Comparison between topical recombinant human epidermal growth factor and Aloe vera gel in combination with ablative fractional carbon dioxide laser as treatment for striae alba: A randomized double-blind trial.

Abstract

Striae distensae are linear atrophic dermal scars. Despite several currently available therapeutic modalities, no consistently effective therapies have been established. This study aimed to evaluate and compare the efficacy of topical recombinant human epidermal growth factor (rhEGF) and ablative fractional carbon dioxide (CO2 ) laser (AFXL) versus ablative fractional CO2 laser and topical Aloe vera gel in treating striae alba. A total of 24 participants with striae alba were enrolled. Patients' striae were divided into the left and right sides. Participants were treated with fractional CO2 laser on both sides for three sessions at 4-week intervals. Immediately after the laser treatment, each side of the striae was randomly assigned to either rhEGF or Aloe vera gel treatment. Patients were required to apply the medication twice daily up to 1 month after the last laser treatment session. Texture, average melanin, and melanin variation were assessed at pretreatment, 1 month after the first, second, and third treatments, and 6 months after the last treatment. Participants were asked to complete a self-administered questionnaire. Nine participants underwent skin biopsies of the nontreated and treated striae, which were obtained from each treated side. Both sides of the treatment area showed significant improvement in texture starting from 1-month follow-up, which sustained up to 6 months after the final treatment, albeit without statistically significant difference between the rhEGF- and Aloe vera-treated sides (P < 0.001, 0.003, and 0.002 for the AFXL-rhEGF-treated side and P = 0.024, 0.001, and 0.001 for the AFXL-Aloe-treated side at 1 month after the first treatment, 1 month after the last treatment, and 6 months after the last treatment, respectively). Participants expressed satisfaction with the AFXL-rhEGF-treated side, which showed significantly greater marked improvement (at 50%) than the AFXL-Aloe-treated side at 6 months after the final treatment (P = 0.034). Post-inflammatory hyperpigmentation (PIH) occurred in 95.8% of participants, which decreased after 6 months compared with baseline. Both treatments improved melanin variation at 6 months after the final treatment, although without significant difference from pretreatment between both groups. Skin biopsy revealed a statistically significant increase in epidermal thickness and decrease in elastic fragmentation in both groups. AFXL-rhEGF and AFXL-Aloe significantly improved the striae surface texture. PIH was the most common side effect, which improved at 6 months. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.