Striae Rubra Research Articles

Matrix metalloproteinase-1 serum level in association with the occurrence of striae distensae

Introduction: Striae distensae are fine atrophic scar tissue on the skin. They are formed on areas with dermal collagen rupture due to excessive stretching of the skin. Matrix metalloproteinase-1 (MMP-1) is an enzyme that degrades collagen types I and III. An imbalance in the expression of MMP-1 and transforming growth factor-beta (TGF-β), cytokine that trigger the synthesis of new collagen, leads to imperfect dermis remodeling process in atrophic scar tissue, which is a clinical appearance of striae distensae. This study aimed to determine the association between serum MMP-1 level and striae distensae. Methods: We conducted an observational cross-sectional study on 40 females with striae distensae and 40 controls. History taking, physical and dermatological examination, followed by blood sampling analysis of serum MMP-1 level with ELISA method were conducted in all subjects. Results: The mean serum MMP-1 levels in the striae distensae group were 51.54±28.03 ng/dL. All subjects in the striae distensae group had striae albae and only 7 subjects (17.5%) had striae rubrae. The most common location of striae distensae is the combination of femoral and gluteus regions (25%). The results of this study showed a relationship between high MMP-1 levels and the risk of striae distensae by 4.89 times (p = 0.002). Conclusion: There was an association between serum MMP-1 levels and striae distensae.

Cutaneous changes in obese patients before and after bariatric surgery

Background: Obesity being a multi-organ disease also affects the skin. Bariatric surgery results in the improvement or remission of many obesity-related comorbid conditions, as well as sustained weight loss and improvement in quality of life. After bariatric surgery, both positive and negative impacts on the skin are seen. Studies have reported improvement in many skin conditions. The present study was conducted with the aim to find cutaneous changes in obese patients before and after bariatric surgery were assessed. Methods: This prospective, observational study included 61 obese subjects who had undergone bariatric surgery. clinical findings of skin, nails, and hair before and after bariatric surgery at 3 months, 6 months, and 9 months follow-up were also recorded. Results: Mean age of the subjects was 44.4±13.284 years. Bariatric surgery resulted in a significant decrease in BMI [40.3 (38.25-42.70) vs 32.0 (30-35) kg/m2]. The median of % effective BMI change was 20.46% (17.12%-24.66%) kg/m2. Amongst obese subjects, the most frequently seen skin condition was acanthosis nigricans [17 (27.9%)] followed by acrochordon [15 (24.6%)] and intertrigo [10 (16.4%)]. Our study showed no significant difference in the prevalence of various skin conditions/diseases before and after the bariatric surgery except for intertrigo, tinea corporis, and striae rubra. Conclusions: various skin/hair/nail conditions and/or diseases develop amongst obese individuals, acanthosis nigricans, acrochordon, intertrigo, seborrheic dermatitis, chronic telogen effluvium, onychomycosis, and longitudinal ridges are common. Weight loss after bariatric surgery provided improvement in skin conditions/diseases.

619 Preventive effect of a dermocosmetic product containing an active ingredient complex, Cicahyalumide® and Rhealba® Oat plantlets extract, on stretch mark appearance

Stretch marks are common lesions of the skin appearing under mechanical overstressed, observed during rapid weight, growth variations or pregnancy. Stretch marks are caused by molecular, cellular and fibrillar damages to the skin, affecting its overall organization. There is a characteristic maturation of stretch marks, which begins as striae rubrae, reversible inflammatory lesions but shift to striae albae, irreversible scars. Thus, it is important to specifically act on the prevention of stretch mark emergence.

Ectopic-Adrenocorticotropic Hormone secretion in adolescents and young adult patients with neuroendocrine neoplasm: a challenge for clinical and social management

Well and poorly differentiated neuroendocrine neoplasms (NENs) may be associated with an ectopic production of Adrenocorticotropic Hormone (ACTH) [1] that leads to a paraneoplastic Cushing Syndrome (CS). This heterogeneous clinical pattern is the result of a hypercortisolism [2] due to an uncontrolled and continuous hyperstimulation of the adrenal cortex, which escapes the negative feedback of the Hypothalamus-Hypophysis axis [3]. Among NENs, ectopic-ACTH secretion (EAS) has been historically associated with small-cell lung cancers (SCLCs), but the improvement of the knowledge and diagnostic techniques led to a broadening of the causes also to NENs with different morphologies and from other sites [4]. According to the previous published data, EAS by gastro-entero-pancreatic (GEP) NENs occurs in almost 13% of cases. Irrespective of the NENs site of origin and the biology (which means morphology and proliferation index), the CS may represent a life-threatening condition for the patients due the consequences of the mineralocorticoid effect of persistent high levels of cortisol. These patients may experience a plethora of different symptoms which includes diffuse oedema, overweight/obesity of the trunk and striae rubrae, but also severe hypokalemia and hypertension, that represent medical emergencies and tumor fatal consequences even without a progression disease [1]. EAS may initially occur with non-specific clinical manifestations, as psychiatric complaints, recurrent orthopedic issues, sexual and reproductive disfunctions [3] that are not easily related to a tumoral cause and lead the patient presents to many specialists before being referred to an endocrinology / oncology Center. For all these reasons, CS diagnosis is often delayed. In a very small pool of cases [5], EAS may occur in the peculiar category of the adolescents and young adults (AYA) patients, worldwide defined as the cancerpopulation between 15 and 39 years of age [6]. Generally, the cancer diagnosis in AYA population is delayed, on one hand due to the sense of invulnerability and the minimizing of the symptoms of AYA patients and, on the other, the trend of the providers to a low suspicion of cancer in AYA population. Therefore, the features of the AYA category together with the equivocal clinical patterns of CS may lead to a delay of the diagnosis and management of EAS by extra-pituitary NENs [3, 7]. Here we reported the case of a NEN AYA patient with CS by EAS and a review of the literature on this topic in this peculiar population.

Efficacy of Fractional Co2 Laser and Human Lyophilized Growth Factors in the Treatment of Stretch Marks: A Clinical and Histopathological Study

Abstract Background Striae distensae are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The natural evolution of striae is from red or purple, raised wavy lesions (striae rubra) to white atrophic lesions with wrinkly surface (striae alba). Objectives The present study was designed to compare the efficacy of fractional CO2 laser alone or combined with lyophilized growth factors or to its efficacy alone in the treatment of striae distensae. Patients and Methods The present study included 20 female patients with SD; they were all recruited from Dermatology Outpatient Clinic, Ain Shams University from may 2017 to march 2018. An informed consent for treatment, photography and punch biopsy was taken before enrollment and the study was approved by Dermatology Research Ethical Committee. Results The present study showed statistically significant clinical and histopathological improvement in areas A and B after treatment. This impronment was in rubra more than alba. Area C showed no clinical and histopathological improvement. Area B showed better results than area A.We propose that LGF alone did not show clinical or histopathologiacl improvement. Treatment was tolerated well by all patients where side effects were minimal in the form of transient PIH that resolved after using bleaching creams. There was no statistically sgnificant difference in the incidence of PIH between areas A& B. Conclusion We concluded that fractional CO2 alone is effective in treatment of SD especially stria rubra in skin type III and IV.

An update in the etiopathogenesis of striae distensae: A review article.

Striae distensae (SD), also known as stretch marks, are common skin lesions causing significant psychological stress and cosmetic disfigurement. They are common to be seen during pregnancy, rapid weight change, puberty and many other pathological conditions including Cushing disease, anorexia nervosa or even excessive use of certain drugs. Clinically, they appear as either red raised linear bands known as striae rubrae (SR) or white depressed atrophic bands known as striae albae (SA). They were first described histopathologically in 1889. Many theories have been established to explain the etiopathogenesis of SD, yet the exact mechanism is still unclear. Also, many treatment modalities have been applied to reach the maximum efficacy with the least side effects. The aim of this review article is to optimize the most recent and accepted concepts on etiopathogenesis and pathophysiology of SD which may help in finding the best lines of management with the most satisfactory outcomes.

A RARE CASE OF PHEOCROMOCYTOMA IN PREGNANCY EXACERBATED BY METOCLOPRAMIDE

Objective: Pheocromocytoma (PHEO) is a rare catecholamines secreting tumor presenting with variable clinical setting, mostly with headaches, sweating, palpitation and poor controlled arterial hypertension. In 85–90% of cases, tumors are of adrenal gland origin while in 10–15% are commonly located in paravertebral sympathetic plexus. The prevalence of PHEO in hypertensive patients ranges between 0.1 and 0.6%; PHEO is extremely rare during pregnancy with a prevalence of 1 in 54000 pregnancies thus, delayed diagnose may cause life-threatening situations. Accurate identification of PHEO during the antenatal period reduces the risk of mortality for mother and fetus. Design and method: We described a case of 33 years old pregnant woman with a one-year history of grade I hypertension. Results: The patient has been previously evaluated by endocrinologist for the onset of “striae rubrae” associated with illness, muscle pain, asthenia, anxiety, palpitations and weakness; lab tests were negative for hypercortisolism thus clinicians hypothesized a “functional syndrome”. However, during the 28th week of gestation she was admitted to the emergency room because of severe headache and severe arterial hypertension. CT brain scan was negative for acute events, lab tests showed mild hypokalemia and proteinuria. An in depth revaluation of the clinical history revealed a treatment with metoclopramide taken one week earlier. Conclusions: Metoclopramide can stimulate catecholamine- and granin-derived peptide secretion from PHEO cells through activation of serotonin type 4 (5-HT4) receptors and induced PHEO crisis. Thus, under suspicion of PHEO exacerbated by metoclopramide we performed lab tests resulted positive for catecholamines secretion while aldosterone and renin levels were normal. Abdomen ultrasound and MRI showed oval lesion located in right adrenal gland confirming diagnosis of PHEO. We started treatment with alpha and beta blockers associated with calcium-antagonist; at 33th week, patient underwent a caesarean section and after seven weeks a videolaparoscopic right adrenalectomy, obtaining a normalization of blood pressure levels.

Hidden hypercortisolism: a too frequently neglected clinical condition.

Classic Cushing's syndrome (CS) is a severe disease characterized by central obesity, hypertension, easy bruising, striae rubrae, buffalo hump, proximal myopathy and hypertricosis. However, several CS cases have also been reported with unusual or camouflaged manifestations. In recent years, several authors investigated the prevalence of "hidden hypercortisolism" (HidHyCo) among subjects affected with bone fragility, hypertension and type 2 diabetes mellitus (DM2). The prevalence of the HidHyCo is estimated to be much higher than that of classic CS. However, similarly to classic CS, HidHyCo is known to increase the risk of fractures, cardiovascular disease and mortality. We reviewed all published cases of unusual presentations of hypercortisolism and studies specifically assessing the HidHyCo prevalence in diabetic, osteoporotic and hypertensive patients. We found 49 HidHyCo cases, in whom bone fragility, hypertension and diabetes were the presenting manifestations of an otherwise silent hypercortisolism. Amongst these cases, 34.7%, 32.7%, 6.1% and 19.0%, respectively, had bone fragility, hypertension, DM2 or hypertension plus DM2 as the sole clinical manifestations of HidHyCo. Overall, 25% of HidHyCo cases were of pituitary origin, and bone fragility was the very prevalent first manifestation among them. In population studies, it is possible to estimate that 1-4% of patients with apparent primary osteoporosis has a HidHyCo and the prevalence of this condition among diabetics ranges between 3.4 and 10%. These data indicate that patients with resistant or suddenly worsening hypertension or DM2 or unexplainable bone fragility should be screened for HidHyCo using the most recently approved sensitive cut-offs.

MON-LB039 Acute Paraneoplastic Cushing’s Syndrome in a Patient With Small Cell Lung Cancer and Co-Incidental Adrenal Adenoma: A Case Report

Background: Paraneoplastic Cushing’s syndrome is a rare cause of hypercortisolism associated with high morbidity, especially in patients with small cell lung cancer. Therefore, early diagnosis and treatment are critical. Clinical Case: Herein we present the case of a 58-year-old man who was referred to the endocrinology department, because of refractory hypokalemia (potassium 2.4 mmol/l; RI: 3.4 - 4.5 mmol/l) despite high potassium supplements and spironolactone therapy. History was remarkable for a metabolic syndrome with newly aggravated hypertension and a 60-pack-year smoking history. The patient reported a 20 kg weight gain in 6 weeks and proximal muscle weakness. On examination, he was overweight (BMI 44.8 kg/m²) with bilateral pitting edema. Other features of hypercortisolism such as striae rubrae, facial plethora or ecchymoses, respectively, were not apparent. Initial biochemical tests showed severe hypokalemia and metabolic alkalosis. Night-time salivary cortisol (205 nmol/l; RI: < 2.5 nmol/l), 24-hour urinary free cortisol (> 4357 nmol/24h; RI: 99 - 378 nmol/24h) and serum ACTH (158 ng/l; RI: < 61 ng/l) were markedly elevated. While the MRI of the head demonstrated no pituitary pathology, the CT of thorax and abdomen revealed a pulmonary mass as well as an incidental right adrenal mass. Bronchoscopic biopsy of the pulmonary mass confirmed the suspected diagnosis of ACTH-producing small cell lung cancer. The dignity of the right adrenal mass remained unclear, since the radiologic features per se could not differentiate between adrenal adenoma and metastasis. Chemotherapy with cisplatin/etoposide and inhibition of steroidogenesis with ketoconazole were initiated, which largely controlled the hypercortisolism. Imaging studies after completion of two cycles of chemotherapy showed a tumor response with regression of the pulmonary mass. The right adrenal mass remained stationary under chemotherapy. Thus, an adrenal metastasis could be excluded as potential cause of the adrenal mass, suggesting an incidental adrenal adenoma as the most likely diagnosis. Conclusion: Paraneoplastic Cushing’s syndrome requires high clinical suspicion for early diagnosis, since many of the classical clinical features of hypercortisolism may still be absent, even if the underlying cancer is already advanced. In patients suspected to have Cushing’s syndrome a three-step diagnostic approach is recommended: (1) biochemical confirmation of hypercortisolism, (2) differentiation between ACTH-dependant and -independant hypercortisolism and (3) identification of its source. This approach helps avoiding misdiagnosis in patients who have both an ACTH-producing cancer and an adrenal adenoma [1].

The Effectiveness of Fractional CO2 Laser in Treatment of Striae Rubra and Striae Alba : A Comparative Study

Background: Striae distensae are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The natural evolution of striae is from red or purple, raised wavy lesions (striae rubra) to white atrophic lesions with wrinkly surface (striae alba). Aim of the Work: was to compare the efficacy of the fractional CO2 laser in the treatment of striae rubra versus striae alba. Patients and Methods: The present study included 20 patients above the age of 18 of both sexes; 10 patients had striae rubra and 10 patients had striae alba. They were recruited from Dermatology outpatient clinic in Ain Shams University Hospital from June 2017 to January 2018. 4 sessions of Fractional CO2 Laser for each patient were performed one month apart. The treated striae were randomly selected from each patient (Striae rubra and alba) and were assessed before starting treatment, at the beginning of every session and one month after the last session as regards length, width, texture, color of striae and any complications encountered. Results: No significant difference was found on comparing the clinical response (improvement of color P= 0.653), (improvement of atrophy P= 0.606), side effects (Hyperpigmentation P= 0.531), (Pain P=0.606), (Hypopigmentation P=0.305), (Erythema P= 0.060), of both striae alba and rubra to the laser treatment. Conclusion: The present study showed significant clinical improvement in both types of striae distensae treated by Fractional CO2 Laser with non-significant difference between the 2 groups except the development of erythema in striae rubra group. Furthermore, the histological improvement was significant for both groups with low incidence of the side effects. Recommendations: Larger scale studies with longer follow up period are recommended to further clarify the role of fractional CO2 laser in treatment of striae distensae.

In vivo study of dermal collagen of striae distensae by confocal Raman spectroscopy.

This research work mainly deals with studying qualitatively the changes in the dermal collagen of two forms of striae distensae (SD) namely striae rubrae (SR) and striae albae (SA) when compared to normal skin (NS) using confocal Raman spectroscopy. The methodology includes an in vivo human skin study for the comparison of confocal Raman spectra of dermis region of SR, SA, and NS by supervised multivariate analysis using partial least squares discriminant analysis (PLS-DA) to determine qualitatively the changes in dermal collagen. These groups are further analyzed for the extent of hydration of dermal collagen by studying the changes in the water content bound to it. PLS-DA score plot showed good separation of the confocal Raman spectra of dermis region into SR, SA, and NS data groups. Further analysis using loading plot and S-plot indicated the participation of various components of dermal collagen in the separation of these groups. Bound water content analysis showed that the extent of hydration of collagen is more in SD when compared to NS. Based on the results obtained, this study confirms the active involvement of dermal collagen in the formation of SD. It also emphasizes the need to study quantitatively the role of these various biochemical changes in the dermal collagen responsible for the variance between SR, SA, and NS.

Generalized striae rubra due to chronic abuse of clobetasol and minoxidil formule in a patient with psoriasis

Generalized striae rubra due to chronic abuse of clobetasol and minoxidil formule in a patient with psoriasis

Management of stretch marks (with a focus on striae rubrae).

Stretch marks are one of the most common benign cutaneous lesions and encountered esthetic problems. Striae rubrae and striae albae can be differentiated on the basis of clinical appearance. Histologically, disturbances of the dermal fiber network and local expression of receptors for sexual steroids have been detected. The epidermal changes are secondary. Prevention of stretch marks using topical ointments and oils is debatable. Treatment of striae rubrae by lasers and light devices improves appearance. Microneedling and non-ablative and fractionated lasers have been used. This review provides an overview on current treatment options with a special focus on laser treatments.

Cushing Syndrome Following Single Steroid Injection: A Case Report and Review of the Literature

Iatrogenic Cushing’s syndrome (ICS) is a well-known adverse effect of glucocorticoids. It usually develops after prolonged exposure to excessive amounts of synthetic glucocorticoids. The manifestations of ICS are generally dose and time dependent. We will report on our own case of ICS followed by a review/highlight of published cases of ICS following single steroid injection. The development of ICS after a single and low dose of synthetic glucocorticoid is an exceptional event and only a few patients have been reported to date in the literature. Here we will report on the case of a twenty-one -year-old female patient who developed ICS with striae rubra which appeared fifteen days after irrational use of a single intramuscular injection of betamethasone (Diprofos). Endocrinological evaluation confirmed hypothalamic-pituitary-adrenal axis suppression. Her striae showed gradual fading over the next two months leaving only thin white striae similar to stretch marks. We performed a review of the literature using a computer search in the Science Direct, Google Scholar, and National Library of Medicine from 1950 to January 2016 for ICS following single injection of synthetic glucocorticoids using the terms ‘single injection’, ‘iatrogenic’, ‘betamethasone’, ‘triamcinolone’, ‘hydrocortisone’ ‘dexamethasone’ ‘adrenal suppression’ ‘Cushing case report’ and ‘Cushing’s syndrome’. Nine case reports of ICS were found in both children and adults following a single steroid injection. There are multiple factors affecting the response to steroids that make one develop Cushing’s syndrome while the others do not. Governments in developing countries must make more serious efforts to enforce the existing laws that prohibit the irrational use of steroids.

Laser and Light Treatments for Striae Distensae: A Comprehensive Review of the Literature.

Striae distensae (SD) are common dermatologic lesions that often arise as a result of rapid weight change, certain endocrine conditions, or prolonged exposure to steroids. SD initially present as raised edematous plaques (striae rubra), after which they become white and atrophic (striae alba) owing to local breakdown and reorganization of collagen and elastin. There currently exists no reliable treatment option, though numerous topical applications have been attempted. Lasers and light represent emerging noninvasive therapies that have demonstrated some success targeting vascular chromophores in striae rubra and stimulating collagen and elastin production in striae alba. An extensive literature review was performed to gather all available articles studying laser and light treatments for SD. Lasers and light can significantly improve the appearance of both striae rubra and striae alba. Generally, striae rubra are more responsive to therapy and can be treated successfully with a variety of lasers without major adverse effects. Fractional lasers exhibit the strongest results for striae alba repigmentation and collagen induction, and several other lasers produce temporary repigmentation. Lasers in combination with other modalities such as topical agents and additional energy devices have also demonstrated promising preliminary results; however, large comparative studies are necessary to validate these outcomes.

Evaluation of Various Therapeutic Measures in Striae Rubra.

Background:Striae are linear atrophic depressions that form in areas of dermal damage in the skin. As on date, no consensus or protocol exists for the treatment of stria rubra. Topical retinoids, chemical peels, microdermabrasion, radiofrequency, photothermolysis, intense pulsed light and lasers are some of the modalities used.Aims and Objective:To compare the efficacy of various therapeutic modalities in striae rubra.Methods:This prospective cohort study comprised of a total of fifty patients from August-2012 to October-2013 in a tertiary care center in Western India, Gujarat having striae rubra. They were randomly divided into five groups of ten patients each. Patients were evaluated on the basis of visual assessment, both by doctor as well as the patient. Group I was given topical tretinoin (0.1% w/w) gel applied once at night, Group II-microdermabrasion (MDA) combined with trichloroacetic acid (TCA) (30%) peel, Group III-mesotherapy, Group IV-Q-switched Nd: YAG laser, and Group V-combination treatment of microdermabrasion, salicylic acid peel and retinol (yellow) peel. Patients were treated at an interval of 15 days for 2 months and then at monthly intervals. Objective assessment was done at 2nd month, 6th month, and at the end of 1st year.Results:Patients in Group I treated with topical tretinoin showed the least response with 80% (8) of them showing minimal clinical improvement (0–25%) as compared to patients in Group V in which 60% (6) patients showed moderate clinical improvement (50–75%). While majority of the patients in Group II, III, and IV showed mild clinical improvement (25–50%).Conclusions:Striae rubra is a common cause of concern for adolescent population. Combination treatment with microdermabrasion, salicylic acid and retinol yellow peel gave superior results as compared to other therapeutic options. Mild to moderate improvement was seen with Nd: YAG laser, mesotherapy and MDA + TCA whereas minimal improvement were seen with topical tretinoin.

Clinical and serological features of juvenile systemic lupus erythematosus in an italian tertiary centre of pediatric rheumatology

38 (36.5%) patients, were an important cause of morbidity. Oral ulcers and serositis were found in 27 (25.9%) and 25 (24%) patients respectively. Neurologic involmentent occurred in 20 (19.2%) patients. Seizures were observed in 8 (7.6%) patients. Infections remain a major problem in morbidity: serious infective manifestations occurred in 21 (20.1%) patients. Avascular necrosis of bone occurred in 7 (6.7%) patients, 3 of whom suffered more than 1 episode. Six (5.7%) patients developed steroid induced cataract. Tendon ruptures were observed in 4 (3.8%) patients. Growth failure and established osteoporosis, resulting from prolonged corticosteroid treatment in chronically active disease, were unfrequent but severe complications in our jSLE series occurring respectively in 8 (7.6%) and 5 (4.8%) patients. Cushingoid features and striae rubrae were frequent problems observed in 17 (16.3%) patients, due to disease itself and/or its treatment, that caused increased psychological distress, particularly in adolescents. Finally there were 4 deaths. Two due to infection complications and two due to myocardial infarction.

Col6a1 null mice as a model to study skin phenotypes in patients with collagen VI related myopathies: expression of classical and novel collagen VI variants during wound healing.

Patients suffering from collagen VI related myopathies caused by mutations in COL6A1, COL6A2 and COL6A3 often also display skin abnormalities, like formation of keloids or “cigarette paper” scars, dry skin, striae rubrae and keratosis pilaris (follicular keratosis). Here we evaluated if Col6a1 null mice, an established animal model for the muscle changes in collagen VI related myopathies, are also suitable for the study of mechanisms leading to the skin pathology. We performed a comprehensive study of the expression of all six collagen VI chains in unwounded and challenged skin of wild type and Col6a1 null mice. Expression of collagen VI chains is regulated in both skin wounds and bleomycin-induced fibrosis and the collagen VI α3 chain is proteolytically processed in both wild type and Col6a1 null mice. Interestingly, we detected a decreased tensile strength of the skin and an altered collagen fibril and basement membrane architecture in Col6a1 null mice, the latter being features that are also found in collagen VI myopathy patients. Although Col6a1 null mice do not display an overt wound healing defect, these mice are a relevant animal model to study the skin pathology in collagen VI related disease.

Superficial Dermabrasion Versus Topical Tretinoin on Early Striae Distensae: A Randomized, Pilot Study

Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. Prospective, single-center, randomized, open-label study. Thirty-two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients.

A Superficial Texture Analysis of 70% Glycolic Acid Topical Therapy and Striae Distensae

Sir:FigureStriae distensae are a very diffused type of skin atrophy that cause considerable cosmetic disfigurement that is difficult to treat. Various therapeutic options are available for the purpose of improving the appearance of existing stretch marks, including surgical treatments, laser, topical therapy, and chemical peeling. Only one randomized controlled trial has been published stating that a prophylactic antistriae cream (Centella asiatica extract, α-tocopherol, and collagen-elastin hydrolysates) induced a significant absolute prevention of striae gravidarum in 89 percent of the patients studied.1 The aim of our study was to evaluate objectively, by skin texture analysis and spectrophotometry, whether the use of glycolic acid peeling improves stretch marks. We designed a double-blind controlled trial on a total of 40 patients ranging in age from 16 to 35 years. Patients were divided into two groups: those with striae rubrae (group A) and those with striae albae (group B). Each group was treated for 6 months as follows: 70% glycolic acid lotion (NeoStrata Company, Inc., Princeton, N.J.) was applied on the left thigh for 1 to 2 minutes (until erythema appeared), and placebo was applied to the right thigh. The total number of applications was six (from t0 to t6). Skin texture parameters analyzed were anisotropy, number of skin furrows, and furrow width, using the silicone replica technique, where silicone casts were analyzed by scanning electron microscopy2 and then by image software. Hemoglobin and melanin content for skin color were analyzed by means of a spectrophotometer. Pretreatment and posttreatment quantitative values from a single patient constituted a paired data set. Data expressed in numerical values have been examined by comparison among averages (time 0 and time 6) with the t test. Statistical significance was designated at value of p < 0.05. In group A, skin texture analysis of striae rubrae showed a significant decrease in furrow width after 6 months (p < 0.01). Spectrophotometric measurements showed a statistically significant decrease in hemoglobin (p < 0.01). In group B, skin texture analysis of striae albae showed a similar decrease in furrow width as striae rubrae (p < 0.01). Spectrophotometry evidenced a statistically significant increase in melanin (p < 0.01). None of the parameters in the control group showed significant differences after placebo application. Management of striae distensae is problematic and controversial. Despite the large number of studies regarding striae treatment (surgical and chemical), results remain poor. The advent of laser therapy has represented a breakthrough in the approach to striae. Laser therapy seems to be effective on striae rubrae.3 Moreover, this treatment is rather expensive, and repetitive treatment can cause pigment alteration and is not recommended for dark skin. Topical chemical treatment seems to enhance striae rubrae aspects also.4 Glycolic acid accelerates collagen synthesis by fibroblasts and modulates matrix degradation and collagen synthesis through keratinocyte-released cytokines.5 These results suggest that glycolic acid could be useful to recovery from striae distensae. The topical therapies analyzed in this study were chosen because they are readily available on the market and easy to administer. Our results emphasize that 70% glycolic acid is associated with improvement in 15 percent and after 6 months induces some stretch mark modification but does not lead to recovery in either striae rubrae or striae albae (Fig. 1).Fig. 1: (Left) Lateral thigh area of a 23-year-old woman before treatment (original magnification, × 10). Stria rubra appears as a linear lesion raised above the surrounding tissue with a different skin pattern compared with the surrounding skin. (Right) Lateral thigh area 6 months after glycolic acid topical treatment of stria rubra (original magnification, × 10). Note the flattening of the primary furrows and their transverse diameter reduction. A decrease in depth of the transverse primary sulci is noticeable.Our results emphasize objectively that glycolic acid induces only some stretch mark modifications that are perceived by the patients. These results encourage the use of peeling with glycolic acid in the treatment of stretch marks, perhaps using it over time or in combination with other topical medications. Vittorio Mazzarello, M.D. Department of BioMedical Science Francesco Farace, M.D. Department of Microsurgical Specialties–Plastic Surgery Unit Pasquale Ena, M.D. Clinical Dermatology Grazia Fenu, M.D. Department of BioMedical Science Pietro Mulas, M.D. Department of Microsurgical Specialties–Plastic Surgery Unit Luisella Piu, M.D. Department of Farmacological Science Corrado Rubino, M.D. Department of Microsurgical Specialties–Plastic Surgery Unit, University of Sassari, Sassari, Italy