الفهرس 
Striae DistensaeOnly 14 pages are availabe for public view
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Abstract
Striae distensae are a well-recognized, common skin
condition that rarely causes any significant medical
problems but are often a significant source of distress to
those affected. The natural evolution of striae is from red or
purple, raised wavy lesions (striae rubra) to white atrophic
lesions with wrinkly surface (striae alba).
The histopathological findings vary according to the
duration of the lesions; striae rubra show a perivascular
lymphocytic infiltrate around dilated venules. The collagen
fibers in the reticular dermis are thin, stretched and aligned
parallel to the skin surface, there are fine elastic fibers
predominating throughout the dermis. While striae alba are
characterized by thinning of the epidermis due to flattening
of the rete ridges. The collagen fibers are reduced and
packed in thin straight bundles in papillary dermis running
parallel to the skin surface. The elastic fibers become
increased and thicker throughout the dermis.
Successful treatment of striae has always been
challenging, although several treatments have been
proposed, no consistent modality is curable. Laser has
become a popular therapeutic modalities used to ameliorate
striae, this includes pulsed dye, copper bromide, diode,
long pulsed 1064-nm Nd-YAG, excimer laser, ablative and non ablative fractional (CO2 and Er-YAG) laser. These
modalities are available for treatment, yet none of them is
consistently effective, and no single therapy is considered
to be pivotal for this problem. With a high incidence and
unsatisfactory treatments, striae remain an important target
of research for an optimum consensus of treatment.
The present study was designed to evaluate and
compare the effect of fractional CO2 laser in the treatment
of both striae alba and rubra using histological and clinical
assessment.
Twenty patients above age of 18 of both sexes
classified in to 2 groups; 10 patients had striae alba and 10
had striae rubra. The duration of striae varied from 1 month
to 8 years. Patients were subjected to 4 sessions with 4
weeks interval and a follow up period of one month after
the last session. A 3-mm punch biopsy was taken from stria
to be treated before treatment and one month after the last
session, all biopsies were subjected to histological and
image analysis studies.
The present study showed significant clinical
improvement in striae appearance for both striae alba and
striae rubra. Five patients of striae alba group reported that
the color of their striae was improved after treatment. Four
patients of striae rubra group showed decrease erythema.
Also 8 patients with striae alba and 7 with striae rubra expressed increase in tightness of their skin at the end of
study.
Our study showed non significant difference between
the effect of fractional CO2 laser in treatment of striae rubra
and alba except for the persistence of prolonged erythema
which was developed in 3 patients of striae rubra group. we
recommend further studies to be done on larger scales of
striae rubra patients to ensure this side effect of fractional
CO2 laser on striae rubra.
Treatment was tolerated well by all patients where side
effects were minimal, mostly pain during the session post
inflammatory hyper-pigmentation and post inflammatory
hypo-pigmentation in patient with striae rubra. These side
effects were statistically non-significant for striae alba and
striae rubra respectively.
The histological findings in the present study support
our explanation of the clinical improvement; the collagen
fibers were increased and closely packed in the upper
reticular dermis in almost all patients.
The present study showed obvious clinical and
histological improvement in patients of both striae treated.
Larger studies with long follow up period are recommended.