Striae Distensae Treatment & Management

In current practice, even with the significant dermatologic advances in topical medicaments and light-based devices, total resolution of these lesions remains an unattainable goal.

Avoidance of rapid weight loss or gain may help prevent the emergence of stretch marks, especially in high-risk groups such as teenagers and expecting mothers. Adolescents with striae can expect some improvement in their striae over time.

Striae distensae are most likely to respond to pharmacologic products and clinical interventions at their early stage (striae rubra). Once they become white (striae alba), only few treatment modalities exist and they are become quite difficult to treat.

Intensive moisturization of the lesions and the use of vitamin C, fruit acids, retinols, and other pharmaceuticals has been advocated for the early treatment of striae distensae rubra.

Topical application of tretinoin has been shown to significantly improve the clinical appearance of early striae distensae (striae rubra) as depicted below.^{[1, 2, 3]} It should not, however, be used in pregnant or breastfeeding females owing to a theoretical concern about its teratogenic effects. The use of other retinoids such as adapalene and tazarotene may also hold promise in the treatment of striae distensae.

Treatment with the 585-nm flashlamp pulsed dye laser at low energy densities was shown to improve the appearance of striae.^{[4, 5]} Multiple treatments at 4- to 6-week intervals are usually required. At a lower fluence (2-4 J/cm²), the 585-nm flashlamp pulse dye laser (FLPDL) has been purported to increase the amount of collagen in the extracellular matrix. The 585-nm FLPDL has a moderate beneficial effect in reducing the degree of erythema in striae rubra but has no apparent benefit in striae alba. Because of the potential for adverse effects, FLPDL treatments should be performed with extreme caution or even not at all in darker-skinned patients (phototypes V and VI).^{[6, 7, 8]}

A study from Korea evaluated the effectiveness of using 585-nm pulsed dye laser with radiofrequency (Thermage; Hayward, Calif) for striae distensae. Thirty-seven patients with abdominal striae distensae were treated with the Thermage and 585-nm pulsed dye laser in the first session at baseline. An additional 2 sessions of pulsed dye laser therapy were performed at weeks 4 and 8. Thermage was used at a fluence of 53-97 J/cm², and pulsed dye laser-therapy was used at a fluence of 3 J/cm² with a 10-mm spot. Skin biopsy specimens were taken from 9 patients.

In the subjective assessment, 89.2% of the patients showed "good" and "very good" overall improvement, and 59.4% were graded as "good" and "very good" in elasticity. All of the 9 specimens showed an increase in the amount of collagen fibers, and increased elastic fibers were found in 6 specimens. The authors reported that Thermage and pulsed dye laser appear to be an effective treatment for striae distensae.^[9]

In another study involving the use of a 1064-nm long-pulsed Nd:YAG laser, the authors reported subjective data (55% of patients reported excellent improvement), and objective photographic findings (40% of evaluating physicians reported excellent improvement). Minimal adverse effects were reported.^[10]

Intense pulsed light, a noncoherent, nonlaser, filtered flashlamp that emits a broadband visible light, has been reported to yield clinical and microscopical improvement in striae distensae. It seems to be a promising treatment modality with minimal adverse effects and little-to-no down time. Its efficacy in the treatment of photodamaged facial skin has been widely reported; it promotes the production of neocollagen and elastic fibers.^[11]

Most of the enhancements in the treatment of striae pertain to striae rubra; only very limited modalities have shown promise in improving the appearance of striae alba. Lasers and light sources emitting UV-B irradiation (eg, the 308-nm excimer laser) have been shown to repigment striae distensae (striae alba). The improvement is due to an increase in melanin pigment, hypertrophy of melanocytes, and an increase in the number of melanocytes.^[4]

In another study, a 1550-nm fractional photothermolysis laser was investigated for the treatment of striae distensae alba in Asian patients. Significant improvement in the appearance of the stretch marks was observed 2 months after treatment. Histologic examination revealed a substantial increase in epidermal thickness as well as collagen and elastic fiber deposition. Minimal pain and post treatment hyperpigmentation were the main adverse events reported. Fractional photothermolysis laser treatments appear to improve the appearance of striae distensae alba, particularly through repetitive treatments.^[12]

The author had good success using low concentrations (15-20%) of trichloroacetic acid and performing repetitive papillary dermis-level chemexfoliation as shown below. The peels can be repeated at monthly intervals, with improvement in skin texture, firmness, and color.^[13]

A recent publication pertaining to the use of carbon dioxide ablative fractionated lasers in the treatment of striae distensae showed that the benefit has been questionable; the authors stated, "The data were inconclusive regarding the treatment of striae distensae following a series of treatments, with some patients demonstrating significant improvement while others showed no change from baseline."^[14]