Treatment Of Striae Distensae Research Articles

Efficacy and safety of bipolar fractional radiofrequency vs. 2940-nm Er:YAG ablative fractional laser in striae distensae treatment: A split abdomen study.

Striae distensae (SD) is a challenging cosmetic condition. Ablative fractional laser (AFL) is an effective method for treating SD. Recently, fractional radiofrequency (FRF) has been shown to be a promising treatment for SD; however, few studies have shown the differences between FRF and AFL in the treatment of SD. This study aimed to evaluate and compare the clinical efficacy and safety of bipolar FRF with 2940-nm erbium yttrium aluminum garnet (Er:YAG) AFL in the treatment of SD. Twenty volunteers with abdominal SD were enrolled in this study. One half of the abdomen was treated with 2940-nm Er:YAG AFL, whereas the other half was treated with bipolar FRF, with three sessions at 4-week intervals. Photographic evaluations of clinical improvement were conducted by two independent investigators before and after treatment, and the patients provided self-assessments. Two participants underwent three punch biopsies, one before treatment and two obtained from bilateral representative skin lesions on the abdomen 3 months following the final treatment. Clinical improvements were observed in SD on both sides of the abdomen after the two treatments. Post-treatment skin biopsies revealed increased thickness in the epidermis and dermis, and higher collagen and elastin density compared to those at the baseline. No statistically significant differences were observed in the clinical outcomes between the two treatment approaches. The efficacy and safety of bipolar FRF treatment are comparable to those of 2940-nm Er:YAG AFL treatment, providing an alternative and effective treatment for SD.

Clinical efficacy of stromal vascular fraction gel in the treatment of mature striae distensae.

Striae Distensae (SD) is a common dermatological lesion. The mechanism of formation is unclear, the prevailing theory is mechanical pulling of the skin and hormonal changes. Traditional SD treatment methods include topical drugs, photoelectric therapy, stripping and others, but each has limitations. Stromal vascular fraction gel (SVF-gel) is a filler physically prepared from granular fat, enriched with adipose-derived stem cells (ADSCs) and extracellular matrix (ECM). A good effect in the treatment of neck lines, wounds, acne, and other aspects. SD formation and treatment goals are comparable to those of neck lines. In this study, SVF-gel filling will be used to treat mature SD, and its effectiveness and safety will be discussed in detail. From December 2019 to June 2022, recruit patients who want to treat SD caused by obesity or pregnancy among those who have "autologous fat aspiration" to change their body shape. Preoperatively, the area to be treated for SD was marked, autologous fat aspiration was performed, and the aspirated fat was prepared as SVF-gel and filled into the preoperatively marked SD. All patients had preoperative and postoperative follow-up with planar photographs and VISIA skin analyzer photographs to assess surgical results and safety from subjective and objective perspectives. A total of 36 patients were enrolled, with 31 of them successfully followed up on. The mean Global Aesthetic Improvement Scale (GAIS) score six months after surgery was 1.87±0.03. At six months postoperatively, the overall patient satisfaction rate was 90%. The depth, area, and colorof SD improved six months after surgery, and no serious complications occurred in any of the patients. SVF-gel is a safe and effective method of improving mature SD and can be used as a clinical treatment option.

Striae Distensae: Clinical Results and Evidence-Based Evaluation of a Novel 675 nm Laser Wavelength.

Background: A current popular aesthetic problem, especially among younger women, is striae distensae (SD), also referred to as "stretch marks.". Aim: The potential use of the 675 nm laser has been investigated in the treatment of SD. Methods: Patients underwent three sessions of the 675 nm laser with a 1-month interval between sessions. A total of three sessions were performed. The Manchester Scar Scale was used to assess stretch mark changes, and the mean scores related to each parameter at baseline and 6M FU after the last treatment session were measured. A clinical photographic evaluation was performed to show the aesthetic improvement of SD. Results: The patients' treated areas were the abdomen, thighs, buttocks, and breasts. Mean scores related to each Manchester Scar Scale parameter, with their relative percentage change, at baseline and 6M FU after the last treatment session were significantly improved. The total mean Manchester Scar Scale score significantly diminished from 14.16 (±1.30) to 10.06 (±1.32) at 6M FU (p < 0.01). The clinical photographs showed promising aesthetic SD improvement. Conclusions: 675 nm laser therapy demonstrated a good tolerance for the treatment of stretch marks applied to various body areas preventing any discomfort for the patient and with a significant improvement in skin texture.

Treatment of Striae Distensae with Filler Injection: A Systematic Review.

Stretch marks, also known as striae cutis distensae (SD), are visible linear scars that occur in regions of dermal damage due to skin stretching. Stretch marks are not serious health issues, but they may have a major psychological effect on patients. Due to poor skin color improvement or prolonged skin atrophy, there is no standard treatment for SD. Fillers have been studied for their effectiveness in the treatment of SD. This systematic review aims to determine the efficacy of fillers onSD. This systematic review is reported following PRISMA guidance. We included all relevant articles published up to November 2022 in the following electronic databases: Science Direct, Midline, the Web of Science, CINAHL, and Google Scholar. The initial search yielded 119, of which seven were included after applying inclusion and exclusion criteria. The systematic review included a total of 184 female participants who were over the age of 18 years old. Three studies used jet volumetric remodeling (JVR) to inject HA pneumatically. One study injected polycaprolactone filler. One study used calcium hydroxylapatite, micro-needling, and ascorbic acid. MFU-V and CaHA were given in one study. One study delivered MFU-V using micro-focused ultrasound. All studies showed that it reduces SD with only mild, temporary side effects. More favor was given to combining CaHA and MFU-V, which had the fewest side effects compared to other dermal fillers. As monotherapy or combination therapy, injectable dermal fillers may treat SD with minimal adverse effects. We suggest that more RCTs look into injectable dermal filler to find out what is best for patients with SD and compare it to other treatment methods in terms of results, costs, and side effects to provide satisfactory practice and basic guideline interventions for these cases.

Combined Fractional CO 2 Laser With Intradermal Platelet-Rich Plasma versus Fractional CO 2 Laser Alone in the Treatment of Striae Distensae.

Striae distensae (SD) or stretch marks are common cutaneous conditions that occur because of the stretching of the dermis.OBJECTIVE To evaluate and compare the efficacy of fractional carbon dioxide (CO 2 ) laser alone versus combined fractional CO 2 laser with platelet-rich plasma (PRP) in SD treatment. Thirty adult female patients with SD (SR and SA) were enrolled. In each patient, a split-lesion design was conducted as follows: pairs of SD on both sides of the midline were selected and allocated to groups A and B. Group A: was treated with combined fractional CO 2 laser with intradermal PRP. Group B: was treated with fractional CO 2 laser alone. Skin biopsies were taken from the lesions before and after treatment for histopathologic evaluation. In group A, a significant excellent improvement of the SD was achieved more than in group B ( p = .007) and the mean of improvement was significantly higher (60.33 ± 26.49) than that in group B (43.80 ± 27.43) ( p -value = .001). Group A was also associated with a more significant dermal deposition of collagen and elastic fibers. Combined fractional CO 2 laser with PRP was more effective than fractional CO 2 laser alone for the treatment of SD.

New Progress in Therapeutic Modalities of Striae Distensae.

Striae distensae (stretch marks/striae gravidarum) is one of the common cosmetic problems that can cause psychological distress and anxiety to patients due to its disfiguring damage, especially for women. The etiology of striae distensae is currently unknown, and risk factors include low maternal age, family history of stretch marks, excessive weight gain during pregnancy, and high neonatal weight. This article reviews the latest literature on the most commonly used, most popular, and novel treatment modalities and analyzes the hot spots and difficulties in striae distensae treatment in recent years. Topical treatment modalities are mainly used as an adjunctive treatment. Ablative lasers and non-ablative lasers are the most popular, among which picosecond has been tried in striae distensae treatment in the last two years. Combined treatment modalities are currently a hot spot for SD treatment, and microneedle radiofrequency and fractional CO2 laser combined with other treatments are the most common. Microneedle radiofrequency is the most commonly used and achieved therapeutic effect among the combined treatment modalities.

The Alleviating Effect of Lagerstroemia indica Flower Extract on Stretch Marks through Regulation of Mast Cells.

Striae distensae (SD) or stretch marks are common linear scars of atrophic skin with disintegrating extracellular matrix (ECM) structures. Although fibroblasts contribute to the construction of ECM structure in SD, some studies have reported that mast cell degranulation causes the disruption of ECM in early SD lesions. Lagerstroemia indica flower (LIF) has traditionally been used in India as a diuretic. However, little is known about the effect and molecular action of Lagerstroemia indica flower extract (LIFE) on alleviating SD. This study evaluated the effects of LIFE on mast cell degranulation and the synthesis of ECM components in fibroblasts. LIFE inhibits the adhesion of rat basophilic leukemia (RBL) cells, RBL-2H3 on fibronectin (FN) and the expression of integrin, a receptor for FN, thereby reducing focal adhesion kinase (FAK) phosphorylation. In addition, LIFE attenuated the allergen-induced granules and cytokine interleukin 3 (IL-3) through the adhesion with FN. Moreover, the conditioned medium (CM) of activated mast cells decreases the synthesis of ECM components, and LIFE restores the abnormal expressions induced by activated mast cells. These results demonstrate that LIFE suppresses FN-induced mast cell activation and promotes the synthesis of ECM components in fibroblast, which indicates that LIFE may be a useful cosmetic agent for SD treatment.

Comparative study between the effectiveness of plasma skin regeneration versus micro-needling in the treatment of striae distensae.

Striae distensae (SD) or stretch marks, a common condition causing significant cosmetic concern and distress, are linear dermal scars associated with epidermal atrophy that occur due to overstretching. Recently, micro-needling with dermapen is considered as one of the therapeutic modalities for SD. Also, plasma skin regeneration with plasma jet has been recommended as an effective method for the treatment of SD. The aim was to compare between the efficacy of both methods in the treatment of SD. This study included 30 patients with striae distensae. Body was divided into two halves; one was treated with plasma jet for two sessions with 1month interval and follow-up one month after the last session and the other half was treated with dermapen for four sessions with two weeks interval and follow-up one month after. There was no statistically significant difference (p- value >0.05) between dermapen and plasma jet procedures as regard to width, Total Atwal Score, Atwal score component, score of erythema, and skin texture after treatment. There was high statistically significant difference (p value <0.01) between dermapen and plasma jet as regards pain with higher values with plasma jet while there were statistical higher values concerning hyperpigmentation and erythema with dermapen. There was high statistically significant difference (p value <0.001) between width of striae before and after treatment with dermapen. Both lines of treatments are effective and promising therapeutic modalities for striae distensae with minimal side effects.

Subcision, chemical peels, and platelet-rich plasma: Combination approaches for the treatment of striae distensae.

Striae distensae (SD) are disfiguring skin condition causing cosmetic troubles and psychological distress. The aim was to compare the efficacy and safety of platelet-rich plasma (PRP) versus its combination with subcision or medium-depth peeling (glycolic acid 70% followed by trichloroacetic acid [TCA] 35%) for SD treatment. Seventy-five female patients with SD were divided into three equal groups with the contralateral side in each patients represented the control group. Group A treated with PRP, group B received PRP + subcision while group C received PRP + combined peeling (GA 70% + TCA 35%). Primary outcome included clinical improvement, patients' satisfaction, and Dermatology Life Quality Index (DLQI). Striae measurement, skin biopsies were also assessed. Very much improvement was achieved in 28%, 44%, and 36% in groups A, B, and C respectively. The combined groups (B and C) showed significantly higher patients' satisfaction and DLQI than group A (p= 0.03), (p < 0.0001). A significant decrease in all striae measurements was achieved with all groups (p<0.001); however, groups B and C showed more decrease (p=0.2 and 0.4). A highly significant decrease in the mean number of sessions was found in group B (p < 0.0001). All groups demonstrated improvement in dermal collagen deposition, which was higher in the combined groups. Side effects were mild and well tolerated. The combination of PRP with subcision or peeling was more effective and offered a higher therapeutic response than PRP alone. Moreover, the subcision has superior efficacy in striae albae and safer in darker skin types.

Systematic review of single and combined treatments for different types of striae: a comparison of striae treatments.

Striae distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost-effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by 20 May 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light-based devices and topical treatments are the most commonly applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side-effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.

A COMPARATIVE STUDY BETWEEN THE FRACTIONAL CO2 LASER AND CARBOXYTHERAPY IN TREATMENT OF STRIAE DISTENSAE: A CLINICAL AND HISTOPATHOLOGICAL STUDY

Striae distensae (SD), commonly known as stretch marks, represent linear dermal scars associated with epidermal atrophy. It is prevalent in all races. Objective: The aim of this study was to compare the efficacy and the safety of use of ablative fractional CO2 laser therapy and carbon dioxide gas intradermal injection in treatment of striae distensae. Methods: The present study included 20 patients diagnosed with striae distensae who had never received any previous treatment for SD. There were three groups; each group composed of 10 patients: The first group was treated with ablative fractional CO2 laser resurfacing 10,600 nm The treatment parameters in this study were: energy (30-40 mJ), pulse duration (1.4-1.8 ms), scanning area (20 mm x 5 mm), depth level (1-2) and density level (8-16) according to each patient condition and skin type. Stria of the second group was treated with intradermal injection of carbon dioxide gas. 4-mm bunch biopsies were taken from patients before and after treatment by and results showed high percentage of excellent improvement with fractional CO2 laser.Results: Carbon dioxide laser showed significant higher percentage of excellent improvement after last session of treatment of SD, when compared with carbon dioxide injection.Conclusion: Treatment with CO2 laser showed significant higher frequency of striae with excellent improvement, with good improvement, when compared to treatment with CO2 injection (carboxytherapy). Fractional CO2 laser is promising tool in dermatology and in treatment of SD (safe and effective).

Carboxytherapy for striae distensae: A promising modality.

Striae distensae (SD) is a very common skin problem. Although a lot of treatment modalities have been proposed, few of them are effective. Recently, carbon dioxide therapy (CDT) or carboxytherapy was used in many indications of cosmetic dermatology such as SD. To objectively evaluate the use and effectiveness of CDT for treatment of SD. Twenty patients were subjected to 8 sessions of CDT injection at 2-week intervals using carboxy-gun. Patients were photographed, and skin specimens were obtained from the treated area before and after 4months of treatment. Using a computerized 3D camera, skin topography was objectively analyzed before and after treatment. Evaluation of collagen and elastic fibers by special histopathological staining, in addition to histometric analysis, was also done to evaluate treatment efficacy. Clinically, SD was statistically significantly improved after CDT injection compared with baseline (mean percentage of improvement of length and width, 59.8±15.9; P<.05). Meanwhile, the improvement observed by the 3D camera correlated with the clinical improvement. Histometric analysis showed an increase in epidermal thickness (P<.0001) in association with re-appearance of rete ridges following treatment. Histochemical evaluation of changes in elastic and collagen fibers after treatment showed better organization of curled and fragmented elastic fibers, which was accompanied by an increase in collagen content that became denser, arranged in bundles and parallel to the epidermis. CDTis an effective, promising, and simple minimally invasive procedure for improving SD with few side effects and low downtime.

Comparative study of efficacy and safety of fractional CO2 laser and microneedling fractional radiofrequency (MnRF) in the treatment of striae distensae

Striae Distensae (SD) are common disfiguring skin conditions having significant psychological impact on affected patients, especially in young healthy women. Management of striae poses a therapeutic challenge. Recently, fractional CO2 laser and microneedling radio frequency have shown to be efficacious in the treatment of SD. However, there is paucity of such studies in Indian population. Hence, we intend to conduct the present comparative study. To compare the efficacy and safety of fractional CO2 laser and Microneedling fractional radiofrequency (MnRF) in the treatment of SD. A total of 30 patients (18-40 years) having SD, attending the out-patient department at the Department Of Dermatology, Venereology and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were alternately allocated into group-A (fractional CO2 group) and group-B (MnRF group). Patients in both the groups received four sequential treatments with an interval of 4 weeks between each session. Clinical assessment of the improvement of striae was done based on Global Improvement Scale (GIS) at the end of 1 month after the last session, by a Side-by-side comparison of Pre-operative photographs. In addition, patients were asked to provide their opinion on improvement of striae using the patient satisfaction Visual Analogue Score (VAS). In our study, at the end of 1 month after the last treatment session, according to GIS, clinical improvement of SD was better in Group B when compared to Group A (p=0.000023), which was statistically significant. Patients in Group B were more satisfied with their treatment than the patients in Group A, according to the patient satisfaction VAS score, which was again found to be statistically significant (p=0.00086).Five patients (33.33%) in Group-A had post-inflammatory hyperpigmentation. In the present study, MnRF was found to be more efficacious and safe than fractional CO2 laser in clinical improvement of striae distensae.

Reflectance confocal microscopy for striae distansae treatment monitoring after CO2 fractional laser.

The aim of this study is to describe the efficacy and safety of CO2 fractional laser to treat striae distensae (SD), before (T0) and 1 month after the last laser session (T1), in patients following different protocols based on the number of laser sessions, ≤4 and > 4. Efficacy was estimated with global assessment improvement scale (GAIS) performed by both physicians and patients, reflectance confocal microscopy (RCM), dermatology life quality index (DLQI). Safety was evaluated through pain assessment and adverse events. Eighteen patients with SD were enrolled. Clinical improvement of SD was observed in all patients at T1, as compared to T0. Furthermore, a reduction of RCM features of SD was observed at T1, above all in patients receiving >4 treatments, as compared to T0. Interestingly, we describe herein a new RCM feature of SD, the "neat-wall", corresponding to a distortion of the normal dermo-epidermal junction (DEJ), with a well-demarcated margin. A significant improvement of DLQI (P-value = .007) was also registered after SD treatment. Adverse events included temporary erythema and edema. In conclusion, the current study confirms the efficacy and safety of fractional CO2 laser, proposing RCM features, such as parallel collagen fibers and the neat-wall, as potential markers of SD treatment response.

Comparative effectiveness of different therapies for treating striae distensae: A systematic review and network meta-analysis.

Background:Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis.Methods:A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework.Results:Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively).Conclusion:Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.

Ablative fractional CO2 laser vs lyophilized growth factor intralesional injection vs combination of both modalities for striae distensae treatment.

Different studies had evaluated the efficacy of fractional CO2 laser and platelet-rich plasma (PRP) in treating striae distensae (SD). Lyophilized growth factors (LGF) represent another form of delivering growth factors similar to PRP with a more standardized method. To the best of our knowledge, no previous trials have been reported using LGF in SD. We aimed to compare the efficacy of ablative fractional CO2 laser vs intralesional injection of LGF vs combination of both modalities for SD treatment. This study included 20 female patients with SD. All patients received three modalities of treatment in separate three areas: area A: received fractional CO2 laser, area B: received combination of fractional CO2 laser and intradermal injection of LGF, and area C: received intradermal injection of LGF. Each area received three sessions with 6-week intervals. The outcome was evaluated clinically and histopathologically before treatment and six weeks after the last session. There was a statistically significant clinical and histopathological improvement of SD both in areas A and B after treatment. Area C exhibited nonsignificant clinical and histopathological improvement. Area B showed the best improvement results as compared to areas A and C. We reported that fractional CO2 laser combined with LGF injection was more effective than fractional CO2 laser alone in SD treatment based on clinical and histopathological assessment. We do not advocate LGF as a monotherapy for SD treatment; instead, LGF can be used as a combined therapy with fractional CO2 laser to improve its outcome.

Combined microneedling with topical application of platelet-rich plasma versus microneedling alone in the treatment of stria distensae: clinicopathological analysis

Background Striae distensae (SD) are common skin conditions. Objectives This study was done to test the hypothesis that ‘the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.’ Patients and methods Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes. Results As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis. Conclusions This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.

Role of microneedling in treatment of patients with striae distensae

Objective The aim of this work was to elucidate the efficacy and safety of microneedling in the treatment of striae distensae (SD). Background SD is a common form of dermal scarring that appears on the skin as violaceous, erythematous, or hypopigmented linear striations. Microneedling therapy or collagen induction therapy is a minimally invasive, nonsurgical, and nonablative procedure that involves the use of a microneedling device to create controlled skin injury. Data sources Medline databases such as PubMed, Medscape, Science Direct, and EMF-Portal and all materials available on the Internet from 2010 to 2017 were searched. Study selection The initial search presented seven articles that have studied the role of microneedling in the treatment of SD. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls mentioned, adequate information provided, and assessment measures defined. Data synthesis Comparisons were made by structured review with the results tabulated. Findings The use of skin microneedling is found to be effective in the treatment of SD. Conclusion This study concluded that the use of skin microneedling is effective as a new modality for the treatment of SD.

Treatment of striae distensae with non-ablative fractional laser: clinical and in vivo microscopic documentation of treatment efficacy.

The efficacy of NAFL in the treatment of striae distensae (SD) has been demonstrated. Nevertheless, the base for this improvement has not been clarified yet. The aim of this study is to describe in vivo variations occurring in the skin after the treatment, using reflectance confocal microscopy (RCM). Ten patients asking for the treatment of SD were enrolled. Clinical and RCM images were acquired before the treatment, immediately after 1 and 6months after the first treatment. One thousand five hundred forty-nanometer laser treatments were performed every 4weeks for 6 sessions. Efficacy was estimated through the evaluation of pre- and post-treatment clinical pictures by two expert and independent physicians and with GAIS. Improvement of SD was observed in 80% of patients. Temporary erythema and edema were reported. RCM revealed the dissolution of collagen bundles and the appearance of new papillae, as compared to baseline. NAFL represents an effective and safe treatment modality for SD. We report herein in vivo variations occurring in SD after NAFL treatment.

Striae Distensae: Preventative and Therapeutic Modalities to Improve Aesthetic Appearance.

Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. The authors identified 68 articles that met inclusion and exclusion criteria. There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.