Comparison of the effectiveness of two fluences using long-pulsed Nd:YAG laser in the treatment of striae distensae. Histological and morphometric evaluation

Abstract

Striae distensae are common undesirable skin lesions of significant aesthetic concern. To compare the efficacy of two fluences (75 and 100 J/cm) of long-pulsed Nd:YAG laser in the treatment of striae. Forty-five patients (Fitzpatrick skin types III-V) aged between 11 and 36 years with striae (23 patients with rubra type and 22 with alba type) were enrolled in the study. Each stria was divided into three equal sections, whereby the outer sections were treated with long-pulsed 1064 nm Nd:YAG laser, at a fluence of 75 or 100 J/cm, and fixed laser settings of 5 mm spot size and 15 ms pulse duration. The middle section was an untreated control. All subjects received four treatments at 3 weeks interval. Three 2-mm punch biopsies were taken from six subjects, all of the same stria, one before treatment and the other two from the outer sections, 3 months after the last session. Paraffin-embedded skin sections were subjected to histological and quantitative morphometric studies for collagen and elastic fibres. Results were assessed clinically through photographic evaluation and were considered satisfactory for both doctors and patients. A significant improvement in appearance of striae alba using 100 J/cm was found while striae rubra improved more with 75 J/cm. Histologically, collagen and elastin fibres increased in posttreatment samples. A satisfactory improvement in striae distensae lesions was seen through clinical and histological evaluation. Thus, long-pulsed Nd:YAG laser is a safe and effective module of laser treatment for these common skin lesions.

Dermoscopy and VISIA imager evaluations of non‐insulated microneedle radiofrequency versus fractional CO2 laser treatments of striae distensae

“…Biopsies have been used as a more objective evaluated tool, but are invasive procedure and may result in scarring, which is not acceptable for all patients. 1,2,6,10,11,26,27 A non-invasive but objective evaluation method for SD treatment has thus been urgently needed.…”

“…Striae distensae (SD), also known as a stretch mark, is a common cosmetic issue. 1 The exact pathogenesis of SD is still unclear, but mechanical stretching of the skin is one of the primary causes that can result from adolescent growth, pregnancy, bodybuilding or sudden weight changes. SD often presents on the abdomen, breasts, thighs or buttocks, and occurs in 70% of pregnant women (where it is referred to as striae gravidarum).…”

“…Topical and acid peel treatments often produce little improvement . Different laser/light therapies have shown some benefits, such as intense pulsed light (IPL), flash‐pumped 585‐nm pulse dye laser (PDL), 308‐nm excimer laser,1064‐nm Nd:YAG laser and non‐ablative fractional photothermolysis . However, caution is required with these interventions because of Post‐inflammatory hyperpigmentation (PIH) occurrence in darker skin types .…”

Carboxytherapy for striae distensae: A promising modality

“…Deficiency of fibrillin was reported to have a crucial role in SD histogenesis 11 . Many types of minimally invasive procedures are at hand for management of SD including; skin needling, microdermabrasion, chemical peels, mesotherapy, platelet‐rich plasma, stem cell therapy, soft tissue fillers, nonablative light‐based rejuvenation, fractional photo‐thermolysis, radiofrequency, and carboxytherapy 12‐17 …”

Striae distensae treatment review and update

“…Goldman et al have used it successfully for SR.[52] In another study by Elsaie with the use of two different fluences, investigators reported significant improvement in SA at higher energy of 100 J/cm 2 , while SR responded better with 75 J/cm 2 (four sessions). [53] An Egyptian study by El-Ramly et al failed to show any statistically significant clinical improvement in SD after four sittings of Nd:YAG laser. [54]…”