I recommend OTC retinol products such as Philosophy Help Me and Neutrogena Healthy Skin to my patients. Of course, prescription retinoids such as Retin-A, Tazorac, and Differin are stronger and, therefore, may be more effective than retinol. I also suggest retinoic acid peels, such as the Ultra Peel Exfoliating Treatment or the Esthetique Peel.
In-Office Treatment
Glycolic acid can be administered in the office at higher doses than those contained in OTC products. After three or four visits, patients usually notice a slight change in the length, width, and intensity of striae rubra. In-office glycolic peels are safe for all skin types, although lower concentrations should be used for people with darker skin tones. As suggested above, the combination of glycolic acid and a retinoid can be effective. In fact, various prescription-strength retinoids are often applied as a preparation for a glycolic acid peel.
Lasers
Since vascular lasers are designed to treat dilated blood vessels, which are characteristic of striae rubra, they present a potent treatment option. These instruments are associated with epidermal turnover as well as increased collagen production and elastic remodeling. I prefer the Dornier 940-nm laser for stretch marks, but some physicians use the 585-nm or 595-nm laser.
In a recent study, investigators treated 20 patients with striae rubra using the 1,064-nm long-pulsed Nd:YAG laser, which has been successfully used to foster dermal collagen synthesis. Subjective evaluations were made by patients (with 55% rating the results as excellent), and the investigators used before-and-after photos to assess treatment efficacy. Forty percent of the doctors considered the results to be excellent. Overall, the investigators found this laser to be an effective option for treating striae rubra, with minimal side effects (Dermatol. Surg. 2008;34:686–91).
In another study, researchers evaluated the efficacy of the Therma Cool TC (Thermage Inc.), in combination with a 585-nm pulsed dye laser, for the treatment of striae distensae in people with darker skin types. Overall improvement was termed “good and very good” by 89% of the participants in the subjective evaluation. Skin biopsies of nine patients also revealed that the level of collagen fibers in each sample increased (Dermatol. Surg. 2007;33:29–34).
In a previous study of patients with dark skin types (IV-VI), researchers studied the effects of a nonablative 1,450-nm diode laser on striae distensae. Eleven Asian patients were treated with the laser with cryogen cooling spray on half of the body; the untreated half served as the control. The investigators concluded that, for patients with skin types IV-VI, the nonablative 1,450-nm diode laser is not a viable option for treating stretch marks (Lasers Surg. Med. 2006;38:196–9).
Intense Pulsed Light
In research on the efficacy of intense pulsed light (IPL), investigators treated 15 women with abdominal striae distensae. Their study was based on the reported efficacy of IPL in fostering the synthesis of collagen and the ordering of elastic fibers. Before-and-after photos and skin biopsies of all 15 patients exhibited significant clinical and microscopic improvements, including differences in dermal thickness (Dermatol. Surg. 2002;28:1124–30).
A more recent examination of an IPL infrared device, the NovaPlus, which attains high fluences with high-frequency stacked pulses, was conducted on 10 patients who had striae distensae. Review of before-and-after photographs and three-dimensional skin surface analysis yielded an equal outcome, and few subjects observed improvement, but histologic assessment revealed improvement in epidermal and dermal condition. The researchers concluded that additional treatment sessions might afford better chances for desired cosmetic results, given the absence of side effects (Aesthetic Plast. Surg. 2008;32:523–30).
Fractional Photothermolysis
Despite the enhancements in overall treatment of striae distensae, few modalities have provided promise in significantly improving the appearance of striae alba.
Perhaps until now. In a recent study of the safety and efficacy of fractional photothermolysis for the treatment of stretch marks in Asian skin, researchers irradiated the striae distensae on the right buttocks of six female volunteers aged 20–35 years using a 1,550-nm fractional photothermolysis laser.
Patients were followed for 2 months. Fleeting mild pain and hyperpigmentation were the adverse events reported. Overall, significant amelioration in the appearance of the stretch marks was observed 2 months after treatment. Histologic examination revealed a substantial increase in epidermal thickness as well as collagen and elastic fiber deposition. Investigators also noted that skin elasticity had become somewhat normalized (Am. J. Clin. Dermatol. 2008;9:33–7).
Conclusions
Although preventive measures can be used to reduce the likelihood of developing stretch marks, prevention is a challenge.
Treatment options are continually expanding. Glycolic acid and retinoids have demonstrated efficacy in in-office procedures and OTC products. Vitamin C may also impart some benefit. In addition, lasers are emerging as viable treatment options. The vascular laser is recommended for striae rubra and the Fraxel laser for striae alba.