الفهرس 
STRIAE DISTENSAEOnly 14 pages are availabe for public view
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Abstract
S
triae distensae are a well recognized common skin condition that rarely causes some significant medical problem but is often a significant source of stress to those affected. They arise from progressive and rapid stretching of the dermis. The classic anatomical sites affected include the abdomen and breast for pregnancy related striae, the outer thighs or lumbosacral regions in adolescent boys, and the buttocks, thighs, upper arms and breasts in adolescent girls. Striae distensae are two and a half times as frequent in women and affect up to 90% of pregnant women.
Early lesions may be raised and irritable, but they soon become flat, smooth and livid red or bluish in colour. Their surface may be finely wrinkled. They are commonly irregularly linear, several centimetres long and 1–10 mm wide. After some years, they fade and become relatively inconspicuous.
The histological studies revealed, initial inflammatory changes followed by flattening and thinning of the epidermis due to underlying changes in the numbers and organization of collagen. In mature striae there is stretched collagen fibers aligned parallel to the skin surface, followed by subsequent loss of collagen and increased flattening of rete ridges.
The causes of striae are not clear. They usually occur frequently in numerous physiological and pathological conditions such as adolescent growth spurts, pregnancy, obesity, Cushing’s and Marfan syndromes, and long-term systemic or topical steroid use. Especially in association with pregnancy, they are referred to as striae gravidarum.
Several treatments have been proposed, yet no consistent modality is available It has always been suggested that effective treatment of SD must be instituted during the active stage, well before the scarring process is complete. The first reliable method of treatment involved using tretinoin cream. Subsequent modalities were reported afterward. The erythema of ‘younger’ striae is claimed to respond to the 585 nm pulsed dye and Nd:YAG lasers. Microneedling therapy, also known as collagen induction therapy, is a recent addition to the treatment for managing SD.
Our study was conducted on 30 patients presented by striae rubra aiming to compare the effectiveness of dermaroller, 585nm PDL and topical tretinoin0.5% in treatment SR. We included four groups of subjects: Group I included 10 patients treated by dermaroller 1.5mm, group II included 10 patients treated by 585 nm PDL and group III included 10 patients treated by topical tretinoin 0.5% cream and 10 healthy persons serving as a control considered as group IV.
Clinical improvement of striae was assessed using Quartile grading system which assess erythema, tightness and texture. Also, assessment of surface area measurement was done. Persons of the control group were subjected to one punch biopsy, while two punch biopsies from lesions were taken from three patients of each group (one before and one after treatment) for histological assessment through H&E, Masson trichrome and Acid orcein stain.
There was a significant clinical improvement in the three groups after treatment where dermaroller showed the highest texture and tightness improvement followed by 585nm PDL then topical 0.5% tretinoin cream. Regarding erythema 585nm PDL showed best improvement followed by dermaroller and finally, topical 0.5% tretinoin cream. There was a statistically significant improvement of surface area measurement in the three groups without statistically significant difference between them.
Hematoxylin and eosin stain revealed an improvement in rete ridges pattern in all groups. Neocollagenesis was observed in group I and group II.
Masson’s trichrome stain for collagen revealed marked increase and well horizontally oriented wavy collagen bundles in group I and II but group III showed mild increase in collagen but with a distorted orientation.
Pinkus acid orcein stain showed that elastic fibers were uniformly increased in number in the papillary and reticular dermis in group I and II. Group I showed long and wavy appearance in the upper and lower dermis while group II showed thin and fragmented elastic fibers in the papillary dermis. While in the reticular dermis, they appeared as a woven meshwork of relatively long, wavy fibers. Group III revealed unchanged elastic fibers in the papillary dermis. Some elastic fibers appeared horizontal, wavy and displaced deeper in the reticular dermis.
The irritating sensations from the topically applied tretinoin and expensive costs for laser usage limit their indication. As needling therapy can be safely performed on all skin types without the risk of dyspigmentation and simple with low cost, plus the ease of use, they may be considered as a reasonable therapeutic option for the treatment of striae lesions.