Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 214
Filtrar
1.
Medicine (Baltimore) ; 99(39): e22256, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991422

RESUMO

BACKGROUND: Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis. METHODS: A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework. RESULTS: Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively). CONCLUSION: Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.


Assuntos
Ceratolíticos/administração & dosagem , Lasers de Gás/uso terapêutico , Ablação por Radiofrequência/métodos , Estrias de Distensão/terapia , Tretinoína/administração & dosagem , Administração Tópica , Adolescente , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
2.
Sci Total Environ ; 744: 141016, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-32755791

RESUMO

Parabens are widely used as antimicrobial preservatives in personal care products (PCPs). Stretch mark cream is widely used by pregnant and lactating women for the treatment of striae gravidarum. This can be a potential source of paraben exposure, not only to pregnant/lactating women but also to fetuses/newborns. Little is known, however, with regard to the occurrence of parabens in stretch mark creams. In this study, we analyzed eight parabens and their metabolites in 31 popular stretch mark creams originated from various countries including China. The concentrations of Σparaben (sum of eight parabens/metabolites) ranged from 0.007 to 1630 µg/g, with mean and median values of 453 and 273 µg/g, respectively. Methyl- and propyl-parabens accounted for >95% of Σparaben concentrations. We examined the measured paraben concentrations against ingredients listed on the product labels. Parabens were listed as ingredients in those creams that contained concentrations >100 µg/g except for four samples with such high concentrations. Six cream samples that were labeled 'paraben-free' contained trace levels (0.007-9.92 µg/g) of these preservatives. Mean dermal ∑paraben exposure dose from the use of stretch mark creams (30.6 µg/kg bw/day) was well below the current acceptable daily intake value (5 mg/kg bw/day). In comparison to diet and indoor dust ingestion pathways, paraben-laden stretch mark cream may be a major source of paraben exposure in pregnant and lactating women. This study provides information on parabens and other preservatives in stretch mark creams and measures to reduce exposures during pregnancy and lactation.


Assuntos
Parabenos/análise , Estrias de Distensão , China , Exposição Ambiental/análise , Feminino , Humanos , Recém-Nascido , Lactação , Gravidez
3.
J Cosmet Sci ; 71(2): 77-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271710

RESUMO

Striae distensae (SD) are linear dermal scars that arise from progressive stretching or tearing of the dermal layer. This study tests the safety and efficacy of a topical formulation of silicone-based scar cream containing selective synthetic recombinant human growth factors, hyaluronic acid, and vitamin C to improve overall appearance and texture of SD. Twenty-two subjects with SD alba were recruited and randomized to apply the topical formula to half of their SD laterally twice a day for 1 month. Patient surveys were obtained at 1 month for overall appearance, texture, and tolerability. Three-dimensional imaging was obtained at baseline and at 1 month and submitted to independent evaluators for grading on overall appearance. Subjects reported improved texture and appearance in 86.4% of SD. Subjects reported 100% of untreated SD to have no change in overall appearance or texture. 90.9% of subjects reported no tolerability issues. 9.1% of the treated group reported mild issues such as slight itching or redness the first day of application, which subsided in 2 days for all patients. Independent evaluators indicated improvement in 72.7% of SD in comparison to improvement in 36.3% of untreated SD. This study demonstrates that the investigated topical formulation is safe and effective to use for SD.


Assuntos
Estrias de Distensão , Ácido Ascórbico , Eritema , Humanos , Silicones , Pele
4.
BMC Pregnancy Childbirth ; 20(1): 103, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050916

RESUMO

BACKGROUND: Striae gravidarum are a common occurrence in pregnancy and many women use a topical product to prevent their development or lessen their appearance if they do develop. There is a lack of evidence on the effectiveness of many of the products used by women. This study arose from challenges in recruitment to a pilot randomised trial (ISRCTN trial registration number:76992326) designed to evaluate the feasibility of a definitive trial to compare a moisturising oil to no treatment in the prevention and reduction in severity of striae gravidarum. The study reported here explored the factors influencing recruitment to that pilot trial. METHODS: A qualitative descriptive study was undertaken involving primigravid women attending an Irish maternity hospital. Data were collected by semi-structured telephone interviews over a four-week period and analysed using the framework method of analysis. Fifteen interview transcripts were included in the analysis. RESULTS: Four main themes consisting of twelve categories were identified from the interview data. The themes focused on women's prevention of stretch marks and their choice of anti-stretch mark product, who and what influenced that choice and influences on trial participation. In relation to influences on trial participation, the possibility of being randomised to the non- intervention or control group was a deterrent for many women. CONCLUSIONS: The prevention of stretch marks is important to pregnant women, as is their choice of product to prevent them. Offering women the opportunity to be part of a trial that would be of low burden and would test a well-known product may optimise recruitment. However, reluctance to be randomised because of the possibility of being allocated to the non-intervention control group suggests that further work is needed in this field on how best to communicate uncertainty to potential participants.


Assuntos
Seleção de Pacientes , Complicações na Gravidez/prevenção & controle , Gestantes/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estrias de Distensão/prevenção & controle , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Pesquisa Qualitativa
5.
J Cosmet Dermatol ; 19(1): 190-198, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31131982

RESUMO

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.


Assuntos
Pele/patologia , Estrias de Distensão/etiologia , Adolescente , Adulto , Biópsia , Colágeno/química , Colágeno/genética , Colágeno/metabolismo , Elastina/química , Elastina/genética , Elastina/metabolismo , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Voluntários Saudáveis , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , Pele/química , Análise Espectral Raman , Estrias de Distensão/patologia , Adulto Jovem
6.
Dermatol Surg ; 46(4): 459-464, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31403543

RESUMO

BACKGROUND: Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation. OBJECTIVE: To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae. MATERIALS AND METHODS: Twenty-five consecutive adults (SPT I-V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated. RESULTS: Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed. CONCLUSION: The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.


Assuntos
Técnicas Cosméticas/instrumentação , Agulhas/efeitos adversos , Estrias de Distensão/terapia , Adulto , Técnicas Cosméticas/efeitos adversos , Eritema/epidemiologia , Eritema/etiologia , Extremidades , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/epidemiologia , Transtornos da Pigmentação/etiologia , Púrpura/epidemiologia , Púrpura/etiologia , Tronco , Resultado do Tratamento
7.
J Gynecol Obstet Hum Reprod ; 49(1): 101619, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31430563

RESUMO

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.


Assuntos
Recesariana , Pelve/patologia , Diagnóstico Pré-Natal/métodos , Estrias de Distensão/classificação , Aderências Teciduais/diagnóstico , Adulto , Área Sob a Curva , Índice de Massa Corporal , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estrias de Distensão/etiologia , Estrias de Distensão/patologia , Aderências Teciduais/classificação , Aderências Teciduais/etiologia , Aderências Teciduais/patologia
8.
Dermatol Surg ; 46(3): 348-357, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31714381

RESUMO

BACKGROUND: Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge. OBJECTIVE: To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine. MATERIALS AND METHODS: A 2-part systematic review and expert analysis of publications before October 2018. RESULTS AND CONCLUSION: Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Plasma Rico em Plaquetas , Alopecia/cirurgia , Cicatriz/cirurgia , Técnicas Cosméticas , Humanos , Rejuvenescimento , Envelhecimento da Pele , Estrias de Distensão/cirurgia , Cicatrização/fisiologia
9.
J Cosmet Dermatol ; 19(1): 241-245, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31020789

RESUMO

BACKGROUND: Striae gravidarum (SG) can cause pregnant women severe psychological stress. OBJECTIVE: This study aimed to compare primigravidas with and without SG concerning fasting blood coenzyme Q10 (CoQ10), age, skin type, family history, gestational weight gain, pre- and post-pregnancy BMI, daily water consumption during pregnancy, gender and weight of baby, and the educational level. METHODS: The study included 79 primigravidas in the gestational week of 36 or above. The patients were divided into two groups based on the presence of SG. The fasting blood CoQ10 levels and other associated parameters were compared between the groups. RESULTS: Of the 79 primigravidas, 35 (44.3%) had SG. There was no statistically significant relationship between striae and CoQ10 (P = 0.144 and P = 0.189, respectively). Predisposing factors for striae were young pregnancy, light skin color, family history, high pre- and post-pregnancy BMI, increased gestational weight gain, and increased newborn weight. There was no significant relationship between striae development and educational level or water consumption during pregnancy. CONCLUSION: This is the first study to show that CoQ10 did not significantly differ between women with and without SG. Further studies with a larger case series are needed to elucidate predisposing factors for striae and involvement of CoQ10 in this condition.


Assuntos
Complicações na Gravidez/epidemiologia , Estrias de Distensão/epidemiologia , Ubiquinona/análogos & derivados , Adulto , Fatores Etários , Peso ao Nascer/fisiologia , Feminino , Ganho de Peso na Gestação/fisiologia , Número de Gestações , Humanos , Recém-Nascido , Idade Materna , Anamnese , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez/sangue , Fatores de Risco , Pigmentação da Pele/fisiologia , Estrias de Distensão/sangue , Estrias de Distensão/diagnóstico , Ubiquinona/sangue , Circunferência da Cintura/fisiologia , Adulto Jovem
11.
Skin Therapy Lett ; 24(5): 1-6, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31584784

RESUMO

Platelet-rich plasma (PRP) is an autologous serum containing high concentrations of platelets and growth factors. PRP continues to evolve as an important treatment modality with many applications in dermatology, particularly in the areas of hair restoration, skin rejuvenation, acne scars, dermal augmentation, and striae distensae. Furthermore, combining PRP with laser therapies, microneedling, dermal fillers, and autologous fat grafting produces synergistic effects, leading to improved aesthetic results. Future studies should standardize PRP treatment protocols for specific indications. PRP holds considerable promise in dermatology with therapeutic applications continuing to expand.


Assuntos
Dermatologia , Plasma Rico em Plaquetas , Alopecia/terapia , Cicatriz/terapia , Técnicas Cosméticas , Humanos , Rejuvenescimento , Estrias de Distensão/terapia
12.
Taiwan J Obstet Gynecol ; 58(5): 640-644, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542085

RESUMO

OBJECTIVE: We study the risk factors that affect the formation of striae gravidarum in women in Jiangsu Province of China under current living habits. MATERIALS AND METHODS: This sample is based on 400 primiparas from obstetric of the Affiliated Hospital of Jiangnan University in Wuxi from February 2017 to October 2017. Among them, there are 200 pregnant women with striae gravidarum and 200 without striae gravidarum. Striae gravidarum predictors were selected such as age, height, pre-pregnancy BMI, postpartum BMI, daily sitting time, weight gain during pregnancy, fetal weight, and diet on maternal. RESULTS: (1) The pregnant women who had striae gravidarum were generally lower in height than those who did not have striae gravidarum and had a higher BMI index than those who did not have striae gravidarum before and after childbirth. (2) In the pregnant women who have had striae gravidarum, the incidence of abdominal striae gravidarum in sedentary women is significantly lower than those in non-sedentary women, the incidence of striae gravidarum in legs is higher than those in non-sedentary women, and no significant difference in hip striae gravidarum. (3) In all pregnant women who have striae gravidarum, abdomen striae gravidarum tend to be lighter and leg striae gravidarum tends to be heavier in sedentary women, but no significant effect on the hip. (4) Regular consumption of honey, milk, trotters, freshwater fish, eggs, and tremella can reduce the incidence of striae gravidarum. CONCLUSION: The lifestyle and eating habits have a certain influence on the formation and severity of stretch marks.


Assuntos
Complicações na Gravidez/etiologia , Estrias de Distensão/etiologia , Adulto , China/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Estilo de Vida , Paridade , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Estrias de Distensão/epidemiologia
13.
J Obstet Gynaecol Res ; 45(12): 2358-2363, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31531933

RESUMO

AIM: To evaluate the diagnostic value of striae gravidarum (SG) presence and localization in predicting the intraperitoneal adhesion (IPA) risk in pregnant women with a history of at least one previous cesarean delivery (CD). METHODS: A total of 100 pregnant women with repeated CD were included in this prospective observational study. Patients were divided into three groups according to severity of SG with Davey scoring system. Intraoperative adhesion severity and extension were evaluated by using Nair classification system. Moreover, operation duration and neonatal outcomes were analyzed. RESULTS: Demographic features were comparable between the groups. Adhesion scores were significantly higher in mild and severe SG groups (for mild SG: 1.93 ± 0.99, for severe SG: 2.81 ± 0.88 and for no SG: 1.4 ± 0.57; P < 0.001). Analysis revealed a positive correlation between IPA and severity of SG (P < 0.001). There was a correlation between increased striae density and adhesion severity especially in the right and left upper quadrants of the abdomen (for right quadrant: r = 0.515, P < 0.001; for left quadrant: r = 0.359, P = 0.005). CONCLUSION: Our results suggest that preoperative evaluation of SG severity and extend particularly in upper quadrants is a feasible option to predict IPA risk in patients with repeated CD.


Assuntos
Doenças Peritoneais/etiologia , Complicações na Gravidez , Estrias de Distensão/complicações , Aderências Teciduais/etiologia , Recesariana , Feminino , Humanos , Gravidez , Estudos Prospectivos , Risco , Índice de Gravidade de Doença
14.
Saude e pesqui. (Impr.) ; 12(2): 343-349, maio/ago 2019. ilus, tab
Artigo em Português | LILACS | ID: biblio-1016557

RESUMO

O laser de baixa potência é um recurso utilizado em lesões de pele, contudo ainda pouco explorado no tratamento de estrias alba. Objetivo: comparar dois comprimentos de laser de baixa potência (660 nm e 830 nm) sobre estrias albas. Um grupo de 24 mulheres foi dividido em três: G1 ­ 660 nm; G2 ­ 830 nm; G3 ­ placebo. Realizaram-se 12 aplicações de laser, durante quatro semanas. Foram avaliadas fotos das estrias no antes, depois e após duas semanas das aplicações do laser para mensurar a área ocupada pelas estrias por meio de planimetria digitalizada, bem como seus aspectos. Pela planimetria observou-se redução estatisticamente significativa na área ocupada em G1. Na análise qualitativa, o grupo tratado com laser de 660 nm apresentou melhora no aspecto das estrias. A aplicação utilizando o laser de baixa potência com comprimento de onda de 660 nm demonstrou efeitos positivos na área analisada, bem como no aspecto das estrias.


Although low-power laser is employed in skin lesions, it is only scantily used in the treatment of white striae. Comparison of two low-power laser lengths (660 nm and 830 nm) on white striae. A group of 24 females was subdivided into three groups: G1 ­ 660 nm; G2 ­ 830 nm; G3 ­ placebo. Twelve laser applications were undertaken during four weeks. Photographs of striae before, after and after two weeks of laser application were performed to measure area with striae by digital planimetry and their aspects. Planimetry revealed statistically significant decrease in area occupied in G1. Group treated with 660 nm laser qualitatively improved striae aspect. Application with lower-power laser at 660 nm had a positive effect on the area analyzed and in the aspects of the striae.


Assuntos
Humanos , Feminino , Adulto , Pele , Terapia com Luz de Baixa Intensidade , Estrias de Distensão
15.
Ginekol Pol ; 90(6): 325-330, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276184

RESUMO

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.


Assuntos
Recesariana/efeitos adversos , Cicatriz/patologia , Pele/patologia , Estrias de Distensão/patologia , Aderências Teciduais/diagnóstico , Abdome , Adulto , Cicatriz/etiologia , Estudos Transversais , Feminino , Humanos , Complicações Pós-Operatórias/patologia , Gravidez , Adulto Jovem
17.
Int J Cosmet Sci ; 41(3): 311-319, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31069805

RESUMO

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.


Assuntos
Modelos Biológicos , Pele/patologia , Estrias de Distensão/patologia , Fibroblastos/metabolismo , Fibroblastos/patologia , Perfilação da Expressão Gênica , Humanos , Pele/metabolismo
18.
Lasers Med Sci ; 34(7): 1295-1304, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31044363

RESUMO

Striae distensae (SD) cause a cosmetic problem to many patients. Recently, fractional micro-needle radiofrequency (FMR) device has been introduced in treatment of SD. Also, fractional CO2 laser has been used as a resurfacing laser technique in the treatment of SD. The aim of our study was to assess and compare between the efficacy of FMR and fractional CO2 laser in treatment of SD. Seventeen female patients with SD were enrolled in this study. Detailed history was taken and dermatological examination was done to determine the type of striae, the location, and measurement of the width of the largest striae on each side. In each patient, one side was randomly assigned to treatment by FMR (area A), and the other side to treatment by fractional CO2 laser (area B). Our results showed that both techniques were effective. A slight better efficacy was encountered with FMR, but the difference was not statistically significant (p = 0.716). The current study concluded that FMR and fractional CO2 laser are almost equally effective in the treatment of SD (rubra and alba). Development of post inflammatory hyper-pigmentation (PIH) was evident with fractional CO2 in contrast with FMR, and the difference was statistically significant (p = 0.001).


Assuntos
Lasers de Gás , Agulhas , Terapia por Radiofrequência , Estrias de Distensão/cirurgia , Adulto , Terapia Combinada , Feminino , Humanos , Satisfação do Paciente , Estrias de Distensão/terapia , Resultado do Tratamento
19.
Acta Dermatovenerol Croat ; 27(1): 44-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31032793

RESUMO

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.


Assuntos
Cicatriz/patologia , Líquen Escleroso e Atrófico/patologia , Esclerodermia Localizada/patologia , Estrias de Distensão/patologia , Idoso , Cicatriz/complicações , Feminino , Humanos , Líquen Escleroso e Atrófico/complicações , Esclerodermia Localizada/complicações , Estrias de Distensão/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA