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1. Stretch marks................................................................................................................................................ 1
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Stretch marks
Author: Kaufman, Joely, MD
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Abstract: None of these preventive measures have been proven in clinical trials, though several, including
cocoa butter and shea butter, have had a reputation for this purpose. Fractional resurfacing offers a possible
mechanism to remedy many of the associated components of a stretch mark The ability to resurface off-face,
which in the past was not possible with classic resurfacing devices, may offer a new weapon in the war against
stretch marks.
Full text: Headnote
Using lasers, light devices for treating striae
Striae distensae are a very common post-pregnancy complaint in women, yet they frequently occur in other
situations, as well. Obesity, rapid weight gain or weight loss, puberty or weightlifting can also cause striae.
Chronic use of topical steroids, especially in intertriginous or Cushing's syndrome also will lead to stretch marks.
Some data suggests that up to 90 percent of pregnant women will develop striae, and up to 70 percent of
adolescents (females more than males). With this high of an incidence - and no cure - we can definitely expect
to see more research and development in this area.
Histologically, striae demonstrate atrophy of the epidermis with flattening of the rete ridges. The dermal collagen
is densely packed, similar to a scar. Elastic fibers are thin and fragmented.
Ideally, treatment of striae would target all of these components, including the epidermis, dermal collagen and
abnormal elastin. Possible preventive measures include keeping the skin moist, hydrated and healthy.
Elastic skin may be less likely to tear with stretching. Regular use of moisturizers including oils may help
achieve these results. None of these preventive measures have been proven in clinical trials, though several,
including cocoa butter and shea butter, have had a reputation for this purpose.
In my opinion, true prevention does not exist, leaving much of the focus on treatments.
Treatments for stretch marks are paramount, but most are based on theory and anecdotal reports, and not true
science.
Topically applied retinoids have been shown to clinically improve the appearance of early striae. Tretinoin .05
percent to 0.1 percent should be applied nightly, as tolerated. If no desquamation ensues, application can be
increased to twice a day.
For those patients who cannot tolerate tretinoin application without side effects, combination with a lipid
containing moisturizer may increase tolerability.
Other topical medicaments for treatment of striae include growth factor creams, peptide products, retinols,
trichloracetic acid peels and microdermabrasion.
Many of the creams marketed for striae contain "proprietary proteins and peptides" which can run from $40 to
$240 for a 6-ounce tube-per ounce, the cost of American caviar. Months of treatments may be necessary for
results, resulting in a possibly large financial burden for no guaranteed improvement.
As our laser armamentarium has become more sophisticated, is there now a role for these devices in the
treatment of striae?
Let s take a systematic approach to the problem. Since the histologic changes in striae occur in the epidermis
and dermis, a deep-penetrating laser would be ideal. In addition to penetration into the dermis, restructuring and
thickening of the epidermis, plus a remodeling of both elastin and collagen fibers, would be necessary.
These are many of the same goals of laser treatments for photoaging. The erythema associated with striae
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rubra would also need to be amenable to this wavelength. The device must also be safe for use off-face, since
most striae occur there. It may be that one device is not enough to eliminate these lesions. Also, striae rubra
may end up responding differently than older striae alba lesions.
Lasers have been used in striae since McDaniel reported the use of the pulsed dye laser (PDL) on stretch
marks in 19%. Originally lasers, like the PDL, had their best success at treating striae rubra.
The erythema in the stretch mark was used as the chromophore for PDL's 585/595 nm wavelength with much
success. Erythema of the striae was reduced in several studies, improving the cosmetic appearance of the
lesion, but not eliminating it.
Erythema in striae responds best to low-fluence treatments using PDL with a larger spot size, perhaps
correlating with deeper laser penetration. Still, little to no response at all was seen for the textural component of
the lesions.
Current reports on treatment for striae distensae include use of fractional resurfacing devices including Fraxel
Restore (1550 nm) (Kin, 2008), RF + 585 nm pulsed dye (Suh, et al, 2007), eximer laser (Goldberg, et al, 2005)
and intense pulsed light (IPL) (Hernandez-Perez, et al, 2002).
In most studies, pulsed dye lasers were effective at reducing erythema of striae rubra, but not effective at ,
improving the appearance of striae alba (Jimenez, et al, 2003).
When used in combination with a radiofrequency device (Thermage), a histologie increase in collagen was
noted, with 59 percent of patients noting a "good" improvement in elasticity.
Eximer lasers (UVB) showed some promise at repigmenting striae alba, but as expected, no improvement in the
textural component of the stretch mark.
Nonablative devices, such as the Smoothbeam (1450 nm, Candela), have clinically not been very useful,
though they do increase collagen histologically.
Fractional resurfacing offers a possible mechanism to remedy many of the associated components of a stretch
mark The ability to resurface off-face, which in the past was not possible with classic resurfacing devices, may
offer a new weapon in the war against stretch marks.
Epidermal turnover and increased collagen production and elastin remodeling, make these devices almost ideal
for striae and scars. There are only few published studies to date on striae and fractional resurfacing.
A study using fractional resurfacing (Fraxel Restore, Reliant) on six patients showed both clinical improvements
in melanin and erythema indices, and also elasticity (Kin, et al, 2008).
Histologically, an increase in collagen and elastin deposition was visualized, as well as an increase in epidermal
thickness. These devices are only moderately effective at removing erythema, as their target is water and not
hemoglobin.
As we have seen in our clinic, these devices maybe more effective on striae alba than striae rubra. Also,
combination with a PDL prior to fractional resurfacing for striae rubra may yield the most impressive results.
Sidebar
Treatments for stretch marks are paramount, but most are based on theory and anecdotal reports, and not true
science.
Sidebar
As our laser armamentarium has become more sophisticated, is there now a role for these devices in the
treatment of striae?
AuthorAffiliation
BY JOELY KAUFMAN, M.D.
CONTRIBUTING AUTHOR
Subject: Lasers; Studies; Clinical trials;

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Publication title: Dermatology Times


Volume: 29
Issue: 4
Pages: 54
Number of pages: 1
Publication year: 2008
Publication date: Apr 2008
Year: 2008
Section: Cosmetic Dermatology
Publisher: Advanstar Communications, Inc.
Place of publication: North Olmsted
Country of publication: United States
Publication subject: Medical Sciences--Dermatology And Venereology
ISSN: 01966197
CODEN: DETIEG
Source type: Trade Journals
Language of publication: English
Document type: News
Document feature: Photographs
ProQuest document ID: 231208606
Document URL: http://search.proquest.com/docview/231208606?accountid=50673
Copyright: Copyright Advanstar Communications, Inc. Apr 2008
Last updated: 2013-12-04
Database: ABI/INFORM Complete

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Bibliography
Citation style: Vancouver
(1) Kaufman J. Stretch marks. Dermatology Times 2008 04;29(4):54.

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