الفهرس | Only 14 pages are availabe for public view |
Abstract Striae distensae, or stretch marks, are linear scars in the dermis which arise from rapid stretching of the skin over weakened connective tissue. Striae may result from a number of causes, including but not limited to, rapid changes in weight, adolescent growth spurts, pregnancy, steroid induced (endogenous or iatrogenic witch may be topical or systemic) and generally appear on the abdomen, buttocks, thighs, knees, calves, breasts or lumbosacral areas. Pathogenesis of striae distensiae includes retraction of collagen and elastin fibers resulting in a lack of supporting material and an atrophy of epidermis. Various modalities of treatment have been used to treat striae including topical retinoid therapy, chemical peels, ultrasound therapy, micro-dermabrasion, IPL, and near infrared lasers and have shown limited benefit to the patients especially those with striae alba. Carboxytherapy affects the tissues mainly via decreasing affinity of Hb to O2 (Bohr effect) resulting in higher release of O2 from Hb with temporary vasodilatation and thus increasing blood flow to supply oxygen and nutrients to the skin and subcutaneous tissue. All these changes lead to neocollagenesis and skin rejuvenation. Platelet rich plasma -beside the hemostatic function of the platelets- affects the tissues via promoting tissue repair and releasing of multiple growth factors. The aim of this study is to compare the clinical efficacy and safety of CT and PRP for the treatment of striae distensae. The study conducted mainly on striae distensea in the area between diaphragm and knees measuring the degree of change in diameter of the striae lines in cm. Regarding the age of patients in this study, it varied between 17 and 47 years old. This may be attributed to that striae distensae are mostly occurs after pregnancy, weight loss and growth spurt. Regarding the gender of the patients in this study; all patient were selected to be females to decrease variables and to declare the hormonal state as a factor in affecting the end result, and to gain their interest in the cosmetic outcome to guarantee their compliance to treatment sessions, however, three of them discontinued the treatment coarse due to long duration of the treatment. In the present study, the most common sites affected by striae distensae were the abdomen, buttocks, flanks and thigh, and less commonly breast, groin and knees. In the present study, CT injection was done once/week for eight treatment sessions while PRP sessions were once every two weeks for four sessions and a follow up evaluation done after one month of the last session. By the use of CT injection as treatment, most of our patients showed better skin condition with increased plumpness and positive changes in the texture and appearance of the treated area in the form of repigmentation and much smoother transition from scar tissue to normal surrounding skin. Improvement after PRP injection was mild and referred to the use of PRP as a monotherpy without adding any of the methods of skin ablation and rejuvenation as microneedling, microdermabrasion, fractional laser or RF as in previous studies. The fact that points that PRP should be an adjuvant treatment and not a monotherapy. In the present study, it was very obvious that carboxy therapy has the upper hand on PRP injection in the treatment of striae distensea regarding the results and patients satisfaction, where evaluation of clinical results after treatment sessions showed that in group A (treated by CT) there were five patients had excellent improvement, nine had marked improvement, three had moderate improvement, two had minimal. improvement and only one patient showed no improvement. With high overall satisfaction rate While in group B (treated by PRP), no patients showed excellent improvement, only one patient had marked improvement, three had moderate improvement, ten had minimal improvement and six patient showed no improvement (according to Quartile grading scale) with low overall satisfaction rate. Almost all high satisfactory results were for striae alba patients. By the use of CT injection as treatment, most of our patients showed better skin condition with positive changes in the texture and appearance of the treated area in the form of repigmentation and much smoother transition from scar tissue to normal surrounding skin. This was in disagreement with previous studies who suggested treatment of striae distensae was more effective during the active stage before scarring process is completed. Regarding to the side effects in this study; CT is safe and effective treatment. The reported side effects were few and minor for most of the patients and included pain at the injection site as well as immediate erythema, edema and popping effect of the scar, which did not last more than thirty minutes. Some needle-entry bruising was noted, which resolved within seven to ten days. Platelet rich plasma injection showed much tolerability and safety, but though it should be accompanied by other methods as mentioned before. Carboxytherapy was safe and cost effective therapy in treatment of striae distensae, it has minimal side effects with no allergic reactions or postinflammatory hyperpigmentation. However, sever pain should be taken in consider to be managed during treatment sessions. |