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1.
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
2.
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
3.
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
4.
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
5.
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
6.
J Bone Joint Surg Am ; 101(5): 392-399, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845033

RESUMO

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.


Assuntos
Cicatriz/etiologia , Procedimentos Cirúrgicos Dermatológicos/métodos , Procedimentos Ortopédicos/efeitos adversos , Adolescente , Síndrome de Cushing/patologia , Extremidades , Feminino , Cabeça , Humanos , Masculino , Pescoço , Fotografação , Complicações Pós-Operatórias/etiologia , Envelhecimento da Pele/fisiologia , Estrias de Distensão/patologia , Tronco
8.
Am J Clin Dermatol ; 20(2): 277-287, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30618025

RESUMO

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.


Assuntos
Técnicas Cosméticas , Lasers de Estado Sólido/uso terapêutico , Agulhas , Estrias de Distensão/terapia , Adulto , Biópsia , Colágeno/metabolismo , Feminino , Humanos , Qualidade de Vida , Estrias de Distensão/patologia , Resultado do Tratamento
9.
J Cosmet Laser Ther ; 21(4): 213-216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30130428

RESUMO

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.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Microscopia Confocal , Agulhas , Estrias de Distensão/terapia , Estética , Feminino , Humanos , Fotografação , Estrias de Distensão/patologia , Adulto Jovem
10.
Skin Res Technol ; 25(3): 283-288, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30345576

RESUMO

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.


Assuntos
Fenômenos Fisiológicos da Pele , Estrias de Distensão/patologia , Adulto , Elasticidade/fisiologia , Eritema/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pele/anatomia & histologia , Pele/diagnóstico por imagem , Pele/patologia , Pigmentação da Pele , Estrias de Distensão/complicações , Estrias de Distensão/fisiopatologia , Propriedades de Superfície , Ultrassonografia , Adulto Jovem
11.
Lasers Surg Med ; 51(3): 230-238, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30480320

RESUMO

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.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Terapia com Luz de Baixa Intensidade , Estrias de Distensão/radioterapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Estudos Prospectivos , Estrias de Distensão/diagnóstico por imagem , Estrias de Distensão/patologia , Resultado do Tratamento , Adulto Jovem
12.
Acta Dermatovenerol Croat ; 26(1): 61-63, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29782303

RESUMO

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.


Assuntos
Clindamicina/efeitos adversos , Erupção por Droga/etiologia , Testes do Emplastro/métodos , Estrias de Distensão/etiologia , Administração Oral , Biópsia por Agulha , Clindamicina/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Erupção por Droga/patologia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Medição de Risco , Índice de Gravidade de Doença , Estrias de Distensão/patologia , Suspensão de Tratamento
13.
Dermatol Surg ; 44(5): 697-704, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29701622

RESUMO

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.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Ceratolíticos/administração & dosagem , Satisfação do Paciente , Plasma Rico em Plaquetas , Estrias de Distensão/terapia , Tretinoína/administração & dosagem , Abdome/patologia , Administração Cutânea , Adolescente , Adulto , Feminino , Humanos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Estrias de Distensão/patologia , Coxa da Perna/patologia , Fatores de Tempo , Resultado do Tratamento , Gravação em Vídeo
14.
J Cosmet Dermatol ; 17(6): 1008-1015, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29316152

RESUMO

BACKGROUND: Striae distensae are dermal scars with a linear atrophic depression. The exact origin of striae distensae remains unrevealed, but low expression of collagen and fibronectin genes in the affected tissue was found. Several treatment modalities have been proposed, yet no consistent modality is available. AIM OF THE WORK: To evaluate and compare the efficacy and safety of carboxytherapy vs platelet-rich plasma (PRP) in treatment of stretch marks. PATIENTS AND METHODS: This study included 20 patients with striae alba. Every patient received treatment in the form of PRP injection in their right side (group A) and carboxytherapy session in their left side (group B) every 3-4 weeks for 4 sessions. Skin biopsies were taken before and after treatment, and they were subjected to fibronectin immunohistochemical stain. RESULTS: There was a significant improvement in striae alba in both groups after than before treatment. There was no significant difference between both groups as regards either percentage of improvement, response (grading scale), or patient satisfaction. The fibronectin-stained area was significantly higher in both groups after than before treatment, and it was significantly higher after treatment in group (B) than group (A). CONCLUSIONS: Both methods were safe and effective with minimal side effects. There was no significant difference between both methods of treatments. This was confirmed histopathologically by fibronectin expression which is found to be low in striae and increased significantly after treatment. But fibronectin expression was higher in group (B) than (A).


Assuntos
Dióxido de Carbono/uso terapêutico , Plasma Rico em Plaquetas , Estrias de Distensão/patologia , Estrias de Distensão/terapia , Adolescente , Adulto , Biópsia , Dióxido de Carbono/administração & dosagem , Dióxido de Carbono/efeitos adversos , Feminino , Fibronectinas/metabolismo , Humanos , Imuno-Histoquímica , Injeções Intradérmicas , Masculino , Satisfação do Paciente , Pele/patologia , Estrias de Distensão/metabolismo , Resultado do Tratamento , Adulto Jovem
15.
Br J Dermatol ; 178(3): 749-760, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28815554

RESUMO

BACKGROUND: Striae gravidarum (SG), or stretch marks of pregnancy, begin as erythematous streaks and mature into hypopigmented atrophic bands. OBJECTIVES: In order to investigate molecular alterations that may promote atrophy of SG, we investigated dermal type I collagen fibrils, which provide human skin with support. METHODS: We obtained skin samples of recently developed, erythematous abdominal SG from pregnant women. To examine the organization of collagen fibrils, second-harmonic generation imaging was performed using multiphoton microscopy. Immunostaining was used to determine protein expression and localization of type I procollagen, the precursor of type I collagen fibrils. Real-time polymerase chain reaction was used to determine gene expression levels. RESULTS: In control (hip) and stretched normal-appearing perilesional abdominal skin, dermal collagen fibrils were organized as tightly packed, interwoven bundles. In SG, collagen bundles appeared markedly separated, especially in the mid-to-deep dermis. In the spaces separating these bundles, loosely packed wavy collagen fibrils lacking organization as bundles were present. These disorganized fibrils persisted into the postpartum period and failed to form densely packed bundles. Numerous large fibroblasts displaying type I procollagen expression were in close proximity to the disorganized fibrils, suggesting that the fibrils are newly synthesized. Supporting this possibility, immunostaining and gene expression of type I procollagen were increased throughout the dermis of SG. CONCLUSIONS: Early SG display marked separation of collagen bundles and emergence of disorganized collagen fibrils that fail to form bundles. These alterations may reflect ineffective repair of collagen bundles disrupted by intense skin stretching. Persistent disruption of the collagenous extracellular matrix likely promotes formation and atrophy of SG.


Assuntos
Doenças do Colágeno/patologia , Complicações na Gravidez/patologia , Estrias de Distensão/patologia , Estudos de Casos e Controles , Doenças do Colágeno/metabolismo , Colágeno Tipo I/metabolismo , Feminino , Colágenos Fibrilares/fisiologia , Fibroblastos/metabolismo , Humanos , Gravidez , Complicações na Gravidez/metabolismo , Pró-Colágeno/biossíntese , Pele/irrigação sanguínea , Estrias de Distensão/metabolismo , Adulto Jovem
16.
J Cosmet Dermatol ; 17(6): 1170-1174, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29214715

RESUMO

OBJECTIVE: The aim of the study was to evaluate the effectiveness of carboxytherapy in the treatment of striae distensae. Additionally, discomfort and side effects associated with the treatment were assessed. MATERIALS AND METHODS: This study involved 15 women aged 22-40 years. They underwent 3 sessions of carboxytherapy at one-week intervals. Treatment was performed in skin area within stretch marks located on stomach, buttocks, and thighs. Cutometric probe was used to evaluate skin elasticity. Four measurements were performed-immediately before each treatment and one month after the last session. Photographic documentation was made before and after a series of treatment to perform clinical evaluation of changes in skin condition. RESULTS: Statistical analysis of results obtained with the use of Cutometer (R2 and R8 parameters) demonstrated that carboxytherapy significantly improved skin elasticity within stretch marks (P < .05). The analysis of photographic documentation revealed 58% improvement in stretch mark visibility. The width and length of stretch marks decreased, and their color became more like the natural color of the skin. Carboxytherapy is associated with moderate pain/discomfort. The occurrence of hematoma is the main side effect of this procedure. CONCLUSIONS: Carboxytherapy seems to be an effective method of reducing stretch marks. This procedure is safe, and it can be performed without the risk of complications. Moreover, it does not require special postoperative convalescence. Photographic documentation is a method of assessment of aesthetic procedures effectiveness, which is complementary to other objective methods (eg, the use of MPA probes).


Assuntos
Dióxido de Carbono/uso terapêutico , Estrias de Distensão/tratamento farmacológico , Adulto , Elasticidade/efeitos dos fármacos , Feminino , Humanos , Fotografação , Estrias de Distensão/patologia , Estrias de Distensão/fisiopatologia , Resultado do Tratamento , Adulto Jovem
17.
J Cosmet Dermatol ; 17(2): 176-183, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28755402

RESUMO

BACKGROUND: Striae distensae (SD) are a common dermatologic problem that plagues many people. Although there are many therapeutic modalities have been used to treat SD, effective method has been disappointing for striae Alba. AIMS: To evaluate the clinical and histopathologic efficacy and safety of the 2940-nm erbium yttrium aluminum garnet (Er:YAG) ablative fractional laser (AFL) with recombinant bovine basic fibroblast growth factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for the treatment of striae alba. PATIENTS AND METHODS: Thirty volunteers with striae distensae alba were enrolled. The subjects completed treatments with the 2940-nm Er:YAG AFL 6 times at 4-week intervals. Following this treatment, the subjects were required to spray rb-BFGF for 1 week at home. They then received LED-RL once every 7 days for three sessions between the two laser treatments. Two independent investigators evaluated clinical improvement at pretreatment and 1, 3, 6, and 12 months post-treatment, patients also provided self-assessments of clinical improvement. Two biopsies were obtained from two subjects, both of the same sites of striae alba, one before the first treatment and one 6 months after the last session. RESULTS: All 30 subjects demonstrated clinical improvement after treatment. Skin biopsies after treatment showed an increase in epidermal thickness, dermal thickness, and collagen and elastin density when compared to that at the baseline. CONCLUSIONS: The combination of the 2940-nm Er:YAG laser with rb-bFGF and LED-RL for the treatment of striae alba was a safe and effective approach for improving the appearance of striae alba.


Assuntos
Cromoterapia , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Estrias de Distensão/patologia , Estrias de Distensão/terapia , Adulto , Animais , Bovinos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Edema/etiologia , Eritema/etiologia , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Adulto Jovem
19.
Dermatol Surg ; 43(5): 635-648, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28375972

RESUMO

BACKGROUND: Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. OBJECTIVE: Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. METHODS AND MATERIALS: A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. RESULTS: The authors identified 68 articles that met inclusion and exclusion criteria. CONCLUSION: There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.


Assuntos
Estética , Terapia a Laser , Estrias de Distensão/prevenção & controle , Estrias de Distensão/terapia , Humanos , Estrias de Distensão/etiologia , Estrias de Distensão/patologia
20.
J Cosmet Dermatol ; 16(2): 279-286, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28374517

RESUMO

BACKGROUND: Striae distensae (SD), a type of dermal scarring, are psychologically disappointing. To date, information and scientific research behind the role of hormonal factors in the development of SD are still unclear. It is vital to understand striae to offer patients the best therapeutic options. OBJECTIVES: To investigate early alterations regarding the expression of estrogen, androgen, and glucocorticoid receptors (estrogen receptor (ER), androgen receptor (AR), glucocorticoid receptor (GR) in skin samples of multigravida (MG) and nulligravida (NG) cases and to compare them with normal controls. METHODS: This study included 30 subjects (10 MG and 10 NG cases with early SD and 10 healthy controls). Biopsies from SD lesions, perilesional normal skin of cases and normal skin of controls were examined immunohistochemically for ER, AR, and GR expression using immune peroxidase technique. RESULTS: Comparing MG and NG with controls, ER expression appeared reduced in MG and NG (P-value<.001), AR was elevated in MG (P-value<.05) with no considerable difference in NG (P-value>.05), while GR was elevated in both MG and NG (P-value<.05). On comparing perilesional skin with SD lesions in each of MG and NG groups, SD lesions revealed reduced ER expression in both groups (P-value<.05), whereas in MG group: AR expression was elevated with no difference detected regarding GR (P-value˃.05); meanwhile in NG, elevated expression in both AR and GR expression was noted (P-Value<.001) CONCLUSIONS: Striae distansae lesions demonstrated a significant increase in the expression of AR and GR and a declined expression of ER indicating their involvement in the development of early SD.


Assuntos
Receptores Androgênicos/análise , Receptores Estrogênicos/análise , Receptores de Glucocorticoides/análise , Estrias de Distensão/patologia , Adulto , Feminino , Número de Gestações , Humanos , Imuno-Histoquímica , Gravidez , Receptores Androgênicos/biossíntese , Receptores Estrogênicos/biossíntese , Receptores de Glucocorticoides/biossíntese , Estrias de Distensão/metabolismo , Adulto Jovem
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