36 Aesthetic Dermatology S KIN & ALLERGY N EWS • November 2008

C OSMECEUTICAL C RITIQUE Stretch Marks

tretch marks, or striae distensae, are erly, also has the capacity to promote col- and, therefore, may be more effective than and the ordering of elastic fibers. tissue in the ’s dermal layer lagen synthesis. It can be used individual- retinol. I also suggest retinoic acid peels, Before-and-after photos and skin biopsies Sthat result from rapid growth or ly or in combination with . I such as the Ultra Peel Exfoliating Treat- of all 15 patients exhibited significant clin- weight gain. These , which can be recommend SkinCeuticals C E Ferulic and ment or the Esthetique Peel. ical and microscopic improvements, in- found crisscrossing the , abdomen, La Roche-Posay Active C. Supplementa- cluding differences in dermal thickness hips, thighs, buttocks, and arms, occur in tion with oral vitamin C 500 mg twice dai- In-Office Treatment (Dermatol. Surg. 2002;28:1124-30). females and males, particularly as a result ly may also confer some benefit. Glycolic acid can be administered in the of- A more recent examination of an IPL in- of adolescent growth spurts, , Relastin, marketed as an eye cream and fice at higher doses than those contained frared device, the NovaPlus, which attains , rapid muscle growth (from weight a face cream, is touted by its manufactur- in OTC products. After three or four vis- high fluences with high-frequency stacked lifting, for example), and prolonged use of er for its ability to increase elastic tissue, its, patients usually notice a slight change pulses, was conducted on 10 patients who topical . which may ameliorate in the length, width, and intensity of stri- had striae distensae. Review of before- In these instances or peri- stretch marks. Its efficacy is ae rubra. In-office glycolic peels are safe for and-after photographs and three-dimen- ods of growth, collagen and unconfirmed at this point. all skin types, although lower concentra- sional skin surface analysis yielded an equal are not produced fast tions should be used for people with dark- outcome, and few subjects observed im- enough to accommodate the er skin tones. As suggested above, the provement, but histologic assessment re- expansion of other cuta- In an early study of retinoids combination of glycolic acid and a vealed improvement in epidermal and der- neous layers, rendering the for the treatment of striae can be effective. In fact, various prescrip- mal condition. The researchers concluded normally elastic less distensae, 16 of 20 patients tion-strength retinoids are often applied as that additional treatment sessions might af- flexible and manifesting in with stretch marks from var- a preparation for a glycolic acid peel. ford better chances for desired cosmetic re- visible epidermal marks. ious causes completed the sults, given the absence of side effects Initially, these dermal al- study, 15 of whom exhibited Lasers (Aesthetic Plast. Surg. 2008;32:523-30). terations present as pink, significant clinical improve- Since vascular lasers are designed to treat BY LESLIE S. red, or purple lesions, BAUMANN, M.D. ment (J. Dermatol. Surg. dilated blood vessels, which are charac- Fractional Photothermolysis known as striae rubra. If the Oncol. 1990;16:267-70). teristic of striae rubra, they present a po- Despite the enhancements in overall lesions are untreated, they Retinoids promote the tent treatment option. These instruments treatment of striae distensae, few modal- become white (striae alba) and the texture production of collagen and elastin. When are associated with epidermal turnover as ities have provided promise in significant- of the may change from swollen to retinoids are massaged nightly into striae well as increased collagen production and ly improving the appearance of striae alba. flattened or moderately depressed. A high rubra, the appearance and texture of the elastic remodeling. I prefer the Dornier Perhaps until now. In a recent study of proportion of teenage girls and pregnant lesions can improve significantly. In fact, 940-nm laser for stretch marks, but some the safety and efficacy of fractional pho- women are beset with striae distensae. the use of 0.1% for the treatment physicians use the 585-nm or 595-nm laser. tothermolysis for the treatment of stretch Dermatologists now have a number of of striae rubra has been established as ef- In a recent study, investigators treated 20 marks in Asian skin, researchers irradiat- options to tackle this cosmetically stressful fective for more than a decade (Dermatol. patients with striae rubra using the 1,064- ed the striae distensae on the right but- condition, including novel laser treatments Surg. 1998;24:849-56). Retinoids are not as nm long-pulsed Nd:YAG laser, which has tocks of six female volunteers aged 20-35 for striae alba, but the primary focus here effective for the treatment of striae alba, been successfully used to foster dermal years using a 1,550-nm fractional pho- is on topical and cosmeceutical options. however, and are contraindicated in preg- collagen synthesis. Subjective evaluations tothermolysis laser. nant and breastfeeding women. were made by patients (with 55% rating Patients were followed for 2 months. Prevention In a study evaluating commercial topical the results as excellent), and the investi- Fleeting mild pain and hyperpigmenta- There is no surefire method to prevent products for the treatment of striae alba, gators used before-and-after photos to as- tion were the adverse events reported. stretch marks per se, but avoidance of a investigators tested two regimens on 10 pa- sess treatment efficacy. Forty percent of Overall, significant amelioration in the rapid gain or loss of weight improves one’s tients who had abdominal striae alba with the doctors considered the results to be ex- appearance of the stretch marks was ob- chances of not developing these lesions. skin types ranging from I to V. Patients ap- cellent. Overall, the investigators found served 2 months after treatment. Histo- Several topical agents have demonstrat- plied 20% glycolic acid (MD Forté) to the this laser to be an effective option for logic examination revealed a substantial in- ed efficacy in high-risk patients. For indi- whole treatment area on a daily basis for treating striae rubra, with minimal side ef- crease in epidermal thickness as well as viduals who are pregnant or experiencing 12 weeks. Patients also were directed to ap- fects (Dermatol. Surg. 2008;34:686-91). collagen and elastic fiber deposition. In- adolescent hormonal changes, moisturizing ply 0.05% tretinoin emollient cream (Ren- In another study, researchers evaluated vestigators also noted that skin elasticity three or four times daily is recommended. ova) to half of the treatment area, and 10% the efficacy of the Therma Cool TC had become somewhat normalized (Am. Skin becomes more pliant and elastic when L-ascorbic acid, 2% zinc sulfate, and 0.5% (Thermage Inc.), in combination with a J. Clin. Dermatol. 2008;9:33-7). it is well hydrated. Moisturizers that contain tyrosine cream to the other half. 585-nm pulsed dye laser, for the treat- cocoa butter, shea butter, or Centella asiat- Improvement in the appearance of ment of striae distensae in people with Conclusions ica (also known as gotu kola) as a prime in- stretch marks, assessed at 4 and 12 weeks, darker skin types. Overall improvement Although preventive measures can be used gredient are the best. To increase their ef- was documented for both regimens. In was termed “good and very good” by to reduce the likelihood of developing ficacy, massage such formulations deeply addition, a comparison of treated striae 89% of the participants in the subjective stretch marks, prevention is a challenge. into the affected areas. I recommend Belli alba with untreated lesions revealed that evaluation. Skin biopsies of nine patients Treatment options are continually ex- Elasticity Belly Oil, which contains healthy both regimens were effective in decreas- also revealed that the level of collagen panding. Glycolic acid and retinoids have amounts of both cocoa butter and C. asi- ing papillary dermal thickness and in- fibers in each sample increased (Dermatol. demonstrated efficacy in in-office proce- atica, to my patients. creasing epidermal thickness (Dermatol. Surg. 2007;33:29-34). dures and OTC products. Vitamin C may Surg. 1998;24:849-56). In a previous study of patients with also impart some benefit. In addition, lasers Treatment In another study evaluating the effects dark skin types (IV-VI), researchers stud- are emerging as viable treatment options. Identifying striae distensae early is crucial. of a retinoid, 20 women applied tretinoin ied the effects of a nonablative 1,450-nm The vascular laser is recommended for stri- Patients should be advised to seek treat- cream 0.1% to abdominal striae induced diode laser on striae distensae. Eleven ae rubra and the Fraxel laser for striae alba. ment when stretch marks are still red or by pregnancy. In this open-label, multi- Asian patients were treated with the laser Patients are advised to begin at-home purple because the lesions are most like- center, prospective study, researchers ob- with cryogen cooling spray on half of the treatment for stretch marks upon first ly to respond to at-home products and in- served marked improvement in all striae body; the untreated half served as the noticing them and to schedule a derma- office peels at this stage. Once stretch after 3 months, compared with baseline, control. The investigators concluded that, tologic visit. ■ marks are white, treatment becomes more with an average 20% reduction in the for patients with skin types IV-VI, the difficult and less successful. length of the target lesion. Despite the nonablative 1,450-nm diode laser is not a DR. BAUMANN is director of cosmetic Striae rubra may respond to the glycol- emergence in 11 patients of erythema viable option for treating stretch marks dermatology at the University of Miami. She ic acid in various over-the-counter (OTC) and scaling, topically applied tretinoin sig- (Lasers Surg. Med. 2006;38:196-9). has received funding for clinical grants from lotions, most likely through the alpha-hy- nificantly ameliorated pregnancy-induced Allergan Inc., Avon Products Inc., Galderma droxy acid’s capacity to stimulate collagen striae distensae (Adv. Ther. 2001;18:181-6). Intense Pulsed Light Laboratories, Medicis Pharmaceuticals synthesis. I recommend brands with the I recommend OTC retinol products In research on the efficacy of intense Corp., Stiefel Laboratories, and Unilever highest concentration of glycolic acid, such as Philosophy Help Me and Neutro- pulsed light (IPL), investigators treated 15 PLC. To respond to this column, or to suggest such as MD Forté Glycare I and NeoStra- gena Healthy Skin to my patients. Of women with abdominal striae distensae. topics for future columns, write to Dr. ta Ultra Smoothing Lotion. course, prescription retinoids such as Their study was based on the reported ef- Baumann at our editorial offices via e-mail Topical vitamin C, if formulated prop- Retin-A, Tazorac, and Differin are stronger ficacy of IPL in fostering the synthesis of at [email protected].