الفهرس | Only 14 pages are availabe for public view |
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. |