical history. Our findings confirmed a delayed-type hypersensitivity reaction, possibly involving a T-cell-mediated immunologic mechanism. Intradermal and patch tests were found to be useful in order to confirm the diagnosis (4,5). We did not find reports in the literature of drug-induced cutaneous eruptions along the SD as a manifestation of a Koebner phenomenon. Clinical underreporting of this phenomenon could explain the scarce literature on this cutaneous adverse reaction.

Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study.

BACKGROUND: Striae distensae (SD) are dermal scars associated with atrophy of the epidermis. OBJECTIVE: To evaluate the effect and safety of intralesional injection of platelet-rich plasma (PRP) versus topical tretinoin 0.05% in treatment of SD. METHODS: Thirty patients (27 females and 3 males) had bilateral striae distensae were enrolled in this study. In every patient, half of the selected striae were treated with PRP intralesional injection. The other half was treated by topical tretinoin. Skin biopsies were taken from both sides before and after the treatment. Digital photographs were taken at the baseline and at the end of follow-up period. Clinical improvement was evaluated by 2 blind dermatologists in addition to the patient's satisfaction rating. RESULTS: There was statistically significant improvement in the SD treated with PRP and topical tretinoin cream. The improvement was more in the SD treated with PRP injections (p = .015). Patient's satisfaction showed that the improvement was more in the PRP-treated side (p = .003). Collagen and elastic fibers in the dermis were increased in all biopsies after treatment. CONCLUSION: PRP injection and topical tretinoin are safe for the treatment of SD, but PRP is more effective and it gives better therapeutic response than tretinoin.