الفهرس 
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Abstract
Striae distensae or stretch marks, while not a health risk, are a significant cosmetic concern which markedly affects patient psychological condition. Striae are atrophic dermal scars with overlying epidermal atrophy that develop in times of increased glucocorticoid production such as puberty, pregnancy, Cushing‘s syndrome, steroid use, and excessive exercise.
Many treatments are available for treatment of striae such as medical treatment as tretinoin and resurfacing techniques (dermabrasion, and chemical peels, non-ablative and ablative laser treatment). However, many have limitations including skin type, side effect profiles and varying degrees of efficacy. Till now no definite treatment is available for striae but sequential treatment is needed to obtain good results.
This study was conducted to compare the effects of carboxy therapy and microneedling using dermapen combined with chemical peeling by TCA 15-30% in management of striae distensae.
This study was done on 40 female patients with striae distensae, all patients showed striae with different degrees (alba and rubra). Half of patients received carboxytherapy 10 sessions with one week interval and the other halves received microneedling using dermapen, 4-6 sessions with 3 weeks interval. Chemical peeling was done immediately after dermapen. Photos were taken before and after treatment and during follow up session. Skin biopsies (3-4 mm punch biopsy) were taken from the stretch marks before sessions from each patient and at the end of sessions. The biopsies were preserved, then processed, paraffin embedded and stained with Haematoxylin and Eosin for histopathologicalstudy, Masson’s trichrome stain for collagen fibers and Van Gieson’s Stain for elastic fibers.
There was highly statistical significant difference as regards to epidermal thickness before and after CO2 therapy (P<0.001), whereas after treatment 70% of cases showed acanthotic epidermis and 10% of cases showed thick epidermis.
There was highly statistical significant difference as regards to rete ridges before and after CO2 therapy (P<0.001), whereas after treatment all cases had rete ridges.
There was statistical significant difference as regards to collagen fiber size (CF) before and after CO2 therapy (P=0.02), whereas after treatment 60% cases had large CF size.
There was highly statistical significant difference as regards to CB status before and after CO2 therapy (P<0.001), whereas after treatment all cases had thick CB.
There was statistical significant difference as regards to CB pattern of arrangement before and after CO2 therapy (P=0.04), whereas after treatment 20% had even arrangement.
There was highly statistical significant difference as regards to elastic fiber (EF) status before and after CO2 therapy (P<0.001), whereas after treatment 90% cases had increased EF status.
There was highly statistical significant difference as regards to EF caliber before and after CO2 therapy (P<0.001), whereas after treatment 40% cases had thick EF status and 10% had coarse EF caliber.
There was highly statistical significant difference as regards to EF arrangement before and after CO2 therapy (P<0.001), whereas after treatment 60% of cases had branched EF.
There was highly statistical significant difference as regards to congestion of blood vessels before and after CO2 therapy (P<0.001), whereas after treatment no congestion in 70% cases.
There was highly statistical significant difference as regards to epidermal thickness before and after microneedling with TCA (P<0.001). ). All cases before treatment showed thin epidermis while after treatment this sign was maintained only in 10% of them.
There was statistical significant difference as regards to rete ridges before and after microneedling with TCA (P=0.002), whereas after treatment all cases had rete ridges. There was statistical significant difference as regards to spongiosis before and after microneedling with TCA (P=0.04), whereas after treatment all cases showed no spongiosis.
There was highly statistical significant difference as regards to CF status before and after microneedling with TCA (P<0.001), whereas after treatment 90% had straight CF.
There was statistical significant difference as regards to CB status before and after microneedling with TCA (P=0.01), whereas after treatment 20% had normal CB and 60% had thick CB.