Fractional Photothermolysis for the Treatment of Striae Distensae
Macedo,O.R.; Bussade,M.; Fujimura,M.; Salgado,A.G.M.; Secco, L.C.
Background and Objectives:
Striae distensae, better known as stretch marks, are a common disfiguring skin disorder of significant cosmetic concern.They are dermal scars with flattening and atrophy of the epidermis and a common cosmetic and challenging condition to treat. Many sources have reported the use of lasers to diminish the appearance of striae. Successful treatment of these stretch marks has been disappointing. Little has been published about treatment for striae.Various lasers have recently been reported as effective treatment modalities for striae distensae, but pigmentary alterations and minimal degree of improvement are a major concern to the darker skin type.
We evaluate the safety and effectiveness of a novel nonablative 1,550 nm erbium-doped fiber laser in the treatment of striae The Fractional photothermolysis (FP) has been shown to improve atrophic scars and may be expected to improve striae. As yet, no study has been published to document the effects of this laser on striae. Our aim is to evaluate the efficacy of nonablative 1,550 nm erbium-doped fiber laser in the treatment of striae rubra and striae alba.
Fractional photothermolysis (FP) produces arrays of microscopic thermal wounds called microscopic treatment zones (MTZs) at specific depths in the skin without injuring surrounding tissue. Wounding is not apparent because the stratum corneum remains intact during treatment and acts as a natural bandage. Downtime is minimal and erythema is mild.
Fractional Phothermolysis (FP) provides a promising new modality for treatment that is investigated in this study.
Material and Methods:
Fifteen females of various phototypes (I-V), aged 15-50 years, received 5 successive treatments at 2 week intervals with a 1,550 nm erbium-doped fiber laser at various anatomical sites: abdomen, lateral thighs, breasts, back and waist. Striae of all types: fresh, old, mild and severe were treated.
There was no topical treatment associated 1 month before, during or one month after sessions.Patients were given topical anesthetic oitment 1 hour before treatment, and dynamic cooling air device with cooling used during the session to minimize pain.
The following parameters were used: Pulse energy :12 -22 mJ/MTZ and a final density of 2000 MTZs per cm².
Sunscrens were prescribed during treatment.
Clinical photographs were taken before and after each treatment and analysis was undertaken through photographic evaluation by non-treating physicians. Patient satisfaction surveys were also obtained at each follow-up visit.
Of the 15 patients that began the treatment all of them had completed the 5 sessions.
After 5 treatments, appearance of the striae improved . Results were best in fresher and more superficial striae.
In the subjective assessment (digital photography and patients surveys) 20% of the patients showed “very good” to overall improvement the clinical appearance and texture of striae distensae (elasticity, size and width), 40% “good” and 40% were graded as “regular”. Side effects were limited to transient erythema,bronzing, flaking skin and edema in the majority of patients. No prolonged pigmentary changes or scarring were observed. Patient satisfaction surveys mirrored the observed clinical effects.
Striae distansae are a common cosmetic problem especially for women and men, characterized by linear smooth lines of atrophic- appearing skin that are red first and finally white. They are due stretching of the skin, as in rapid weight gain, or mechanical stress, as in weight lifting. Sucessful treatment of these stretch marks has been disappointing.
A new concept of laser called nonablative 1,550 nm erbium-doped fiber laser has been designed to create microscopic thermal wounds to achieve skin rejuvenation, improve atrophic scars and melasma without significant side-effects.
Fractional photothermolysis (FP) has FDA approval for treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, and may be expected to improve striae.
FP produces tiny areas of thermal surrounded, by uninjured tissue called microscopic treatment zones (MTZs). Each MTZ (50 – 150 mm) is surrounded by uninjured tissue, than keratinocytes have a shorter migration path and healing is much quicker.
15 female with striae were treated with nonablative 1,550 nm erbium-doped fiber laser and there was significantly improvement on clinical appearance and texture of striae distensae. Downtime is minimal and erythema is mild, permitting patients to apply cosmetics immediately after treatment. As with other nonablative laser modalities, multiple treatments are required. FP represents an alternative for treatment of dermatologic conditions without the adverse effects of ablative laser devices and can be used on all parts of the body.