BackgroundStriae distensae or stretch marks, although not a health risk, are of significant cosmetic concern as it affects the patient's psychological condition. Although many treatment modalities have been attempted with variable results, there is no standard treatment modality for it. Objective To compare the efficacy of a microneedling system (dermaroller) when used alone or combined with 15-30% trichloroacetic acid (TCA) in the management of striae rubra. Patients and methodsThis clinical trial included 30 female patients with abdominal striae rubra treated with a dermaroller alone on the left side of the abdomen (GI) and with a dermaroller + 15-30% TCA on the right side of the abdomen (GII). Patients were treated for six sessions at 3-week intervals. We assessed the clinical features (length, width, color, and texture) of striae in each group at every session and 3 weeks after the end of the sessions (follow-up). The response to treatment was assessed objectively by the treating physicians and skin biopsies stained with hematoxylin and eosin and picrosirius red stains. Subjective assessment of the clinical photographs and patient satisfaction scores was carried out by two uninvolved blind dermatologists at every session. Results A comparison between GI and GII at the follow-up session revealed statistically significant differences in length (P = 0.002), width (Po0.001), color, and texture (P = 0.049 and 0.041, respectively). More improvement in the striae was noted in GII, as 19 (63.3%) patients showed good to excellent improvement compared with 10 (33.3%) patients in GI. Skin biopsies in GII showed increased epidermal thickness after treatment (Po0.005). Collagen content was increased after treatment in both groups. Side effects including transient erythema, edema, burning pain, and hyperpigmentation were observed more in GII with increasing concentration of TCA peeling. ConclusionBoth dermaroller and dermaroller + 15-30% TCA are effective treatment modalities for striae rubra. However, dermaroller + 15-30% TCA gives better results and dermaroller alone has fewer side effects.