Efficacy of Fractional CO2 Laser and Human Lyophilized Growth Factors in the Treatment of Stretch Marks: A Clinical and Histopathological Study

Abstract

S triae 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, SD remain an important target of research for an optimum consensus of treatment. The present study was designed to evaluate the efficacy of LGF intra-lesion injection versus ablative fractional CO2 laser versus combination of both modalities for SD treatment. Twenty female patients with skin types III-IV aged between 20 and 37 years with both types of SD were enrolled in this study. The treatment area was divided into three areas: area A; received fractional CO2 laser, area B; received combination of fractional CO2 laser and intradermal injection of LGF and area C; received intradermal injection of LGF. Each patient had 3 sessions with six weeks intervals. The outcome was evaluated clinically and histopathologically before treatment and one month after the last session. To the best of our knowledge, no previous studies had tried the treatment of SD by LGF.