Dermabrasion Versus Tretinoin: The Stretch Mark Showdown

Striae cutis distensae, colloquially known as stretch marks, are extremely common and are difficult to treat. Hexsel et al (Dermatol Surg. 2014;40:537-544) published a randomized pilot study to evaluate the efficacy of superficial dermabrasion versus topical tretinoin in the treatment of striae cutis distensae. Thirty-two women were enrolled and all had early (<6 months) striae rubra measuring up to a maximum of 5 mm in length. Exclusion criteria included any striae alba in the area. Two treatment groups were randomized: one received 16 weekly sessions of localized superficial dermabrasion, and the other group applied tretinoin cream 0.05% daily for 16 weeks. All participants were assessed at 4, 8, 12, and 16 weeks. A 3-mm diamond tip rotating at 10,000 revolutions per minute was used for the dermabrasion. The clinical end point of the superficial dermabrasion was no pain or bleeding. Tretinoin was applied once daily at night. The 5-point global aesthetic improvement scale was used to assess patient improvement and biopsies were done in willing participants.

Both groups experienced significant reduction in the width and length of the striae cutis distensae from baseline (P<.05). No differences were seen between the 2 groups, and the global aesthetic improvement scale score did not differ between the 2 groups. Fourteen participants had adverse events including pruritus, erythema, burning, scaling, crusts, swelling, and papules. There was no statistically significant difference in adverse events between treatments; however, the tretinoin group did experience more scaling, pruritus, and erythema. Eight biopsies were done in the dermabrasion group and 1 was done in the tretinoin group. The dermabrasion group showed histologic evidence of epidermal and dermal improvement with a decrease in elastolysis, collagen fragmentation, and epidermal atrophy, as well as an increase in neocollagenesis.

What’s the issue?

Striae cutis distensae is a common and often distressing skin condition. It is well known that treating early striae rubra may be more efficacious than treating later striae alba. Many methods have been employed to treat striae rubra including lasers and creams. This study places superficial dermabrasion against tretinoin in a prospective manner. Although both treatment groups saw improvement, the tretinoin group was noted to experience more scaling, pruritus, and erythema, which can affect treatment adherence and compliance. Dermabrasion was shown to have beneficial effects via histologic examination, not just on the appearance of the striae but also on the skin structures. Dermabrasion can be a suitable option for patients who cannot pursue more costly laser treatments or expensive tretinoin prescriptions. When a patient presents with striae, what is your go-to treatment?

We want to know your views! Tell us what you think.

Reader Comment
How do you rationalize that dermabrasion is less expensive than tretinoin? Patients can purchase it online if their insurance won't cover it.

--Deborah Ohlhausen, MD

Author Comment

This article points out that dermabrasion can be a suitable treatment option. Tretinoin can be expensive if not covered by insurance. Online purchase is not recommended due to the question of safety and efficacy. Therefore, dermabrasion may be a suitable alternative as pointed out by this study.

--Anthony M. Rossi, MD