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Fractional photothermolysis tackles striae distensae


Post-treatment, the Masson's trichrome stain demonstrated that the collagen fibers significantly took up more blue stain, and the elastic fiber stain clearly showed an increase in the number of elastic fibers.

Seoul, Korea - Successfully treating striae distensae has always been challenging.

Fraxel (Reliant) laser therapy can successfully treat striae distensae and can very well be just what the doctor ordered in terms of the future gold standard treatment, according to one expert.

"Past treatments of striae distensae include topical retinoid therapy, chemical peels, as well as pulsed dye laser therapy. All these treatments have been used but have had only varying degrees of success, frustrating both patient and physician.

Studying FP

Dr. Chang says that fractional photothermolysis (FP) is a new concept using arrays of microscopic thermal damage patterns to stimulate a therapeutic response.

The Fraxel laser is designed to deliver 2,000 microthermal zones (MTZs) per square centimeter in a regular treatment session, and is able to provide optimal spacing between MTZs (a 200 to 300 micron distance). In her study, Dr. Chang analyzed the epidermal and dermal response to FP with the aim of correlating histopathological and clinical responses in patients with striae distensae.

The results showed that after one single treatment session of fractional photothermolysis, a promising clinical response in lesion color and size could be achieved.

"We saw that the number of the striae treated, and the sum of the length as well as the measurement of the widest portion of the striae decreased post-treatment. Furthermore, we did not see any side effects such as blistering, scarring, hypo- or hyperpigmentation," Dr. Chang tells Dermatology Times.

Dr. Chang explains that the Fraxel laser can be used on patients with aging and sun damaged skin, wrinkles and fine lines as well as pigmented lesions, and results are very pleasing. She says, however, that using the Fraxel laser for striae distensae has been uncharted territory to date.

Fraxel findings

In the study, four female patients with striae gravidarum were treated with fractional photothermolysis (1,550 nm Fraxel SR laser).

The patients in the study all had Fitzpatrick skin type IV. Dr. Chang performed a single treatment consisting of a pulse energy of 18mJ (MTZ) and a final density of 125 MTZ/cm. Dr. Chang assessed the treatment responses by evaluating pretreatment and four-week post-treatment photographs of the target areas, as well as a skin biopsy in one patient using Masson's trichrome and elastic fiber stainings.

Dr. Chang says the histopathology of the abdominal skin before the laser treatment showed a thinned epidermis, as well as frayed and separated collagen fiber bundles in their horizontal plane.

"After one single laser session, the collagen bundle appeared normal and the dermis was thicker, histologically proving the positive effect of the Fraxel laser on the tissues," Dr. Chang says.

She says that post-treatment, the Masson's trichrome stain showed that the collagen fibers significantly took up more blue stain, and the elastic fiber stain clearly showed an increase in the number of elastic fibers.

"The Fraxel laser proved to be effective for the treatment of striae distensae with practically no down time for the patients. There were no side effects to speak of, and the histopathological results matched our clinical observations," Dr. Chang says.

Disclosures: No disclosures are reported.

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