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E. Moreno-Artero and L. Aguado
fact that creams containing HA also include
allantoin, vitamins A and E, and calcium pantothenate, among others, needs to be taken into
consideration, and a superimposed effect of massage needs to be also considered [7]. Thus, there
is a lack of evidence that creams containing HA
have a benet in SD [7].
Despite this, a substantial number of women
employ different commercially available products for prevention of SG.Brennan et al. have
recently conducted a cross-sectional, descriptive
study in which among 753 pregnant women at
36weeks’ gestation or more, 589 employed different topical products to prevent SD during the
current pregnancy. The 78.2% indicated that they
used a product to prevent or reduce the development of SG, and 36.5% used two or more products. Bio- oil was the most frequently used
product [11].
! Attention
“There is a lack of evidence that the commercially available products today for prevention of
SG have a benet in SD.”
Table 13.2 Review of topical and procedural therapies
Topical treatments Procedural therapies
Topical tretinoin Aluminum oxide
microdermabrasion
Centella asiatica Percutaneous collagen
induction therapy
Chemical peel agents Galvanopuncture
Glycolic acid Platelet-rich plasma
-Ascorbic acid
(vitamin C)
Trichloroacetic acid
feeding, but topical preparations are poorly
absorbed into systemic circulation after topical
application (Table13.2).
13.6.1.1 Topical Tretinoin
Tretinoin, a topical retinoic acid, is the most
employed therapeutic option in daily practice so
far. It stimulates collagen production by activating broblasts. Many studies have demonstrated
that SR can be improved by topical tretinoin at
high doses (0′05% to 0′1%), with minimal or no
effects in SA.Tretinoin has a proved efcacity
and a high level of evidence in the treatment of
SD [3, 4, 12, 13].
13.6 Treatment
The three main mechanisms to improve SD are
enhancing the collagen production, reducing vascularity, and increasing melanin [3].
13.6.1 Topical Treatments
In this section, we review the three most employed
topical drugs in the treatment of SD, tretinoin,
Centella asiatica, and some chemical peel agents,
such as glycolic acid, trichloroacetic acid, and
-ascorbic acid. Since most of the women who
have SG are in the breastfeeding period, it is
important to take into consideration if these therapeutic options could be indicated in this situation. Regarding the safety of Centella asiatica,
glycolic acid, and topical tretinoin, there is little
or no information about transfer into breast milk
because they have not been studied during breast-
13.6.1.2 Centella asiatica
Centella asiatica is a plant used in Asian herbal
medicine for diverse dermatosis such as leprosy,
lupus, eczema, and venous stasis ulcers; it contains triterpenoids (asiaticoside and related compounds), which stimulate broblasts to produce
collagen. Centella asiatica is often combined
with other components, such as α-tocopherol,
collagen and elastin hydrolysates, hydroxyprolisilane-C, rosehip oil, and vitamin E [3].
Mallol etal. demonstrated in a randomized,
double-blind, placebo-controlled trial involving
80 women that daily massage with Trofolastin, a
cream which contains Centella asiatica, to the
abdomen, breasts, buttocks, and hips from the
12th week of pregnancy until delivery was associated with decreased SG incidence compared
with placebo (56% vs. 34%). The cream was
effective for preventing SG in subjects with a
history of puberty-associated SD, but not in subjects with a history of SG from preceding preg-
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nancies. In subjects who developed SG, the
cream reduced the severity of lesions, compared
with placebo [14].
In another randomized, double-blind, placebocontrolled trial, García Hernández etal. showed
no differences in the prevention of SG in 183
women who applied a cream containing triterpenoids from Centella asiatica twice a day to the
abdomen, thighs, hips, buttocks, and breasts from
the 12th week of pregnancy until delivery.
However, if there was not a history of SD, only
6% of women developed SG compared with 35%
in women with a history of SD. If lesions
appeared, the severity of lesions was decreased in
the intervention group. As the authors concluded,
it seems that the cream reduced the severity of
SG developing during pregnancy in all women
and prevents its incidence only in women without
a history of SD [15].
Finally, Martelli etal. proved its efcacy in
the prevention of wrinkles and striae in a
double- blind trial conducted in 20 female volunteers aged between 20 and 25, which applied
twice a day for 1month a combination of Centella
asiatica and boswellic acid. A clinical noninvasive evaluation (temperature, humidity, skin
hydration, and biomechanical properties of the
skin, as extensibility, elasticity, and rmness)
was performed. Boswellic acid blocks LTB4 and
human leucocyte elastase (HLE). LTB4 stimulates chemotaxis, cell adhesion, superoxide production, and hydrolysis, while HLE degrades
elastin, bronectin, laminin, collagen, and proteoglycans of the extracellular matrix in the dermis [16].
13.6.1.3 Chemical Peel Agents
Chemical peel agents, such as glycolic acid,
-ascorbic acid (vitamin C), and trichloroacetic
acid (TCA), induce collagen production
through the creation of an inammatory state in
the dermis [3].
A double-blind controlled trial on a total of 40
patients ranging from 16 to 35 years evaluated
the efcacity of 70% glycolic acid lotion in SR
and SA, with light modications, but without
totally disappearing [17]. Combination of 20%
glycolic acid with 0.05% tretinoin is more effec-
tive than a preparation of 20% glycolic acid with
10% -ascorbic acid in the treatment of SA, both
applied once a day for 12weeks [18].
In a recent study, the efcacity of platelet-rich
plasma (PRP) with microneedling and trichloro-
acetic acid peel for treatment of striae distensae
has been evaluated. Under topical anesthesia,
PRP was injected over the SD with an insulin
31-gauge syringe followed by microneedling
with a 1 mm dermaroller over the striae and
extended 2–4mm beyond the margins. Finally,
TCA peel (35%) was applied for 1min. Three
sessions are done 3weeks apart, with an important clinical improvement at week 9 [19].
l-Ascorbic acid derivative sodium -ascor-
bate is a potent stimulator of collagen and elastin
production in cultures of broblasts derived from
normal human skin and dermal fat, being an
interesting option, especially in combination
with other collagen stimulators, in the treatment
of wrinkled and stretch-marked skin [3, 18].
Karia etal. evaluated various therapeutic measures in SR through a prospective cohort study
performed in 50 patients that were randomly
divided into ve groups receiving topical tretinoin 0.1% applied once a day, microdermabrasion (MDA) combined with TCA 30% peel,
mesotherapy, Q-switched Nd:YAG laser, and a
combination treatment of microdermabrasion,
salicylic acid peel, and retinol yellow peel,
respectively. Patients were each 2 weeks for
2 months and then at monthly intervals.
Combination treatment with microdermabrasion,
salicylic acid, and retinol yellow peel showed the
best results compared to other therapeutic
options, followed by Nd:YAG laser, mesotherapy, MDA+TCA, and topical tretinoin [20].
Pearls and Pitfalls
“Many studies have demonstrated that SR can be
improved by topical tretinoin at high doses
(0′05% to 0′1%), with minimal or no effects in
SA.”
“Even if results are discordant regarding the
prevention of SG, it seems that Centella asiatica
prevents its incidence only in women without a
history of SD; in addition, when SG appear, it
reduces the severity of lesions.”
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E. Moreno-Artero and L. Aguado
“Chemical peel agents, such as glycolic acid,
-ascorbic acid, and TCA, induce collagen production and improve the aspect of SD, especially
when combined with other therapeutic options,
such as tretinoin, microdermabrasion, and
microneedling.”
13.6.2 Procedural Therapies
Procedural therapies include aluminum oxide
microdermabrasion, percutaneous collagen
induction therapy, and galvanopuncture. All of
them increase collagen production by broblasts
(Table13.2).
13.6.2.1 Microdermabrasion
Microdermabrasion is used for cosmetic purposes as SD, scars, acne scars, melasma, photoaging, or ne wrinkles. Devices may be crystal or
crystal- free. Among the rst group, the most
common crystal used is aluminum oxide.
Aluminum oxide induces mechanical dermabrasion of damaged skin, increasing collagen production by broblasts. Using negative pressure,
the device pulls the skin into the handpiece and
releases the abrasive crystals. Three passes over
the treated per sessions and 4–6 weekly sessions
are needed to achieve results [13].
13.6.2.2 Percutaneous Collagen
Induction Therapy
Percutaneous collagen induction therapy, or needling therapy, creates microclefts in the papillary
dermis, leading to thickening of the epidermal
layers and collagen production. Aust etal. conducted a single percutaneous collagen induction
therapy in 22 female patients with SD, under
local tumescence anesthesia. After 6 months,
skin texture and tightening had improved, and on
histology, augmentation in elastin and collagen I
content was seen. Post- inammatory hyperpigmentation was not noticed [21].
Recently, percutaneous collagen induction
therapy has been demonstrated to be superior to
microdermabrasion combined with sonophoresis
and to carbon dioxide laser [22, 23].
13.6.2.3 Galvanopuncture
Galvanopuncture is another needling therapy that
applies a continuous microcurrent in the dermis.
Bitencourt et al. demonstrated in a prospective
single-center study the efcacy and safety of galvanopuncture for the treatment of SA in 32
female patients with SA in the buttocks; 10 sessions 7days apart were performed. All patients
showed clinical improvement [24].
13.6.2.4 Platelet-Rich Plasma
Platelet-rich plasma (PRP) is a concentrated
solution of plasma containing various autologous
growth factors, especially epidermal growth factor, platelet-derived growth factor, transforming
growth factor, and vascular endothelial growth
factor, and proteins that are injected intradermally. PRP increases dermal elasticity by inducing neocollagenesis through the broblasts of the
extracellular matrix [3].
PRP has been used in combination with fractional radiofrequency, which was expected to
enhance the penetration of PRP.Eighteen patients
were treated with four sessions every 2weeks.
After treatment, subjective and objective clinical
improvement was remarkable, and the average
width of the widest striae had decreased from
0.75 to 0.27mm. Biopsies were obtained from
three patients, showing a signicant increase of
both collagen and elastic bers in papillary and
reticular dermis, accompanying increase of subepidermal collagen density. The only reported
side effect was post-inammatory hyperpigmentation (11.1%) [25].
As commented above, PRP has been employed
for the treatment of SD in combination with TCA
and microneedling, with synergistic effects [19].
There is a study comparing PRP vs. microdermabrasion vs. combination of PRP and microdermabrasion in the treatment of SD.It was done
in 68 patients that were randomly assigned to
those three groups. Each patient underwent a
maximum of six sessions at 2-week interval.
There was signicant clinical improvement of
SD in patients treated with PRP and the combination of PRP and microdermabrasion when
compared with patients treated only with micro-
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dermabrasion. Besides, combination of PRP and
microdermabrasion showed faster results. An
increase in collagen and elastic bers in the dermis was observed in cutaneous biopsies [26].
Another study compared PRP (monthly intralesional injections for 3 months) versus topical
tretinoin 0.05% (daily application for 3months)
in the treatment of SD, showing that, even if both
treatments showed statistically signicant
improvement of SD, PRP is more effective than
tretinoin [27].
Pearls and Pitfalls
“Microdermabrasion with aluminum oxide
induces mechanical dermabrasion of damaged
skin, increasing collagen production by broblasts, improving SD.”
“Percutaneous collagen induction therapy, or
needling therapy, creates microclefts in the papillary dermis, leading to thickening of the epidermal layers and collagen production.”
“Galvanopuncture has demonstrated efcacy
for the treatment of SA.”
“PRP, alone or in combination with radiofrequency, TCA, microneedling, or microdermabrasion, has demonstrated subjective and objective
clinical improvement of SD by inducing
neocollagenesis.”
Table 13.3 Energy-based methods
Energy-based methods Efcacy
Radiofrequency SR and SA
Lasers
Fractional carbon dioxide laser
10,600nm
Erbium:yttrium-aluminum-garnet
laser
Pulsed dye laser SR
Nd:YAG 1064nm laser SR and SA
Erbium glass 1540nm laser SR
Copper-bromide laser SR
Diode laser Controverted
Intense pulsed light SR>SA
Infrared light SA
UV light SA
Excimer laser SA
SR striae rubra, SA striae alba
SA>SR
SR and SA
bination with IL or fractional RF and IL, seems to
be effective on both SA and SR [28].
Recently, Ahmed etal. compared the efcacy
between carboxytherapy, PRP, and tripolar radiofrequency; all three proved to be effective clinically and histopathologically in treating both
types of striae, which were well tolerated by the
patients with minimal, transient side effects and
our study results gave us guidelines for their clinical application [29].
13.6.3 Energy-Based Methods
This group includes radiofrequency, lasers,
intense pulsed light, and infrared light. All of
these therapeutic options, often used in combination, have been shown to offer clinical improvement due to reorganization of the collagen and
dermal remodeling (Table13.3) [28].
13.6.3.1 Radiofrequency
Radiofrequency (RF) devices induce a thermal
damage in the dermis caused by a high-frequency
oscillating electrical current, causing collagen
denaturation and subsequent collagen production
by broblasts. Fractional RF is the most effective
system, especially in SR and if it is combined
with topical tretinoin or PRP.Bipolar RF, in com-
13.6.3.2 Lasers
The term laser is an acronym for “light amplication by stimulated emission of radiation.” Lasers
deliver monochromatic (only one longwave),
coherent (waves are in phase with respect to
space and time), collimated (beam diameter does
not increase with distance), and high-intensity
beams of light, which represents a part of the
electromagnetic spectrum. This light acts on different skin chromophores (hemoglobin, melanin,
or water) [30].
The term “ablative” refers to the capacity of
some lasers to vaporize skin structures, whereas
“non-ablative lasers” leave the skin intact [30].
The energy of ablative lasers is capable of
heating water in the skin. This chromophore,
when turned into gas, vaporizes skin cells with
two main consequences: a skin-peeling effect and
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E. Moreno-Artero and L. Aguado
a collagen formation with subsequent retraction
of the dermis and epidermis, tightening the skin.
Ablative lasers can be non-fractionated lasers,
which are devices that act on the entire projected
area of the skin surface, or the most recent fractional lasers, which target an equally disseminated portion of the projected area. The group of
ablative lasers comprises the fractional carbon
dioxide laser 10,064nm (CO2 laser) and the fractional Er:YAG laser [30].
Non-ablative lasers include the erbium glass
1540nm laser, the pulsed dye laser (PDL), the
308nm excimer laser, the Nd:YAG 1064nm, the
copper-bromide laser, and the diode laser [30].
Fractional Carbon Dioxide Laser
10,600nm
The CO
laser is a fractional ablative laser that
2
emits light at a wavelength of 10,600nm in the
infrared spectrum. It delivers high peak uences
(>5–7 J/cm2) in a very short pulse duration
(1ms). It is largely utilized for facial skin resurfacing, to vaporize cutaneous lesions, and to
improve the clinical aspect of scars, including SD
[30]. Recently, Crocco etal. published a twoarm, prospective, self-control open-label study to
evaluate clinically and histologically the changes
in SG after treatment with the CO2 fractional
laser. Thirteen females with SG were recruited
and treated with four monthly sessions of increasing pulse energy levels (80, 90, 100, and 110mJ/
microscopic treatment zone). A statistically signicant increase in the thickness of the epidermal
cell layer and in the amount of collagen bers
was seen in skin biopsies. Clinically, there was a
remarkable diminution in the width of SG [31].
Lee etal. conrmed its efcacy in 27 women
with SA after one session (pulse energy of 10mJ)
[32]. In 2012, Naeini etal. carried out a randomized clinical trial in female patients with SA comparing the CO2 laser every 2–4 weeks with a
topical treatment based on a 10% glycolic acid
+0.05% tretinoin cream once a day. Striae surface
area was signicantly decreased after treatment
in the CO2 laser group in comparison with the
topical treatment [33]. Another study conducted
by Naeini etal. compared the clinical efcacy of
a fractional CO2 laser as well as a combination of
fractional CO
laser and pulsed dye laser (PDL)
2
in the treatment of SA.Eighty- eight SA lesions
in three female patients were included; half of the
lesions were treated with the fractional CO2 laser
and half with the combination of fractional CO2
laser and PDL.Three sessions with 4-week intervals were performed with each therapeutic
option. Results showed that the combined laser
treatment was more effective than fractional CO2
alone [34]. Thus, the efcacy of the CO2 laser has
been better proved in late- stage SA as compared
to SR.Among the adverse effects, post-inammatory hyperpigmentation may be a great problem in the darker skin types IV to VI.
Erbium:Yttrium-Aluminum-Garnet Laser
The Er:YAG laser is a fractional ablative laser
that emits light at a shorter wavelength (2940nm)
than the CO
laser. Its light is 16 times more
2
strongly absorbed by water within the skin cells,
and it has a very short pulse duration, limiting
damage to surrounding areas. In addition to ner
ablation and shortened healing time, pigmentary
changes are also less common, making it benecial for highly pigmented individuals. However,
hemostasis is not complete, causing pinpoint
bleeding at the dermal-epidermal junction, which
leads to a lower degree of skin tightening in comparison with the CO2 laser [30].
Wanitphakdeedecha R etal. conducted a study to
determine the efcacy and safety of the Er:YAG
laser for the treatment of SD in skin phototypes
III–IV.They recruited 21 women with late-stage
SD (the mean stria age was 131 months) and
treated them monthly for 2 months. Each stria
was divided into two parts; one part was treated
with one pass of 400mJ in short pulse mode with
50% overlapping and one pass of 2.2J/cm2 in
smooth mode without overlapping, while the
other half of the stria was treated with two passes
of 400mJ in short pulse mode with 50% overlapping. Most of the patients showed improvement
in skin roughness, skin smoothness, and width,
but there were no statistical differences between
the two modalities of use. However, post-inammatory hyperpigmentation persisting for more
than 6months was more frequent in darker phototypes and the areas of SD treated by only the
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short pulse mode, maybe because the smooth
mode penetration of heat is slower, minimizing
the thermal damage [35].
Recently, Shen etal. evaluated the clinical and
histopathologic efcacy and safety of this laser
with recombinant bovine basic broblast growth
factor (rb-bFGF) and light-emitting diode-red
light (LED-RL) for the treatment of SA. Thirty
patients were treated with 6 monthly sessions of
Er:YAG. Once completed, the subjects were
required to spray rb-bFGF for 1week at home.
They then received LED-three weekly sessions
of RL. All 30 patients demonstrated clinical
improvement, and an increase in epidermal thickness, dermal thickness, and collagen and elastin
density was demonstrated in skin biopsies [36].
There is a French study which combines the
conventional Er:YAG 2940nm laser with a specially designed spatially modulated ablation
(SMA) nozzle in the treatment of both SR and
SA. The RecoSMA technology is a nonfractional, nonthermal, and micro-ablative
method (skin temperature remains stable at
36.68°C, minimizing thermal effect); thus, the
skin’s barrier function is not compromised, which
limits side effects, especially hyperpigmentation,
and reduces recovery time. Patients with latestage SA (maturity of SA between 20 and
32years) responded poorly in comparison with
SR or early SA [37]. In another study of Güngör
et al., SR responded well to the Er:YAG laser,
while mature SA had a poorer response [38].
Pulsed Dye Laser
The PDL uses the liquid medium rhodamine and
emits short pulses of light ashes with a wavelength between 585 and 595nm [30]. The 585nm
PDL has been largely employed for the treatment
of SD. This laser has demonstrated to improve
the erythema of SR because of its high afnity
for its chromophore hemoglobin, but also to
increase collagen in the extracellular matrix of
the dermis when it is utilized at low uences
(2.0–4.0J/cm2). Other authors support that there
is no effect in collagen and elastin production, or
minimal. Thus, it seems largely accepted that its
efcacy in treating SR relies on reducing vascularity and, subsequently, on the erythema of SR,
with a controverted effect on elastin and collagen
production [6]. Thus, it seems reasonable to
expect that PDL has more efcacy in SR than in
SA (Figs.13.3 and 13.4).
Jiménez et al. piloted a trial to conclude
whether the 585nm pulsed dye laser was effective
in both SR and SA after two treatments. Twenty
patients with SR and SA were treated twice, at
baseline and 6weeks apart. A moderate improvement of erythema in SR was seen, and an increase
in total collagen amount was demonstrated histologically both in SR and in SA [39]. However,
PDL is not superior to fractional ablative lasers
and Er:YAG) when treating SA [40].
(CO
2
Regarding SR, there is no consensus whether
PDL is superior to the Er:YAG laser or not [13,
41].
ab
Fig. 13.3 A 31-year-old woman with red striae gravidarum on the abdomen (a) treated with PDL (2 sessions 2months
apart; energy 8.5J/cm
2
, pulses 0.5ms, spot 7mm). Clinical aspect after the second PDL session 2months apart (b)
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E. Moreno-Artero and L. Aguado
ab
Fig. 13.4 A 26-year-old woman with red striae distensae on the hips developed because of a rapid weight gain (a).
Aspect after 2 sessions of PDL 3months apart; energy 8.5J/cm
As seen above, the combination of the fractional CO2 laser and the PDL has been demonstrated to be superior to their use alone [34].
Because the absorption spectrum of melanin
includes visible and infrared light, at the wave-
2
, pulses 0.5ms, spot 7mm (b)
interval. It was showed that they were equally
efcacious in improving texture and atrophy in
SA, with no changes in the number of lesions.
The picosecond laser was, however, less painful
and had a shorter healing time [43].
lengths used by vascular lasers, absorption also
occurs by melanocytes, with the subsequent risk
of hypopigmentation and scarring. Furthermore,
although permanent hyperpigmentation has not
been reported, post- inammatory hyperpigmentation is not infrequent, especially in patients
with a dark skin type (III–VI) [30].
Erbium Glass 1540nm Laser
The erbium glass 1540nm laser is a fractional
non-ablative laser with the ability to create
microscopic columns of coagulated tissue on
the skin tissues, leading to neocollagenesis.
Because it is a non-ablative laser, there is a
preservation of the stratum corneum, diminish-
Nd:YAG 1064nm Laser
The Nd:YAG 1064nm laser is a fractional nonablative laser that has been used to treat SD.In
2016, Elsaie etal. compared the efcacy of two
uences (75 and 100 J/cm2) of long-pulsed
Nd:YAG in 45 subjects with SR and SA. Each
stria was divided into three equal sections, two
areas treated with long-pulsed 1064nm Nd:YAG
laser, with uences of 75 or 100J/cm
2
, and one
non-treated, as a control section. All patients
received four treatments at 3weeks’ interval. SA
showed better improvement with 100J/cm2 u-
ing the risk of post-inammatory hyperpigmentation and allowing faster recovering. It has
also a lower risk of hyperpigmentation when
compared to vascular lasers. Oliveira et al.
reported the efcacy of this laser on four
patients with SR. All of them had skin type IV,
making the treatment of SD challenging, due to
the risk of hyperpigmentation with ablative
laser modalities and vascular lasers. They
showed that the erbium glass 1540nm laser is a
safe option in those cases, with good cosmetic
results [44].
ence, while SR improved more with 75 J/cm2.
Histologically, collagen and elastin bers were
increased in both cases [42].
Zaleski-Larsen etal. evaluated the efcacy of
the non-ablative fractional 1565nm Er:glass and
the picosecond fractional 1064/532nm Nd:YAG
lasers in 20 patients with SA on the abdomen.
Three sessions were conducted with a 3-week
Copper-Bromide Laser
Longo etal. tested the 577 nm copper bromide
non-ablative laser in the treatment of SD, which
has higher rates of absorption by hemoglobin
than its PDL counterpart does, with a 33% of
total response and the rest of the lesions showing
diminution of size [45].
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Diode Laser
The non-ablative 1450nm diode laser has been
used to improve cutaneous atrophic scars; thus, it
was expected to be effective in SD.However, Tay
etal. published a study to evaluate the efcacy of
the 1450nm diode laser in the treatment of SR
and SA in Asian patients with skin types IV–VI,
but no improvement was conrmed [46].
13.6.3.3 Intense Pulsed Light
Intense pulsed light (515–1200 nm) seems to
cause collagen denaturation by emitting energy
pulses with various durations and intervals, followed by neocollagenesis. Hernández-Pérez
etal. evidenced the efcacy of IPL by a prospective study conducted in 15 women with SD on the
abdomen, treated with ve sessions of IPL performed every 2weeks. All of them showed statistically signicative improvement, clinically and
histologically. The 590nm is the most effective
modality [47].
To compare the difference between the treatment efcacy of PDL and IPL, Shokeir et al.
treated 20 patients with SD with PDL on one side
of their bodies and with IPL on the other side
once a month, for ve sessions. SD width was
reduced, texture was improved, and collagen
expression was increased with both PDL and
IPL, with a higher improvement in collagen I
expression with PDL compared to IPL in a signicant manner. The degree of improvement was
higher in SR than in SA [48].
13.6.3.4 Infrared Light
Infrared light (IL) comprises a spectrum of
broadband light emitted by a xenon lamp. It has
been largely used in the treatment of atrophic
facial scars and ne wrinkles. One study including ten patients was performed by Trelles etal. to
evaluate the non-fractional broadband IL for the
treatment of SA; four sessions were given 15days
apart. The parameters selected for the treatment
of stretchmarks were an 800–1800nm bandwidth
and a uency of 31J/cm2. Subjective patient satisfaction, measured by a subjective graded score,
was poor for all patients, but some degree of
improvement was shown in the 3D skin surface
analysis and histological organization of SD [49].
13.6.3.5 UV Light
Because repigmentation is a major goal in the
treatment of SA, UV light has been employed
due to its potential of improving SA color by
increasing the amount of melanin [13]. Sadick
etal. showed that the combination of UVB (296–
315nm) and UVA1 (360–370nm) in nine patients
was efcient in 50% of patients, although it was
only temporary; side effects included transient
hyperpigmentation [50].
13.6.3.6 Excimer Laser
The xenon chloride excimer laser delivers narrow-band (308nm) UVB radiation quicker and
with increased precision compared to standard
UV therapy. Different studies have reported
improvements in SA with excimer laser, while
others do not [13].
Pearls and Pitfalls
“RF seems to be effective on both SA and SR,
especially when combined with topical tretinoin
(SR), PRP (SR, SA), or IL (SA).”
“The CO2 laser is a fractional ablative laser.
The efcacy of the CO2 laser has been better
proved in late-stage SA as compared to SR, especially when combined with PDL.”
“The Er:YAG laser is a fractional ablative
laser that has proved efcacy in late-stage SD; it
has also demonstrated clinical improvement and
an increase in epidermal thickness, dermal thickness, and collagen and elastin density in SA.”
“PDL has demonstrated to improve the erythema of SR because of its high afnity for
hemoglobin; thus, it seems reasonable to expect
that PDL is more efcient in SR than in SA.Its
effect in collagen and elastin production is controverted, but it is not superior to fractional ablative lasers (CO
and Er:YAG) when treating SA.”
2
13.7 Conclusions
SD are atrophic linear scars that may affect pregnant women, as a source of stress during pregnancy or as an aesthetic concern later on. There
are many risk factors, as mechanical stress, pregnancy hormonal environment, younger maternal
242
https://t.me/medicina_free
E. Moreno-Artero and L. Aguado
Striae
rubra
Striae
alba
Fig. 13.5 Algorithm for management of SR and SA.Based on the article of Lokhande etal. (2019)
age, primigravidas, higher maternal body mass
index, and higher weight gain in pregnancy.
Topical tretinoin and pulsed dye laser may
improve the clinical aspect of SR, while the fractional ablative lasers (CO
rior when treating striae alba (Fig.13.5).
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