Table 3a.
Different therapies used for striae distensae
| Type of modality used in study | Type of study | Machine specifications | Frequency and total no of sittings | Results and remarks | Level of evidence |
|---|---|---|---|---|---|
| Fractional ablative CO2 laser[25] | Retrospective cohort study | 10,600 nm at 10 mJ/MTZ | Single session Retrospectively reviewed | Almost 60% of patients showed ≥50% clinical improvement in SA Most of the patients were very satisfied A/E - PIH, pruritus, crusting, oozing, erythema | 4 |
| Fractional non-ablative Er glass laser[31] | RCT | 1550-nm Er:YAG | 1-2 sessions with 4 week intervals | Decrease erythema index, melanin index of the treated SD lesions Skin elasticity was partially normalised with increase in epidermal thickness, collagen and elastic fibre A/E- mild, transient pain and hyperpigmentation | 2 |
| 1550 nm non-ablative fractional Er glass laser[33] | Case series | Moderately high-energy sessions of 1550 nm | 5 sessions at 4 weeks interval | Dimensions of both SA and SR were decreased at 1 month and 1 year after treatment in comparison to before | 4 |
| Fractional non-ablative Er glass laser[34] | Prospective cohort study | 1550 nm at 80-100 mJ/MTZ | 4-8 sessions at 4-week intervals | Mean clinical improvement of~80% after an average of 6-7 sessions Mean patient satisfaction score of 8.2/10 A/E - PIH | 4 |
| Fractional non-ablative Er glass laser[35] | Cross-sectional study | 1540 nm at 70 mJ/MTZ | 3-6 sessions at 1-month interval | 50% of patients showed clinical improvement after 3 sessions and remaining 50% showed after 4-6 sessions A/E - erythema, oedema | 4 |
| Fractional non-ablative Er glass laser[36] | RCT | 1550 nm at 12-18 J/cm2 | 6 sessions with 2-3 week intervals Untreated site acted as controls | 63% patients had almost 50% improvement Improvement in striae dimensions≤50% improvement was observed in texture and colour of the striae A/E - erythema, oedema, blistering | 1 |
| Fractional non-ablative Er glass laser[38] | RCT | Abdomen divided into 2 parts treated with 1540 nm at 50 J/cm2 vs 1410 nm at 30 J/cm2 | 6 treatments at 3-6-week interval | All patients demonstrated clinical improvement with histopathology showing increased epidermal thickness, dermal thickness and collagen and elastin density 28% of 1410-nm treated and 33% of 1540-nm treated groups had good or excellent improvements; 71.4% and 28.6% of patients were very satisfied and moderately satisfied, respectively No significant differences between lasers A/E - 1540-nm laser - pain and 1410-nm laser - PIH, pruritus | 2 |
| PDL[41] | RCT | 585 nm Four treatment protocols (fluence): 1=10 mm, 2.5 J/cm2; 2=10 mm; 3 J/cm2, 3=7 mm, 2 J/cm2; 4=7 mm, 4 J/cm2 untreated striae in same patient acted as controls | Single session | Improved aesthetic appearance and skin shadowing with all protocols Best results observed with higher fluence, i.e., 10-mm spot size+3 J/cm2 A/E - purpura, erythema, hyper-hypopigmentation | 2 |
| PDL[43] | RCT | 585 nm at 3 J/cm2 | Two treatments 6 weeks apart Untreated striae as controls | No significant differences in striae area Colour improvement in SR but not in SA A/E - PIH | 2 |
| 308 nm excimer laser[46] | RCT | 308 nm at 150-900 J/cm2 | Up to 15 sessions | Almost 100% patients achieved darkening and improved appearance of striae | 2 |
| XeClexcimer laser[49] | RCT | 308 nm | Up to 10 sessions with weekly intervals | 80% of patients showed very poor results, without any satisfaction | 2 |
| Long-pulsed Nd:YAG laser[50] | Comparative RCT | Striae divided into 3 sections and treated with 1064 nm at 75 J/cm2 vs 100 J/cm2 vs control 5 mm spot size and 15 ms pulse duration | 4 treatments at 3-week interval | Histopathological and clinical improvement in length and width of striae was seen SA showed better response to 100 J/cm2 and SR responded better with 75 J/cm2 | 2 |
| Long-pulsed Nd:YAG laser[52] | Comparative RCT | 1064 nm Nd:YAG laser | 4 treatments at 4-week interval | Some clinical and histopathological improvement in SD, but it was not statistically significant | 2 |
| 1450 nm diode[55] | RCT | 1450 nm at 4, 8 and 12 J/cm2 | Three sessions with 6-week intervals | Patients failed to show any improvement A/E - erythema, PIH | I |
| Tripollar RF[59] | Case control | 40-50 W | Six sessions with weekly intervals | Improvement of 25-50% and 51-75% in 38.2% and 11.8% of patients, respectively Patients were slightly satisfied, satisfied and very satisfied (12%, 23% and 65% of patients, respectively No significant differences in striae surface smoothness A/E - occasional pinching, sensation during treatment | 4 |
| Nano-fractional RF[66] | Case control | - | 3 sessions 4 week interval | The total surface area and the width and the length of striae alba significantly decreased from the baseline Average mean number of collagen and elastin bundles was significantly increased A/E - PIH | 3 |
| Ablative fractional microplasma RF[67] | Case control | - | Four sessions every 2 weeks | Mean severity score improved by 20% Mean score from patient assessment was 2.4 (≥50%) (good to very good) A/E -erythema, oedema | 4 |
| PCT[72] | Case control | Disk microneedle therapy system (DTS) | 3 sessions with 4-week intervals | Marked to excellent improvement in 43.8% with minimal-to-moderate improvement in remaining patients | 4 |
| Microdermabrasion[76] | RCT | 5 sessions at weekly intervals Other half of body acted as control | Good to excellent (i.e ≥50%) improvement in 50% and mild-to-moderate improvement in the rest Greater improvement in SR Increased type 1 procollagen at mRNA levels in treated striae A/E - PIH, erythema | 2 | |
| IPL[80] | Case control | 535, 550 and 580 nm at 25-35 J/cm2 | Five sessions with 3-4 week interval | Increased collagen, amide1 and beta sheet expression after IPL treatment A/E=stinging sensation | 4 |
| IPL[81] | RCT | 650 nm at 13-15.5 J/cm2 vs 590 nm at 13-14.5 J/cm2 | Five sessions with 2-week intervals Different wavelengths used on opposite sides of body | Significant reductions in length and width with both treatments Significant reduction in erythema with 590-nm wavelength along with superior patient Satisfaction scores A/E=erythema, pain, burning, PIH (all more common with 590-nm wavelength) | 2 |
| UVB/UVA1 light therapy[85] | RCT | UVB: 296-315 nm 1 UVA: 360-370 nm at 45-400 mJ/cm2 | Biweekly treatments for a maximum of 10 treatments | After final treatment, 5 patients had 100% pigmented striae (hyperpigmented), 3 had 76-100%, and 1 had 51-75% improvement After 12 weeks, 2 patients had 51-75% improvement, 3 had 26-50% improvement and 4 had 0-25% improvement Increase in elastic fibre to collagen ratio in 1 patient A/E -erythema, PIH | 2 |
| TCA-based easy peel solution 1 post peel cream[88] | Case control | TCA: 50% | Up to 8 treatments monthly | Almost all had a 60-75% improvement with reduced depth of striae | 4 |