Percutaneous Collagen Induction Therapy as a Novel Therapeutic Option for Striae Distensae

Abstract

Sir: The occurrence of striae distensae is a well-recognized, common skin condition that rarely causes any significant medical problems but is often a significant source of distress to those affected. Striae are atrophic linear plaques, most often found on the breasts, abdomen, hips, and thighs in the dermal layer. This disruption of collagen-elastic matrix may develop in a variety of circumstances, such as during adolescent growth spurts, and during hormonal changes, such as Cushing syndrome. Striae gravidarum are widely known to occur in pregnancy and, aesthetically, they can be a cause of great concern for many women. Maternal age, body mass index, weight gain, and neonatal birth weight were independently associated with the occurrence of striae gravidarum.1 It appears that the group at highest risk of developing severe striae are teenagers. Treatment is often anecdotical. To date, no therapeutic option offers complete treatment.2 Cocoa butter was recently studied in a randomized controlled trial for prevention of striae gravidarum but failed to be effective.3 Percutaneous collagen induction therapy is capable of dermal rejuvenation by smoothing of the skin by thickening the epidermal layers and expression of genes and proteins relevant for dermal regeneration without the risk of dyspigmentation.4,5 Percutaneous collagen induction works best in combination with a scientific skin care program. In contrast to ablative laser therapy, the epidermis remains intact. Thus, the procedure can be repeated safely if needed, and it is also applicable to regions where laser treatments or deep peelings cannot be performed. Twenty-two female patients with stretch marks underwent single percutaneous collagen induction therapy in an outpatient setting. All patients had conventional tumescence anesthesia. The procedure took a mean time of 30 minutes, without any immediate adverse effects, such as abdominal perforation or infection. Follow-up assessment was performed 6 months after the intervention. Assessment of the result revealed improved skin texture, skin tightening, dermal neovascularization, and no change of pigmentation (Fig. 1). Biopsy specimens obtained 6 months after the intervention revealed an increase of collagen I and elastin (Fig. 2). Collagen III was not affected at all.Fig. 1.: Preoperative (above) and postoperative (6 months after treatment) (below) clinical images.Fig. 2.: Preoperative (above) and postoperative (6 months after treatment) (below) histologic photomicrographs of striae distensae showing a considerable normalization of the collagen/elastin matrix in the reticular dermis and an increase in collagen deposition at 6 months postoperatively. The collagen appears not to have been laid down in parallel bundles but is rather in the normal lattice pattern. Masson's trichrome staining. Scale bar = 50 μm (representative example).Given this preliminary clinical observation of percutaneous collagen induction therapy in striae distensae, we strongly believe that further large-scale and possibly randomized controlled trials are mandatory to elucidate the value of this promising technique. DISCLOSURE Dr. Aust is a medical consultant for Care Concept, distributors for Environ Skin Care Products and Roll-CitR in Germany. Neither of the other authors has any financial information to disclose. Matthias C. Aust, M.D. Karsten Knobloch, M.D., Ph.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany