Comparative study of treatment for striae alba stage striae gravidarum: 1565-nm non-ablative fractional laser versus fractional microneedle radiofrequency

Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable.

OBJECTIVE

The aim of this review was to determine the most effective type of EBD for improving the appearance of striae.

MATERIALS AND METHODS

The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted.

RESULTS

Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width.

CONCLUSION

Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.

Review of Fractional Nonablative Lasers for the Treatment of Dermatologic Conditions in Darker Skin Phototypes

BACKGROUND

Fractional nonablative lasers (NAFLs) have demonstrated efficacy and safety for treating dermatologic conditions in patients with darker skin phototypes. Nonablative lasers are preferred in darker skin tones due to lower risk of postinflammatory hyperpigmentation.

OBJECTIVE

This review aims to identify the ideal laser options and parameters for treating common dermatologic conditions in patients with skin types IV-VI.

MATERIALS AND METHODS

A comprehensive literature search was conducted on PubMed in May 2023. Of 1,065 articles were identified, and 40 articles met the inclusion criteria. The studies were classified based on design, dermatologic condition, and skin phototype of patients, and assigned levels of evidence according to the Modified Criteria of the Oxford Center of Evidence Based Medicine.

RESULTS

Strong level 1 evidence supports the treatment of melasma and atrophic scars using NAFL. Moderate level 2 evidence was found for using NAFL in acne vulgaris, striae, and skin rejuvenation; 45% of the studies examined skin types III-IV, 20% III-V, 7.5% II-IV, 5% II-V, 5% IV alone, and 2.5% I-IV.

CONCLUSION

Further research is needed to determine the optimal treatment modalities and parameters for skin types V and VI. Appropriate device selection and conservative treatment settings are crucial for optimizing outcomes and minimizing adverse events.

The role of the beautician in reducing striae

INTRODUCTION

Striae distensae are a permanent skin defect that can affect 50%-90% of the population. The appearance of the changes resembles spindle-shaped skin bands. The skin in this area is wrinkled, thin and looks like a scar. Most often, the changes are found on the skin of the abdomen, buttocks, breasts, thighs, and back. The appearance of striae means that the skin in this area has no hair follicles, sebaceous, and sweat glands. This skin is flabby, not very elastic and, what is very characteristic, the pigmentation of the skin affected by striae is much lower than in healthy skin. Cosmetology in the 21st century is developing very dynamically, new technologies are being developed, new cosmetological devices are being created and combined with treatments that have been known for a long time. Today's science offers hope for people who have struggled with reducing striae for many years and nowadays, nothing is impossible.

AIMS

The objective of this article is to provide information about cosmetological treatment used to reduce striae.

METHODS

In this article, we reviewed the published literature, article published in peer-reviewed journals.

RESULTS

Today's cosmetology offers a wide range of numerous treatments, but the best results are achieved through a synergy of two or more treatments. But we should not forget that we should respond to each customer individually.

CONCLUSION

The striae are not a problem that should be ignored. The beauty therapist is able to reduce them and help the client to improve the appearance of their skin.

Microneedling Therapy for Striae Distensae: Systematic Review and Meta-Analysis

INTRODUCTION

Striae distensae (SD), linear scars of derma, caused by disproportionate skin stretching, which indicates a cosmetic problem and even endangers individuals' psychosocial health. Microneedling, representing a relatively new procedural therapy, has shown brightening but diverse results in the remedy of SD. Our study systematically investigates and further evaluates the efficacy of microneedling for SD.

METHOD

This study was conducted following the PRISMA guidelines. According to the preplanned search strategy, four electronic databases were comprehensively searched for eligible clinical controlled studies. Standardized mean difference (SMD) and odd ratio (OR) with 95% confidence intervals were calculated for continuous data and dichotomous data, respectively.

RESULTS

According to the predetermined criteria, eleven eligible articles of six RCTs and five non-RCTs were included. Concerning clinical improvement, a significant difference was observed in the microneedle radiofrequency treatment subgroup (SMD: 0.57, 95% CI 0.20-0.94, P = 0.003). The pooled result of the second subgroup revealed that microneedling and lasers producing almost comparable effectiveness for treating SD with no significant difference (P = 0.35). The analysis result of the third subgroup of microneedling versus non-laser therapy indicated significant difference at the 5% significance level (SMD:1.01, 95% CI 0.51-1.51, P < 0.0001). With regard to patient satisfaction, the pooled estimate concluded that participants' satisfaction with therapeutic effect between MRF and laser group was comparable (P = 0.26), whereas microneedling exhibited significant superiority than both laser (P = 0.04) and non-laser treatments (SMD: 0.95, 95% CI 0.52-1.38, P < 0.0001). Occurrence of post-inflammatory hyperpigmentation (PIH) was not obvious in microneedling therapy compared to other treatments, and a statistically difference was observed (P = 0.0003). Microneedling treatment caused significant pain compared with laser therapy (P < 0.00001).

CONCLUSION

This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of periorbital aging with negative pressure fractional microneedle radiofrequency: A self-controlled clinical trial

BACKGROUND

Several treatment modalities are used for the treatment of periorbital rejuvenation with variable results. Recent studies showed that fractional radiofrequency may be an effective treatment modality for periorbital aging. This study aims to determine the efficacy and safety of negative pressure fractional microneedle radiofrequency (NPFMR) as a treatment for periorbital aging.

METHODS

Twenty-five patients with periorbital aging were involved in this study. They were treated two times with an interval of 1 month. The patients were evaluated before treatment and 1, 3, and 6 months after the final treatment.

RESULTS

The research findings suggest that periorbital wrinkles of the patients were significantly improved by VISIA system (p < 0.05). Physiological indicators detected by MPA10 system showed that compared with before treatment, the hydration increased (p < 0.05) and trans epidermal water loss (TEWL) decreased (p < 0.05) at 3 and 6 months after treatment. The glossiness increased at 1 month after treatment compared to pre-treatment (p < 0.05) and returned to the baseline level at 3 and 6 months after treatment. There was no significant change in melanin content (p > 0.05). Periorbital dermal thickness of the patients significantly increased at 1, 3, and 6 months after treatment according to skin ultrasound (p < 0.05). A periorbital skin biopsy revealed that the collagen fibers in the dermis were significantly thicker and more orderly after treatment, and the expression of type I collagen fibers and elastic fibers was increased compared with that before treatment. One patient developed post-inflammatory hyperpigmentation (PIH) at 1 month after the first treatment, which improved after active treatment. No other adverse reactions were observed.

CONCLUSIONS

NPMFR could be an effective and safe treatment modality for the treatment of periorbital aging.

Review of radiofrequency microneedling: history, devices and uses

Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.

Clinical evaluation of the efficacy of fractional radiofrequency for the treatment and reduction of stretch marks: A prospective study

BACKGROUND/OBJECTIVES

Skin resurfacing with fractional radiofrequency results in reepithelization, collagen shrinkage, fibroblast stimulation, and neocollagenesis which may be beneficial for the improvement of various skin lesions. This clinical study was conducted to evaluate the safety and efficacy of fractional radiofrequency device (FRF) for the treatment of striae.

METHODS

Seventeen subjects, totaling 67 treatment zones were evaluated. Subjects had 4 FRF treatment sessions to the striae areas, at 4-weeks interval. 3D-standardized photographs of the treatment area with a 3D camera were used to evaluate striae volumetric improvement from baseline to follow up (FU) visits at 12 and 16 weeks post-final treatment. A satisfaction questionnaire was completed by subjects at each of the follow-up visits. Additionally, the mean scores of the live investigator assessments of Global Aesthetic Improvement Scale (GAIS), Subject Satisfaction Scale, Pain Visual Analog Scale and Tolerability Score were calculated.

RESULTS

A total of 15 subjects completed the study (Fitzpatrick skin type I-III, average age 36.2 years) received 4 FRF treatments on multiple different body zones with multiple passes over stretch marks on the abdomen, inner arms, lower buttocks, inner thighs, and/or flanks. Analysis of 3D photographs of the striae affected zones at 16-week FU revealed an average reduction in the striae volume of 19.1%, a reduction of redness of 14.3%, a reduction of pigmentation of 11.2%, and a reduction of striae color of 8.82%. The GAIS improved by 1.7-points when compared to baseline. Treatments were well tolerated with subjects reporting a mean score of 3.8 out of 10 for pain and 3.1 out of 4 for tolerability (indicating the treatment was "tolerable"), with no occurrences of serious adverse events. The average subject satisfaction at 16-week follow-up was 3.1, out of a total of 4, which signified subjects were "satisfied" with their treatment.

CONCLUSION

3D Image analysis of the treated zones presented overall reductions in the color and texture of striae after four treatments with FRF. A combination of ablation and coagulation introduced by FRF treatment resulted in improvement to the appearance of the treated striae.

Efficacy of Combined Treatment with Intense Pulsed Light and Erbium Fractional Laser in Striae Gravidarum

Purpose

Laser and intense pulsed light (IPL) treatments are preferred over invasive procedures due to less pain. This study looked at the efficacy and safety of IPL and Erbium fractional laser for patients with striae gravidarum (SG).

Patients and Methods

All 60 patients with SG were successfully enrolled in the study. IPL treatment was followed by Erbium fractional laser (wavelength 2940 nm) treatment at 4-week intervals for a total of three treatments. SG elasticity was assessed with a SEM575 custom instrument and patients were scored for SG span with an Antera 3D multifunctional skin imaging analyzer. A 3D skin impact system was used to assess patients' epidermal thickness. A visual analog scale (VAS) was used to assess patients' pain scores during the treatment period. Improvement in stretch marks was assessed with the Global Aesthetic Improvement Scale (GAIS). The occurrence of adverse events was recorded at a follow-up of 3 months. Patient satisfaction with the outcome of the treatment was also recorded.

Results

Area of stretch marks decreased from 7.89 ± 0.49 cm² pre-treatment to 4.94 ± 1.16 cm² post-treatment (P < 0.001). The grayness values and atrophy of stretch marks were reduced after treatment. Furthermore, skin elasticity and thickness at the lesions of patients increased significantly after the treatment (P < 0.001), while the width of the stretch marks significantly decreased (P < 0.001). The VAS score was 5.45 ± 1.31, the incidence of adverse events was 25%, and patient satisfaction with the efficacy was 96.67%.

Conclusion

IPL combined with Erbium fractional laser improves the area and atrophy of SG, lightens the color, and increases the elasticity and thickness of the skin, with high treatment safety and remarkable clinical results.

New Progress in Therapeutic Modalities of Striae Distensae

Striae distensae (stretch marks/striae gravidarum) is one of the common cosmetic problems that can cause psychological distress and anxiety to patients due to its disfiguring damage, especially for women. The etiology of striae distensae is currently unknown, and risk factors include low maternal age, family history of stretch marks, excessive weight gain during pregnancy, and high neonatal weight. This article reviews the latest literature on the most commonly used, most popular, and novel treatment modalities and analyzes the hot spots and difficulties in striae distensae treatment in recent years. Topical treatment modalities are mainly used as an adjunctive treatment. Ablative lasers and non-ablative lasers are the most popular, among which picosecond has been tried in striae distensae treatment in the last two years. Combined treatment modalities are currently a hot spot for SD treatment, and microneedle radiofrequency and fractional CO₂ laser combined with other treatments are the most common. Microneedle radiofrequency is the most commonly used and achieved therapeutic effect among the combined treatment modalities.

Study on the methodology of striae gravidarum severity evaluation

Background

Striae gravidarum is a common occurrence in pregnancy and many women expect to prevent its development. At present, laser treatment has been used to improve the appearance of striae gravidarum, but the choice of laser type, treatment time, and frequency depend on the therapeutic effect. How to obtain an effective evaluation of striae gravidarum during and after treatment is very important. However, there is no unified evaluation parameter about striae gravidarum. In this paper, we studied the methodology evaluation of striae gravidarum severity. First, the laser therapeutic apparatus was selected as the experimental equipment and different striae gravidarum photos during treatment were obtained. Second, the subject evaluation parameters were chosen based on the literature research and the dermatologists’ guidance. Then, the striae gravidarum photos were divided into different groups by dermatologists based on these parameters. Finally, the objective detection parameters were designed based on the photos feature and subject evaluation parameters. Then, the objective detection parameters were used as the input of the support vector machine and the evaluation results were compared.

Results

Based on the subject evaluation parameters, the experimental data could be divided into mild, moderate and severe groups. The experiment results showed that the striae gravidarum severity of two randomly patients were improved before and after treatment, which verified the validity of the parameters. In addition, the chosen objective detection parameters were different among different groups. With all the objective parameters as the support vector machine input, we could achieve the best recognition rate (82.71%) in the striae gravidarum severity classification. The four parameters (color difference, average density, average width, distribution area) calculated from the photos as the input could achieve acceptable accuracy (81.69%).

Conclusions

The subject evaluation parameters and objective detection parameters proposed in this paper can be used to evaluate the striae gravidarum severity, which is of great significance for the construction of auxiliary diagnostic instrument for striae gravidarum treatment.