Ways to remove stretch marks

Striae solution Oct 1, 2007 Ilya Petrou, MD Modern Medicine

Keypoints: Numerous treatment modalities are available today for the treatment of striae distensae However, no one treatment has proven to be consistently effective Recent research has shown that UVB/UVA1 combination treatment for striae distensae appears to be promising in terms of both short-term efficacy and safety

NEW YORK Û Most experts would agree that there are numerous treatment modalities available today for the treatment of striae distensae, yet none of them prove to be consistently effective nor is one single therapy considered to be a panacea for this cosmetic thorn so often seen by aesthetic physicians. However, recent research has shown that the combination treatment with UVB/UVA1 for striae distensae appears to be very promising in terms of both short-term efficacy as well as safety.

“Whether due to increased glucocorticoid production such as puberty, pregnancy, Cushing's syndrome, steroid use or excessive exercise, effective treatments for striae distensae are, unfortunately, few and far between. Many therapies are currently available for the treatment of stretch marks, but they usually have unwanted side effects, are costly and leave much to be desired interms of effectiveness,” says Neil S. Sadick M.D., clinical professor of dermatology at Weill Medical College of Cornell University and medical director of the Sadick Research Group in New York City. In search of a more effective therapy, Dr. Sadick recently conducted a 22-week study in which 14 patients (skin types II to VI) with striae alba were treated with a combination of UVB/UVA1 (MultiClearÙ; Curelight Ltd. of Or Akiva, Israel). Each patient received a maximum of 10 treatments unless 100 percent repigmentation of the stretch marks was achieved before the tenth treatment. Three 3-mm punch biopsies were taken from willing participants at baseline, immediately after the final treatment and 12 weeks following the final treatment.

PROMISING RESULTS Nine of the 14 enrolled patients completed all treatments and follow-up visits. Results showed that after the final treatment, all of the nine patients demonstrated a greater than 51 percent repigmentation of the striae alba treated. At the four-week follow-up visit, 67 percent of patients showed a greater than 51 percent improvement, and at the eight- and 12-week follow-up visits, 56 percent of the patients showed a greater than 51 percent improvement of their striae. Dr. Sadick noted that hyperpigmentation of the striae was seen in more than half of the patients treated, but the hyperpigmentation resolved in all patients by the final follow-up visit at 12 weeks. Importantly, all the hyperpigmentation was strictly limited to the treated striae and did not affect any surrounding tissues.

Biopsy results demonstrated histologic changes typical of striae. Dr. Sadick noted that there was epithelial attenuation and that the collagen fibers were of a diminutive caliber. Also, a relative increase in the elastic fiber and collagen ratio was seen.

“Although repigmentation is short term, I believe that this high-intensity UVB/UVA1 device is an effective and safe treatment option for striae alba, and it can be used in all skin types. Because its effect was shown to be relatively short lived, most of these patients require maintenance treatments Û one to two treatments every three to six months Û in order to maintain the cosmetic effect,” Dr. Sadick tells Cosmetic Surgery Times.

NOVEL TECHNOLOGY Dr. Sadick says that the MultiClear device is unique in that it combines UVB and selective UVA1 wavelengths, emitting a high intensity noncoherent light with peaks at 313 nm, 360 nm and 420 nm. It is currently FDA cleared for use in UVB phototherapy as well as PUVA phototherapy to treat psoriasis, vitiligo, atopic dermatitis and hypopigmented scars.

Patients received a twice weekly treatment consisting of a combination of UVB (296 nm to 315 nm) and UVA1 (360 nm to 370 nm) using the MultiClear device. The device used a 23 x 23 mm spot size with a pulse width of 1.3 seconds to 3.7 seconds and a fluence range of 45 mJ/cm2 to 400 mJ/cm2.

Study participants reported feeling “warmth” or “heat” during treatment, but none reported discomfort or pain. No major adverse events resulted from the treatments.

SKIN TYPE NOT AN ISSUE According to Dr. Sadick, skin type is one of the limiting factors seen with other types of therapies used for striae, and this limitation is a real cause for concern Û particularly for patients with darker phenotypes. In this study, darker skin types repigmented sooner, which Dr. Sadick attributed to the higher amounts of melanin in the skin. However, these darker skin types did not maintain the pigment longer than the lighter skin types. “I believe that the therapeutic approach we have taken in this study for hypopigmented stretch marks is a major advance. Hopefully, newer and even more effective technologies will continue to evolve,” Dr. Sadick says. “In my practice, I am using a combination approach of Fraxel plus targeted phototherapy, and this combination therapy appears to achieve optimal results for striae.”

Numerous therapies are employed for the treatment of striae distensae including topical tretinoin, microdermabrasion, and chemical peels, as well as ablative and nonablative laser treatments. Yet, according to Dr. Sadick, none of these treatment modalities can claim to be “the answer” for striae distensae and the cosmetic nemesis they pose to most aesthetic patients. “We are still looking for a 'holy grail' in the form of an effective and viable treatment for stria. Some of the major advances in this direction have been technologies like fractional resurfacing, Portrait Plasma, and combined microablative heating technologies like the Pearl and targeted phototherapies. However, although these modalities have made a major strike forward, none of them have been shown to be 100 percent effective,” Dr. Sadick says.

Reference

Sadick NS, Magro C, Hoenig A. Prospective clinical and histological study to evaluate the efficacy and safety of a targeted high-intensity narrow band UVB/UVA1 therapy for striae alba. J Cosmet Laser Ther. 2007;9:79-83.

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