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Striae distensae (SD), otherwise known as "stretchmarks," are a common presenting complaint, particularly in young healthy women. SD are hypothesized to form in a patient when the cross-linked collagen is "overstretched" and rupture of this collagen matrix causes the striae. Thus, many treatments work by increasing collagen synthesis. This review critically appraises the evidence to date for the treatment of SD, including both energy-based devices and topical treatments. [ABSTRACT FROM AUTHOR]

Summary: Background: Striae distensae are dermal scars with a linear atrophic depression. The exact origin of striae distensae remains unrevealed, but low expression of collagen and fibronectin genes in the affected tissue was found. Several treatment modalities have been proposed, yet no consistent modality is available. Aim of the work: To evaluate and compare the efficacy and safety of carboxytherapy vs platelet‐rich plasma (PRP) in treatment of stretch marks. Patients and methods: This study included 20 patients with striae alba. Every patient received treatment in the form of PRP injection in their right side (group A) and carboxytherapy session in their left side (group B) every 3‐4 weeks for 4 sessions. Skin biopsies were taken before and after treatment, and they were subjected to fibronectin immunohistochemical stain. Results: There was a significant improvement in striae alba in both groups after than before treatment. There was no significant difference between both groups as regards either percentage of improvement, response (grading scale), or patient satisfaction. The fibronectin‐stained area was significantly higher in both groups after than before treatment, and it was significantly higher after treatment in group (B) than group (A). Conclusions: Both methods were safe and effective with minimal side effects. There was no significant difference between both methods of treatments. This was confirmed histopathologically by fibronectin expression which is found to be low in striae and increased significantly after treatment. But fibronectin expression was higher in group (B) than (A). [ABSTRACT FROM AUTHOR]

This research work mainly deals with studying qualitatively the changes in the dermal collagen of two forms of striae distensae (SD) namely striae rubrae (SR) and striae albae (SA) when compared to normal skin (NS) using confocal Raman spectroscopy. The methodology includes an in vivo human skin study for the comparison of confocal Raman spectra of dermis region of SR, SA, and NS by supervised multivariate analysis using partial least squares discriminant analysis (PLS-DA) to determine qualitatively the changes in dermal collagen. These groups are further analyzed for the extent of hydration of dermal collagen by studying the changes in the water content bound to it. PLS-DA score plot showed good separation of the confocal Raman spectra of dermis region into SR, SA, and NS data groups. Further analysis using loading plot and S-plot indicated the participation of various components of dermal collagen in the separation of these groups. Bound water content analysis showed that the extent of hydration of collagen is more in SD when compared to NS. Based on the results obtained, this study confirms the active involvement of dermal collagen in the formation of SD. It also emphasizes the need to study quantitatively the role of these various biochemical changes in the dermal collagen responsible for the variance between SR, SA, and NS. [ABSTRACT FROM AUTHOR]

Summary: Background: Striae gravidarum (SG), or stretch marks of pregnancy, begin as erythematous streaks and mature into hypopigmented atrophic bands. Objectives: In order to investigate molecular alterations that may promote atrophy of SG, we investigated dermal type I collagen fibrils, which provide human skin with support. Methods: We obtained skin samples of recently developed, erythematous abdominal SG from pregnant women. To examine the organization of collagen fibrils, second‐harmonic generation imaging was performed using multiphoton microscopy. Immunostaining was used to determine protein expression and localization of type I procollagen, the precursor of type I collagen fibrils. Real‐time polymerase chain reaction was used to determine gene expression levels. Results: In control (hip) and stretched normal‐appearing perilesional abdominal skin, dermal collagen fibrils were organized as tightly packed, interwoven bundles. In SG, collagen bundles appeared markedly separated, especially in the mid‐to‐deep dermis. In the spaces separating these bundles, loosely packed wavy collagen fibrils lacking organization as bundles were present. These disorganized fibrils persisted into the postpartum period and failed to form densely packed bundles. Numerous large fibroblasts displaying type I procollagen expression were in close proximity to the disorganized fibrils, suggesting that the fibrils are newly synthesized. Supporting this possibility, immunostaining and gene expression of type I procollagen were increased throughout the dermis of SG. Conclusions: Early SG display marked separation of collagen bundles and emergence of disorganized collagen fibrils that fail to form bundles. These alterations may reflect ineffective repair of collagen bundles disrupted by intense skin stretching. Persistent disruption of the collagenous extracellular matrix likely promotes formation and atrophy of SG. [ABSTRACT FROM AUTHOR]

BACKGROUND Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. OBJECTIVE Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. METHODS AND MATERIALS A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. RESULTS The authors identified 68 articles that met inclusion and exclusion criteria. CONCLUSION There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Striae distensae, otherwise known as stretch marks, are white or red scar-like streaks on the skin. Although they are not associated with adverse health outcomes, striae are associated with significant cosmetic morbidity. While they have been well characterised histopathologically, a non-invasive method of microscopic lesion assessment of striae would be welcome. Methods: To gain insight into the small-scale morphological features associated with striae we undertook an in vivo investigation of nine patients with striae alba and one with striae rubra utilising reflectance confocal microscopy (RCM). Results: Here we demonstrate that features known to be present using light microscopy, such as parallel collagen bundles in the dermis, and some features that are not well recognised by light microscopy, including distortion of dermal papillae, are demonstrable using RCM. Conclusions: Characterising the features of early and established striae distensae with confocal microscopy is an important foundation for future work. The potential ability to reliably identify the earliest pathological changes in skin in early lesions or before clinically manifest striae develop - a task facilitated by our findings - will increase the understanding of their pathogenesis and will have significant practical utility in monitoring the impact of future preventative interventions. [ABSTRACT FROM AUTHOR]

A review of the article "Severe disruption and disorganization of dermal collagen fibrils in early striae gravidarum" by F. wang is presented.

Summary: Stretch marks affect 50‐90% of pregnant women and can cause emotional distress. Stretch marks initially appear reddish, and mature over months to years, becoming permanent white streaks with a depressed, scar‐like appearance. As little is known about how stretch marks develop, this study, from the University of Michigan in the US, aimed to examine the molecular changes occurring in early stretch marks, with the reasoning that findings may explain the appearance of mature stretch marks. For the study, women in their second or third trimester of pregnancy provided skin samples of recently developed, reddish stretch marks on the abdomen; additionally, some women provided skin samples after delivery. The skin samples were analyzed using laboratory techniques to examine the appearance, organization and production of collagen, the main protein that provides strength and support to the skin. The authors found that collagen appeared abnormal in early stretch marks. In particular, collagen bundles, which are normally densely packed, appeared markedly separated, as if “pulled apart” by extreme skin stretching. The skin attempts to repair these separated, damaged collagen bundles by making more collagen. However, this reparative process is inadequate, and produces abnormally thin, disorganized collagen strands that fail to form normal bundles. These changes persisted in stretch marks after delivery, and likely explain why mature stretch marks appear depressed and lacking in structural support. The study's findings suggest that methods of preserving the normal organization and structure of collagen may prevent stretch marks. Once stretch marks have formed, treatments that stimulate the production of collagen that is properly organized as densely packed bundles may improve the appearance of stretch marks. Many treatments available for improving stretch marks are not effective, likely because they do not stimulate normal collagen rebuilding. As such, the authors’ findings not only provide insight into how stretch marks develop at the molecular level, but also provide a therapeutic strategy for improving stretch mark appearance. [ABSTRACT FROM AUTHOR]