Avaliação da eficácia da carboxiterapia na melhora da sensibilidade tátil, da satisfação corporal e do aspecto de estrias albas na região glútea em mulheres: um ensaio clínico randomizado / Evaluation of the effectiveness of carboxitherapy in improving tactile sensitivity, body satisfaction and appearance of stretch marks in the gluteus region in women: a randomized clinical trial

Introdução: Estrias são lesões dérmicas lineares que acometem ambos os sexos, sendo duas vezes mais comuns em mulheres. Objetivos: Investigar se a carboxiterapia é eficaz para melhorar a sensibilidade tátil, a satisfação corporal e o aspecto de estrias albas localizadas na região glútea de mulheres. Métodos: 38 mulheres hígidas com estrias albas bilateralmente na região glútea participaram do estudo. A aplicação da carboxiterapia foi realizada em um glúteo e porção superior da coxa através da introdução da agulha hipodérmica paralelamente as estrias. Foram realizadas doze sessões com duração média de 20 minutos cada, com intervalo de sete dias. A eficácia da intervenção foi avaliada através de registros fotográficos, avaliação da dor, avaliação da sensibilidade tátil, e autoavaliação de satisfação pós-tratamento. Resultados: Não houve diferença estatisticamente significativa entre o grupo experimental e o grupo controle no que diz respeito à avaliação dos registros fotográficos. Houve redução significativa entre a dor e melhora da sensibilidade nas voluntárias. Também houve diferença significativa da satisfação com a aparência do próprio glúteo antes e após o tratamento. Conclusão: A carboxiterapia foi eficaz em melhorar a sensibilidade tátil e a satisfação com o corpo de mulheres hígidas com estrias albas na região glútea. (AU)

Introduction: Stretch marks are linear lesions that affect both sexes, being twice as common in women. Objectives: To investigate whether carboxytherapy is effective in improving tactile sensitivity, body satisfaction and the appearance of stretch marks located in the gluteal region of women. Methods: Thirty-eight healthy women with bilateral stretch marks in the gluteal region participated in the study. Carboxitherapy was applied to a gluteus and upper thigh by introducing the hypodermic needle in parallel as stretch marks. Twelve sessions were held with an average duration of 20 minutes each, with an interval of seven days. The assessment of the intervention was assessed through photographic records, pain assessment, assessment of tactile sensitivity and automatic assessment of satisfaction after treatment. Results: There was no statistically significant difference between the experimental group and the control group regarding the evaluation of photographic records. We observed a significant reduction between pain and improved sensitivity in the volunteers, and a significant difference in satisfaction with his appearance before and after treatment. Conclusion: Carboxytherapy was effective in improving tactile sensitivity and body satisfaction in healthy women with stretch marks in the gluteal region. (AU)

Topical corticosteroid induced ulcerated striae

Abstract We report four cases of ulcerated striae following misuse of fixed dose combinations creams containing clobetasol propionate with antifungal and antibacterial agents.

Microagulhamento: uma revisão / Microneedling: a review

Introdução: O microagulhamento também denominado como terapia de indução percutânea de colágeno (TIPC), consiste numa técnica aplicada através de um equipamento chamado roller. A técnica é indicada para rejuvenescimento, alopecia, todos os tipos de cicatrizes, acne, foto rejuvenescimento, estrias, flacidez de pele, melasma, rugas de expressão e melhora do aspecto geral da pele. Objetivo: Realizar revisão da literatura para identificar as principais aplicabilidades clinicas no uso do microagulhamento. Métodos: A pesquisa foi realizada no período de 2009 a 2018, em bases de dados eletrônicas PubMed e Scielo. Os estudos assim recuperados foram descritos e analisados. Resultados: Foram selecionados 12 artigos e 2 livros por apresentar conteúdo relevante. Conclusão: O microagulhamento é uma técnica simples, tratamento inovador e vem sendo utilizado para diferentes patologias dermatológicas. A técnica age pela estimulação natural de colágeno através da resposta ao processo inflamatório e outra facilitando o sistema de acesso transdermal de ingredientes (SATI), conhecido como Drug Delivery.

Introduction: Microneedling, also called percutaneous collagen induction therapy (PCIT), is a technique applied with an equipment called roller. It is suitable for rejuvenation, alopecia, all types of scars, acne, photo rejuvenation, stretch marks, skin flaccidity, melasma, expression wrinkles, and improvement of the general aspect of the skin. Objective: Perform a literature review to identify the major clinical applications of microneedling. Methods: The research was done from 2009 to 2018, in electronic databases PubMed and Scielo. The studies recovered were described and analyzed. Results: We selected 12 articles and two books for their relevant content. Conclusion: Microneedling is a simple technique, an innovative treatment that has been used for different dermatological pathologies. This method acts by naturally stimulating collagen by responding to the inflammatory process and also by activating the transdermal ingredient access system (TIAS), known as Drug Delivery.

Comparação do uso do laser de baixa potência (660 NM E 830 NM) em estrias atróficas de mulheres jovens / Comparing low power laser use (660 NM AND 830 NM) in atrophic striae in young females

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.

Avaliação da eficácia e segurança do microagulhamento com 5-fluorouracil para o tratamento de estrias albas: ensaio clínico randomizado duplo-cego / Evaluation of the efficacy and safety of microneedling with 5-fluorouracil for the treatment of striae alba: double-blind, randomized clinical trial

Introdução: Estrias são um desafio cotidiano ao dermatologista. Na busca por terapias alternativas, surgem o 5-fluorouracil (5-FU) e o microagulhamento ao associarem as seguintes propriedades: inibir fibrose, estimular renovação do colágeno e induzir pigmentação da pele. Objetivo: Avaliar a eficácia e segurança do 5-FU, isolado ou associado ao microagulhamento, no tratamento das estrias albas. Métodos: Estudo duplo-cego comparativo, durante 180 dias, entre três grupos: Grupo A - microagulhamento e 5-FU; Grupo B - 5-FU intralesional; e Grupo C - microagulhamento sem medicação. Mensurou-se a melhora por meio de uma escala numérica de coloração da pele, considerando-se resultados positivos aqueles com redução da discrepância entre a cor da pele adjacente e a da estria. Avaliou-se também a satisfação do paciente e a irritação com cada técnica. Resultados: Grupo A obteve 10% de melhora clínica excelente; 10%, muito boa; e 60%, leve. No grupo B, nenhuma paciente teve melhora excelente ou muito boa. Já no grupo C, observaram-se 20% de melhora clínica muito boa e 70% de melhora leve. Conclusões: Todas as técnicas apresentaram algum grau de melhora das lesões. Assim, propõem- se novos estudos comparando-se as três técnicas, com amostra mais ampla, para avaliar se maior número de sessões resultaria em resultados mais expressivos.

Introduction: Stretch marks are an everyday challenge to the dermatologist. In the search for alternative therapies, we find 5-fluorouracil (5-FU) and microneedling for associating the following properties: inhibition of fibrosis, stimulation of collagen renovation and induction of skin pigmentation. Objective: To evaluate the efficacy and safety of 5-FU, in isolation or associated to microneedling, for the treatment of white stretch marks (striae alba). Methods: Comparative, double-blind study over 180 days, between 3 groups: Group A: microneedling and 5-FU; Group B intralesional 5-FU and Group C microneedling without medication. We measured improvement through a numerical scale of skin coloration, considering positive results those with reduction of the discrepancy between the adjacent skin and the stretch mark. We also evaluated patient satisfaction and irritation with each technique. Results: Group A achieved 10% of excellent clinical improvement, 10% very good and 60% mild. In group B, none of the patients had excellent of very good improvement. In group C, there was 20% of very good clinical improvement and 70% of mild. Conclusions: All techniques showed some degree of improvement of the lesions. Therefore, we propose new studies comparing all three techniques, with a larger sample, to evaluate if more treatments would result in better results.

Application of platelet-rich plasma in dermatology / 中华皮肤科杂志

Platelet-rich plasma (PRP) is a platelet concentrate isolated from the autologous whole blood after centrifugation,and its optimal working concentration is 4-7 times that of the blood platelet count in the whole blood.After the activation by thrombin or calcium chloride,platelets can release various growth factors,which can promote hemostasis,wound healing and angiogenesis.Considered as a kind of low-cost and safe therapy,it has been widely applied to the repair of soft tissue and hard tissue injuries.PRP has also been widely applied to dermatology,including hair loss,skin rejuvenation,scar repair and wound healing.This review summarizes the application of PRP in dermatology.

Uso do laser de baixa potência em estrias de distensão: ensaio clínico randomizado controlado / Use of low level laser therapy in striae distensae: a randomized controlled trial

OBJETIVOS: Avaliar os efeitos da laserterapia de baixa potência (660 nm) no tratamento de estrias albas. MÉTODOS: Foi realizado um ensaio clínico randomizado com 20 mulheres divididas por igual em grupo controle e grupo tratamento. Para inclusão elas deveriam possuir estrias albas em região glútea e aceitar participar do estudo. Os critérios de exclusão foram: realização de outro tratamento para estrias, estado gravídico, uso de esteroides, tabagismo, diagnóstico de câncer, áreas hemorrágicas na pele, diagnóstico de epilepsia, diagnóstico de trombose, ou qualquer alteração cognitiva. Foram realizadas 12 aplicações de laser 660 nm, durante quatro semanas. Após mais quatro semanas de seguimento, foi realizada uma reavaliação. Após cada aplicação foram feitas fotos da região para avaliação do tamanho das estrias por meio de planimetria digitalizada, que avalia a porcentagem de área ocupada pelas estrias. Para essa avaliação foram utilizadas as fotos por ocasião da primeira aplicação (AV1), da sexta (AV2), da 12ª (AV3) e da última avaliação, após quatro semanas do término do tratamento (AV4). Foram realizadas também avaliações qualitativas por tato (profundidade) e inspeção visual (tonalidade e tamanho). RESULTADOS: A análise pela planimetria demonstrou que não houve diferença entre a área ocupada pelas estrias quando se compararam as diversas avaliações do mesmo grupo, até a AV3. Porém na AV4 (quatro semanas após a última aplicação de laser) do grupo tratamento, houve diminuição estatisticamente significativa da área de estrias em relação à AV1. No grupo controle, não houve diferença entre AV4 e as outras avaliações. Na comparação entre os dois grupos, não houve diferença nas três primeiras avaliações. Porém na AV4 o grupo tratamento mostrou menor área das estrias em relação ao grupo controle. Na análise qualitativa o grupo tratado apresentou menor visibilidade e menor profundidade das estrias ao tato. CONCLUSÕES: A terapia com 12 sessões de laser de baixa potência durante quatro semanas teve efeito positivo no tratamento de estrias albas, com os resultados tornando-se evidentes somente quatro semanas após a última aplicação. O laser de 660nm mostrou-se um método não invasivo, indolor e de rápida aplicação.

AIMS: To analyze the effects of low-level laser therapy (660nm) in the treatment of striae alba. METHODS: A randomized clinical trial was conducted with 20 women equally divided into a control group and a treatment group. For inclusion, they should have striae alba in the gluteal region and accept to participate in the study. Exclusion criteria were other treatment for striae, pregnancy, steroid use, smoking, cancer diagnosis, hemorrhagic areas on the skin, diagnosis of epilepsy, diagnosis of thrombosis, or any cognitive impairment. Twelve applications of 660 nm laser were performed for four weeks. After another four weeks of follow-up, a reevaluation was performed. After each application, photos were taken from the region to evaluate the size of the striae by means of scanned planimetry, which calculates the percentage of area occupied by the striae. For this evaluation, the photos taken at the first application (AV1), the sixth (AV2), the 12th (AV3) and the last evaluation, after four weeks of treatment completion (AV4), were used. Qualitative evaluations were also performed by touch (depth) and visual inspection (hue and size). RESULTS: The analysis by planimetry showed that there was no difference between the area occupied by the striae when comparing the various evaluations of the same group, until the AV3. However in AV4 (four weeks after the last laser application) of the treatment group, there was a statistically significant decrease of the stria area in relation to AV1. In the control group, there was no difference between AV4 and the other evaluations. In the comparison between the two groups, there was no difference in the first three evaluations. However in AV4 the treatment group showed a smaller area of the striae in relation to the control group. In the qualitative analysis the treated group had lower visibility and less depth of the striae to the touch. CONCLUSIONS: Therapy with 12 sessions of low-level laser for four weeks had a positive effect on the treatment of striae alba, with results becoming evident only four weeks after the last application. The 660 nm laser showed to be a non-invasive, painless and fast-applied method.

Microagulhamento: série de casos associados drug delivery / Microneedling: a case series associated with drug delivery

A associação do microagulhamento com o drug delivery tem-se mostrado benéfica pois potencializa os resultados de ambas as técnicas. Seis pacientes foram submetidas a duas sessões dessa associação de técnicas no tratamento da face, mãos e estrias, com intervalo de 20 dias. As avaliações foram realizadas por fotografias comparativas padronizadas. Os resultados revelaram redução da acne e melhora das manchas e textura da pele na face, melhora das manchas e textura da pele das mãos, e redução das dimensões e visibilidade das estrias. O presente estudo apresentou resultados promissores associando microagulhamento e drug delivery para tratamentos dermatológicos em face, mãos e estrias.

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Radiofrequência pulsada com multiagulhas (RFPM®) no tratamento de estrias atróficas / Pulsed Radiofrequency with Multineedles (RFPM®) in the treatment of atrophic stretch marks

Introdução: As estrias atróficas representam alterações cutâneas caracterizadas pela perda de colágeno e elastina na derme, assemelhando-se a cicatrizes. Lasers fracionados, microagulhamento e peelings químicos têm apresentado bons resultados em alguns casos, mas não há um tratamento ideal. Objetivo: Avaliar a eficácia da radiofrequência pulsada com multiagulhas (RFPM®) em estrias tardias atróficas. Métodos: Estudo retrospectivo da segurança e efetividade da técnica mediante avaliação dos resultados por aplicação de questionário de satisfação aos pacientes e julgamento dos resultados clínicos por dermatologistas independentes. Resultados: Foram avaliados oito pacientes com idade entre 22 e 38 anos, submetidos à técnica, 100% dos quais relataram satisfação com os resultados, enquanto na avaliação comparativa das fotografias por dois dermatologistas independentes o índice de melhora foi de: 50% em dois pacientes e 75% em seis pacientes. A hiperpigmentação pós-inflamatória foi observada de dez a 20 dias após o tratamento em seis pacientes, tendo sido revertida após tratamento clínico. Conclusão: Esse novo procedimento se apresenta como alternativa ao tratamento de estrias atróficas.

Introduction: Atrophic stretch marks constitute skin disorders characterized by the loss of collagen and elastin in the dermis, and resemble scars. Fractional lasers, microneedling and chemical peels have led to good outcomes in some cases, however there is no ideal treatment. Objective: The objective of the present retrospective clinical study was to evaluate the effectiveness of Pulsed Radiofrequency with Multineedles (RFPM®) in late atrophic stretch marks. Methods: A retrospective study of the safety and effectiveness of the technique was carried out by evaluating outcomes with the application of a patient satisfaction questionnaire and the assessment of clinical results by independent dermatologist physicians. Results: A total of 8 patients (aged between 22 and 38 years) who underwent the technique were evaluated, of whom 100% reported satisfaction with the outcomes. Additionally, in the comparative evaluation of photographs carried out by two independent dermatologist physicians, the improvement rate was 50% in 2 patients and 75% in 8 patients . Post-inflammatory hyperpigmentation was observed in 10 to 20 days after the treatment in 6 patients, having been reversed after clinical treatment. Conclusions: The new procedure is an option in the treatment of atrophic stretch marks.

Evaluation of an ablative and non-ablative laser procedure in the treatment of striae distensae.

Background: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. Objective: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. Methods: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. Results: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. Conclusion: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.

Bullous Striae Distensae in a Pregnant Woman with Systemic Lupus Erythematosus / 대한피부과학회지

Striae distensae is linear bands of atrophic or wrinkled skin, which is usually developed due to being overweight, pregnant or an endocrine alteration. Also, the prototype of striae distensae is observed as a linear band with skin atrophy. However, bullous type of striae distensae is rarely reported in the literature. The patient is a 27-year-old pregnant woman who had general edema and abdominal distension caused by systemic lupus erythematous (SLE) and pregnancy. On the lower abdomen and thigh, she presented with bullous striae distensae resulted from collagen fiber disintegration induced by generalized edema as the secondary mechanism. We report a case of bullous striae distensae in a pregnant woman with SLE.

Striae Distensae on the Sclerodermoid Chronic Skin GVHD Lesion / 대한피부과학회지

Cutaneous chronic graft versus host disease (GVHD) is classified into lichenoid and sclerodermoid forms and may be associated with xerosis cutis, dyschromia, nail and hair changes. A 52-year-old woman was diagnosed with chronic myelogenous leukemia and underwent allogeneic non-myeloablative hematopoietic stem cell transplantation in October 2006. She presented with multiple linear atrophic striae on the erythematous to pigmented firm plaque on the abdomen for 1 year. A biopsy was taken from the linear atrophic striae and firm plaque, respectively. We report a rare case of striae distensae developed on the chronic sclerodermoid skin GVHD lesion diagnosed by clinicopathologic findings.

Avaliação clínica de uma formulação de uso tópico como auxiliar na prevenção de estrias na gestação / Clinical evaluation of a topical formulation to help prevent stretch marks during pregnancy

Introdução: As estrias ocorrem pelo rápido estiramento da pele, típico da gestação. Tratamentos tópicos vêm sendo estudados para prevenir seu aparecimento. Objetivo: avaliar a eficácia preventiva de estrias de uma formulação tópica. Métodos: Avaliaram-se 75 gestantes entre 18 e 40 anos. A área tratada foi o abdome, e a área-controle, a face interna do antebraço, com e sem o produto de teste, avaliando-se: maciez, hidratação e elasticidade além de medidas biofísicas para elasticidade e hidratação. Resultados: Das 75 gestantes, 52 finalizaram o estudo; destas, 9,6% apresentaram estrias na área abdominal tratada. Houve melhora significativa em os todos parâmetros clínicos avaliados (p<0,001). Nas medidas instrumentais, houve melhora significativa da hidratação e elasticidade na área abdominal, superior à da área-controle; quanto ao antebraço, também houve melhora significativa da área tratada em relação ao controle para ambos os parâmetros avaliados (p = 0,001). Comentários e Conclusão: A associação dos ingredientes da formulação (ácido láctico e lactato de sódio em emulsão com triglicerídeos do ácido caprílico e cáprico) foi capaz de aumentar os níveis de elasticidade e hidratação, reduzindo a incidência de estrias em comparação ao relatado em literatura.

Introduction: Stretch marks occur due to the rapid stretching of the skin, which is typical in pregnancy. Several topical treatments to prevent them have been studied.Objective: To evaluate the effectiveness of a topical formulation (lactic acid and sodium lactate in an emulsion with caprylic and capric acids' triglycerides) in the prevention of stretch marks.Methods: Seventy-five pregnant women aged 18-40 were assessed. The treated area was the abdomen and the control area was the inner forearm, with and without the application of the tested product. Softness, hydration, and elasticity ­ and biophysical measurements for hydration and elasticity ­ were evaluated. Results: Of the 52 women who completed the study, 9.6% presented stretch marks in the treated abdominal area. There was a significant improvement in all clinical parameters assessed (p < 0.001). There was a significant improvement ­ compared the control area ­ in the instrumental measurements of hydration and elasticity in the abdomen. A significant improvement was also verified in the treated forearm area compared to the untreated forearm area for both parameters evaluated (p = 0.001).Conclusions: The formulation improved the skin's elasticity and hydration, reducing the striae incidence more than previously reported in the literature.

Em busca dos tratamentos para Striae Rubra e Striae Alba: o desafio do dermatologista / In search of treatments for striae rubra and striae alba: a dermatologists' challenge

A estria atrófica cutânea ou striae distensae (SD) é dermatose muito comum, constituindo causa frequente de consulta ao dermatologista. Devido a seu caráter inestético, pode trazer importantes consequências psicossociais e na qualidade de vida. O objetivo do trabalho foi revisar as possibilidades de tratamento preconizadas na literatura para estrias recentes e antigas. Diante da multiplicidade de fatores etiológicos envolvidos, a literatura é divergente e ampla sobre o tratamento.

Cutaneous atrophic striae (or striae distensae) is a very common skin condition that frequently motivates dermatological consultations. Due to its unaesthetic appearance, it can have a significant impact on patients' psychosocial status and quality of life. This study reviews the literature involving possible treatments for more recent and older cutaneous striae or stretch marks. Given the great number of etiological factors involved, the literature is abundant and divergent regarding the treatment of the condition.

Avaliação histológica comparativa da eficácia de ácido tricloroacético e subcisão, isolados e combinados, no tratamento de estrias abdominais / Comparative histological evaluation of the effectiveness of trichloroacetic acid and subcision (isolated or combined) in the treatment of abdominal striae

Introdução: estrias são consideradas cicatrizes, não sendo conhecidos tratamentos resolutivos para essa condição. Objetivo: comparar a resposta de três modalidades terapêuticas: subcisão , subcisão + ATA 20% e ATA 20% no tratamento de estrias. Métodos: 11 pacientes portadoras de estrias em abdômen inferior, dividido em quadrantes: uma estria de cada quadrante foi submetida a: subcisão, subcisão + ATA 20% e ATA 20%, respectivamente. O quarto quadrante foi utilizado como controle. Cada estria selecionada foi biopsiada antes e após 12 semanas. Para avaliar a eficácia, utilizou-se o teste de Wilcoxon. Para ava-liar comparativamente as diferenças entre os tratamentos foi aplicado o teste de Kruskal-Wallis. Resultados: Em todos os tratamentos realizados houve redução da média pré e pós-tratamento; no entanto, o tratamento com ATA 20% mostrou-se estatisticamente significativo no parâmetro epidérmico e na coloração de fibras colágenas. A subcisão associada ao ATA 20% teve resultado estatisticamente significativo no parâmetro derme superficial enquanto a subcisão isolada mostrou-se significativa apenas na derme superficial. Realizou-se uma sessão de tratamento, sendo necessários estudos subsequentes para avaliação clinico-histológica após número maior de sessões. Conclusões: Os tratamentos propostos são seguros e de baixo custo operacional, sendo ótima opção para estrias abdominais.

Introduction: Abdominal striae(i.e. stretch marks) are considered scars, for which there are no known treatments. Objective: To compare the effectiveness of three treatments: subcision, 20% trichloroacetic acid, and subcision + 20% trichloroacetic acid in the treatment of stretch marks. Methods: The lower abdomens of 11 patients with stretch marks were divided into four quadrants. Each patient had one stria selected for a single treatment session; the three treatments (subcision, 20% trichloroacetic acid, and subcision + 20% trichloroacetic acid) were administered in 3 quadrants, and the 4th quadrant served as a control. Each selected stria was biopsied before and after 12 weeks. The Wilcoxon test was used to evaluate the efficacy of the treatment. The Kruskal-Wallis test was used to evaluate the differences between the treatments. Results: In all treatments there was a reduction in the mean value after treatment, however the 20% trichloroacetic acid treatment was statistically significant for the epidermalparameter and the collagen fiber staining. The subcision associated with 20% trichloroacetic acid presented a statistically significant result in the superficial dermis parameter, while the isolated subcision was significant in the superficial dermis parameter only. Conclusions: These treatments are safe and present low operating costs, which make them a great alternative for treating abdominal striae. Future studies should conduct a clinical-histological evaluation after a greater number of sessions.

Could a Growth Spurt Cause Linear Focal Elastosis Like Striae Distensae?

Linear focal elastosis (LFE) is characterized by several asymptomatic, yellow, palpable, irregularly indurated, striae-like lines extending horizontally across the middle and lower back. A focal increase in elastic fibers is a hallmark of the disease as seen from biopsy specimens. The pathogenesis of LFE is unclear, as is the association between LFE and striae distensae (SD). However, the prevailing opinion is that LFE represents an excessive regenerative process of elastic fibers and is analogous to keloidal repair of SD. Although the timing of onset of LFE and SD was not synchronous in our patient, the triggering factor was the same, which was the growth spurt. This case is supporting the putative association between LFE and SD.

Insight into Striae Distensae with Cosmetic Concern in Korean Women / 대한피부과학회지

BACKGROUND: Striae distensae is a common skin condition that can happen to everyone. Most cases do not have serious problems, but those who are affected may suffer from strong cosmetic stress. There was an epidemiologic study of striae distensae in Korean adolescents. Up to now, variable treatment modalities have been tried including topical application of tretinoin and light-based therapy using pulsed dye lasers or fractional lasers. OBJECTIVE: To evaluate the prevalence of striae distensae in Korean women and estimate their understanding. METHODS: We carried out a survey targeting 256 healthy female adults without a history of medical disease and analyzed the results. RESULTS: The number of patients with striae distensae were 219 (86.0%). Striae distensae was mostly seen at the thigh and calf (84.0%) and longitudinal formed striae, with their long axis parallel to the lines of skin tension, was the most frequent shape (44.0%). The most common color of the striae distensae was white (56.0%) and 78% of patients had experienced this before adulthood. Striae distensae is caused by two major factors, overweight (70.0%) and growth spurts (24.0%), and 244 patients (76.0%) replied that they felt uncomfortable because of this disorder. Nineteen patients (8.6%) with striae distensae had gone through treatment. Among them, 11 (5.0%) had technical treatment in dermatologic clinics such as, pulse dye laser, fractional laser, and chemical peeling. Eight patients (3.7%) were treated with folk remedies including moxibustion and acupuncture therapy. However, 154 patients (71%) responded that they wanted treatment for the striae lesion, and 93 patients (43%) have great intention to treatment. CONCLUSION: A lot of patients are still suffering from striae distensae, but so far there is no appropriate treatment. The biggest problem is that there is very little understanding of striae distensae. Patients should be aware of their striae distensae and we should provide appropriate treatment.

Linear Focal Elastosis Following Striae Distensae: Further Evidence of Keloidal Repair Process in the Pathogenesis of Linear Focal Elastosis

Linear focal elastosis (LFE) is a rare dermal elastosis characterized by hypertrophic yellowish linear plaques and increased abnormal elastic tissues in the lumbosacral area. Although the pathogenesis of this disorder remains unknown, it may be associated with keloidal repair process (KRP) of elastic tissues in striae distensae (SD), because there have been some reported cases of LFE accompanied by SD. We herein report a 14-year-old boy with LFE following SD in the lumbar region. Our case supports the hypothesis of KRP in the pathogenesis of LFE. Immunohistochemical study for transforming growth factor-beta (TGF-beta) was negative. Therefore, we assume that the pathogenesis of KRP in LFE is different from that of keloid development, which is the TGF-beta signaling pathway.

Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial

BACKGROUND: Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite 'gold standard' treatment modality has been determined. OBJECTIVE: To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO2 fractional laser resurfacing in the treatment of striae distensae. METHODS: Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO2 laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study. RESULTS: Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO2 fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites. CONCLUSION: These results support the use of nonablative fractional laser and ablative CO2 fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.

Treatment of Striae Distensae by Thermage and 585-nm Pulsed Dye Laser(V-star(R)) / 대한피부과학회지

Striae Distensae is a very common cosmetic problem. The effectiveness of various lasers, such as the 585-nm pulsed dye laser on the treatment of striae distensae has recently been reported. However, the potential pigmentary alteration of dark skin by pulsed dye laser is known. Thermage is a radiofrequency capable of delivering higher energy fluences to a greater volume of tissue than nonablative lasers, with no epidermal injury. We report three patients who had striae distensae. They were treated with Thermage and 585-nm pulsed dye laser. The treatment was effective and safe for dark skin.