Biophysical properties of striae rubra and striae alba in human skin: Comparison with normal skin

Bullous striae distensae in a nephrotic syndrome patient: First case report from the Middle East of a rare presentation and review of the literature

Striae distensae is a common cutaneous phenomenon that begins as reddish linear atrophic plaques (striae rubra) that over time progress to silvery-white coloration (stria alba). Striae distensae in rare occasions becomes edematous, ulcerative, emphysematous, or urticated. Bullous striae distensae is a sequela of conditions causing interstitial edema along with systemic glucocorticoids use. To our knowledge, only eight cases of bullous striae distensae have been reported in the literature. Herein, we report a 17-year-old female, known case of nephrotic syndrome, presented to our clinic with abdominal fluid-fill cutaneous lesions only for 5 days. She had used systemic glucocorticoids for more than a decade before she was labeled as steroid resistant nephrotic syndrome. Cushingoid body habitus were observed during physical examination, in addition to translucent bullae overlying her previously known stretch marks. Punch biopsy of the lesions revealed dermal edema with thinned collagen bundles. Based on these clinicopathological findings, a diagnosis of bullous striae distensae was made. Awareness of this rare complication and unusual clinical presentation is fundamental to avoid unnecessary and excessive interventions whether investigatory or therapeutic in order to provide appropriate management of the underlying condition.

Efficacy and Safety of an Autologous Micrografting Procedure for Management of Striae Distensae in Women

INTRODUCTION

Striae distensae (SD), or stretch marks, are a common skin problem having a psychological impact and cosmetic concern, especially for women, in whom the prevalence is higher than in men. This study assessed the efficacy and safety of a single autologous micrografting treatment (AMT®) using Rigenera® technology for the management of SD.

METHODS

This single-centre study included 10 healthy women between 24 and 65 years of age, with Fitzpatrick-Goldman skin types I-IV, who had visible SD in glutes/thighs. Each subject acted as their own control. The treatment procedure (microneedling + AMT) and the control procedure (no treatment) were performed on contralateral sides of the glutes/thighs, targeting matched and paired SD. Microneedling was carried out using Dermapen®, equipped with 32 needle heads set at 1.5 mm needle length. The AMT procedure involved extracting biopsies from the mastoid hair zone with a 2.5-mm dermal punch, followed by disaggregation of the biopsies in a physiological saline solution using the Rigeneracons. The disaggregated micrografts were then intradermally injected using 30G 4-mm needles, maintaining a distance of 1 cm between injection points, covering the entire marked treatment region.

RESULTS

In the treated area, at 3 months post-procedure compared to pre-procedure, the following changes were observed, all with statistical significance (P ≤ 0.05): (a) significant reductions in skin roughness (Ra, - 15.9%; Rz, - 22.6%), skin luminance (- 2.0%), and blue-green color distribution (- 10.6%); (b) significant increases in skin microcirculation maximum value (+ 240.1%), skin hydration (+ 71.2%), skin elasticity (+ 216.5%), skin density (+ 34.3%), skin thickness (+ 26.0%), and hypodermis thickness (+ 29.9%). Furthermore, for each of the aforementioned parameters, there was a significantly greater improvement observed with the AMT procedure compared with microneedling at 3 months (all P ≤ 0.05).

CONCLUSION

The AMT procedure using Rigenera technology resulted in an noticeable improvement in the SD appearance after 3 months in healthy women.

Clinical efficacy of stromal vascular fraction gel in the treatment of mature striae distensae

BACKGROUND

Striae Distensae (SD) is a common dermatological lesion. The mechanism of formation is unclear, the prevailing theory is mechanical pulling of the skin and hormonal changes. Traditional SD treatment methods include topical drugs, photoelectric therapy, stripping and others, but each has limitations. Stromal vascular fraction gel (SVF-gel) is a filler physically prepared from granular fat, enriched with adipose-derived stem cells (ADSCs) and extracellular matrix (ECM). A good effect in the treatment of neck lines, wounds, acne, and other aspects. SD formation and treatment goals are comparable to those of neck lines. In this study, SVF-gel filling will be used to treat mature SD, and its effectiveness and safety will be discussed in detail.

METHODS

From December 2019 to June 2022, recruit patients who want to treat SD caused by obesity or pregnancy among those who have "autologous fat aspiration" to change their body shape. Preoperatively, the area to be treated for SD was marked, autologous fat aspiration was performed, and the aspirated fat was prepared as SVF-gel and filled into the preoperatively marked SD. All patients had preoperative and postoperative follow-up with planar photographs and VISIA skin analyzer photographs to assess surgical results and safety from subjective and objective perspectives.

RESULTS

A total of 36 patients were enrolled, with 31 of them successfully followed up on. The mean Global Aesthetic Improvement Scale (GAIS) score six months after surgery was 1.87 ± 0.03. At six months postoperatively, the overall patient satisfaction rate was 90%. The depth, area, and color of SD improved six months after surgery, and no serious complications occurred in any of the patients.

CONCLUSIONS

SVF-gel is a safe and effective method of improving mature SD and can be used as a clinical treatment option.

Stretch marks: a visible expression of connective's involvement in autism spectrum disorders

In autism spectrum disorders (ASDs) in the pediatric population, skin manifestations are generally attributable to the concomitance of allergic forms or to accidental, self-inflicted or abusive lesions. However, clinical evidence has highlighted the presence of an increasing number of abdominal stretch marks, probably caused by the increase in the number of obesity cases in the pediatric population, in general, and therefore also among children with ASD. Stretch marks are often attributed to obesity, as they have an incidence of more than 50% in obese individuals. In the first part of this article we hypothesized that in addition to obesity there are other factors, such as a structural alteration on the skin in people with ASD, which can contribute/aggravate the phenomenon of stretch marks. Despite the high frequency with which stretch marks are found in children with ASD, this aspect has never been studied, the structure of the skin of children with ASD is not known. Furthermore, it is not known whether this structure is different from that of subjects without ASD. In the second part of the article, we hypothesized the mechanisms of the negative impact of simple abdominal stretch marks on the symptomatic picture of children with ASD. The presence of stretch marks, altered tactile perception, altered sensitivity to clothing fabrics can be a combination that influences development and determines negative consequences in the neurological picture of a child with ASD, as it is already known that the altered sensory perception in children with ASD contributes to the deterioration of social behavior. Furthermore, the presence of stretch marks may play a role in the postural and motor defects of children with ASD.

Effect of Purple Passion Fruit Extract Cream (Passiflora edulis Sims var. Edulis) 6% against Striae Distensae

ABSTRACT Background: Striae distensae is a skin disorder that causes cosmetic and psychological problems. Purple passion fruit (Passiflora edulis Sims var. Edulis) is widely cultivated, especially in North Sumatra. The seeds are abundant and unused industrial waste. Purple passion fruit seeds contain piceatannol, ascorbic acid, flavonoids, resveratrol, hydroalcohols and sterols which play a role in the repair of striae distensae through anti-inflammatory mechanisms, increase fibroblast proliferation and collagen production, increase crosslinking between collagen fibers and moisturizers. Objective: To determine the effect of 6% purple passion fruit (Passiflora edulis Sims var. Edulis) seed extract cream on striae distensae. Subjects and Methods: This study is a pre-experimental clinical trial with a pretest-posttest research design on 40 subjects with striae distensae. Diagnosis was confirmed by history and clinical evaluation using the Manchester scar scale before and after administration of 6% purple passion fruit extract cream at weeks 0, 2, 4, 6, 8. Adverse effects were recorded during the study and satisfaction levels were assessed at the end. Results: The majority of subjects' ages ranged from 29 to 39 years (72.5%). There was a significant reduction in Manchester scar scale in striae distensae, both after being given a 6% purple passion fruit extract cream or a combination of 1% tretinoin cream for 8 weeks, with a mean reduction of 25% (p = 0.000). Striae distensae after being given 6% purple passion fruit extract cream compared to 6% purple passion fruit extract cream combined with 1% tretinoin cream, there was no significant difference (p = 0.791). From a total of 40 subjects, none experienced side effects (0%). As many as 57.5% of the subjects showed a good level of satisfaction. Conclusion: The use of 6% purple passion fruit seed extract cream can improve the appearance of striae distensae without side effects and the level of satisfaction is good.    

Imaging striae distensae: a comparison between PS-OCT and digital dermoscopy

Stretch marks or striae distensae (SD) cause emotional distress and negatively affect the psychological well-being of patients. We investigate and compare two methods for quantifying the severity of SD: visual scoring of images captured using a clinical visible-light dermatological camera (C-Cube, Pixience Inc) and measuring the local birefringence of skin using polarization-sensitive optical coherence tomography (PS-OCT). Data on skin visually affected by SD and visually normal skin were collected from 19 human volunteers. Our results show a weak correlation between visual scores of the C-Cube images and the birefringence values obtained from the PS-OCT system. SD datasets have a significantly larger birefringence values compared to visually normal datasets.

Platelet-rich plasma for striae distensae: What do we know about processed autologous blood contents for treating skin stretchmarks?-A systematic review

Striae distensae, also known as stretch marks, particularly associated with female sex, pregnancy, obesity, and/or hormonal change, are linear bands of benign dermal lesions. Although not posing any health risk, aesthetically unpleasing stretch marks can cause significant psychological distress among those affected. In abundance of therapeutic approaches, some literature sources proclaim platelet‐rich plasma to be a promising treatment modality for striae distensae. We aimed to shed some light on the current literature evidence of platelet‐rich plasma for treating stretch marks and performed an English literature analysis with two independent reviewers in accordance with PRISMA guidelines searching the PubMed and Web of Science databases in June 2019. Of the 12 found studies, 6 matched inclusion criteria. With no control groups in two, just two other reports used intraindividual comparisons, and all but one publication performed histopathological assessments. All studies observed clinical and subjective improvements without using validated scores or patient‐reported outcome measures (PROMs). The main findings were that multiple treatments with platelet‐rich plasma demonstrated increased epidermal thickness, rete ridges formation, and collagen/elastin formation, while decreasing the inflammatory cell infiltrate. The current literature evidence supporting the use of platelet‐rich plasma for striae distensae is poor. We propose in this review an outline for a study protocol with intraindividual control groups, standardised scores, validated PROMs, and participant incentives to enhance the scientific power in future clinical trials.

Development of a clinical scale to assess the severity of striae distensae

BACKGROUND AND OBJECTIVE

There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale.

MATERIAL AND METHODS

After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested.

RESULTS

Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90).

CONCLUSION

An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.

Tasmannia lanceolata leaf extract alleviates stretch mark appearance in a randomized, placebo-controlled clinical trial in women and stimulates extracellular matrix synthesis in ex vivo human skin explants

BACKGROUND

The leaves of Tasmannia lanceolata mainly contain polygodial that is known to exhibit a range of biological functions including anti-inflammatory effects.

AIMS

These studies aimed to assess the effects of Tasmannia lanceolata extract (TLE) on skin and more particularly on stretch marks in women.

PATIENTS/METHODS

A double-blind, randomized, placebo-controlled clinical study was carried out on 29 women, aged from 25 to 60 years, to investigate the effects of TLE on stabilized stretch marks. TLE and placebo products were topically applied daily for 8 weeks. Skin roughness and firmness of stretch marks were assessed by 2D and 3D photograph processing and analyses. Dermal density and thickness were evaluated using ultrasound, while stretch mark conditions (length, color, and depth) were determined by clinical scoring. Matricial proteins (pro-collagen I and elastin) and pro-matricial factors, like TGF-β concentrations, were quantified from cultures of human skin explants presenting stretch marks, treated with TLE or vehicle control.

RESULTS

Skin roughness of stretch marks was significantly reduced in the TLE group after 8 weeks of treatment. Skin firmness of stretch marks was significantly increased in the TLE group after 4 weeks of treatment, and this improved effect was maintained until the end of the study. Dermal density and thickness were significantly increased in the TLE group compared to the placebo group. Furthermore, TLE restored the dermal condition of the stretch mark skin, up to normal skin levels. In addition, pro-collagen I and elastin concentrations were found to be higher in the TLE-treated stretch mark skin explants compared to the untreated ones, associated with higher quantities of TGF-β production.

CONCLUSION

These results revealed that TLE could help improve the aspect of stabilized stretch marks in women by restoring the matricial environment.

Evaluation of anisotropic properties of striae distensae with regard to skin surface texture and viscoelasticity

BACKGROUND

Striae distensae (SD) are skin lesions of parallel streaks, which mostly occur during rapid tissue expansion. Considering the etiological mechanism of SD, including dermal network ruptures and alignment to mechanical stretch, structural directionality or anisotropy could be expected. Non-invasive objective methods for measuring the anisotropy of SD have not been suggested yet. Therefore, we evaluated the anisotropic properties of SD with regard to skin surface texture and viscoelasticity, to verify them as new objective evaluation parameters of SD.

METHODS

Thirty-two healthy subjects with SD on their body participated. Anisotropy of skin surface texture and biomechanical properties of SD-involved skin and adjacent normal skin was assessed and compared.

RESULTS

Analysis of skin surface texture, based on the ×60 magnified images, revealed that SD have more disordered patterns compared to the regular honeycomb patterns seen in the normal surrounding skin. SD have bigger sizes of each blob than normal skin. The overall anisotropy of skin texture was significantly higher in SD. Skin biomechanical parameters, measured using Cutiscan^® , indicated the less deformable, less recovered, and less viscoelastic properties of SD. When comparing viscoelastic properties over 360°, SD were more anisotropic than the adjacent normal skin as well.

CONCLUSION

We observed that SD were significantly more anisotropic than adjacent normal skin with regard to skin surface texture and viscoelasticity. Therefore, anisotropy could be an objective evaluation parameter to represent the distinctive features of SD. It can be applied for evaluation of the SD severity and clinical efficacy of various treatments.