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8Aug 2019

Fractional Co2 VS other modalities in STRETCH MARKS

Stretch marks are longitudinal, narrow streaks or lines developing on the skin with an off-colour hue. They are a form of scarring in the skip caused by the tearing of the Dermis which first appear as reddish or purple lines but tend to gradually fade to lighter shades. These are often the result of the rapid stretching of the skin associated with rapid growth or rapid weight changes.

They may also be influenced by hormonal changes associated with puberty, pregnancy, body building,Obesity, crushings’s syndrome, marfan syndrome, hormone replacement therapy and misuse of oral and topical steroids as well as that of protein supplements. Both genders may be affected though females are a bit more prone to it. By definition they are dermalscars associated with epidermal atrophy. They appear as linearbands that are initially erythematous to violaceous and gradually fade to become skin colored or hypo-pigmented atrophic lines that may be thin or wide. Cause largely remains unknown but closely relates to changes in structure that provide the skin with its tensile strength an elasticity. Mechanical stretch of skin in  association with hormonal factors has been postulated with its Pathogenesis. some  hormones like Estrogen ,Relaxin and Adrenocortical hormone decrease the adhesiveness between collagen fibers and increase ground substance which result in the formation of striae. They may also formed due to the structure of connective tissue changes that include realignment and decreased expression of collagen, fibronectin elastin and fibrillin. However, in most of the studies there is no direct correlation between degrees of Striae from extent of skin stretching. Affected areas appear empty and are mostly soft to touch. They can be anywhere on the body where large amounts of fat are stored. Abdomen, breast, upper arm, back, thigh hip are the areas more involved. Although no significant medical problem, aesthetically Striae are cause of great concern and are responsible of psychological stress too.

stretch marks are not medically of any concern but aesthetically the marks can be a cause of concern and Anxiety for many women and it affects the quality of life as they are disfiguring.

stretch marks cannot be treated completely but there are various treatments available that improves the appearance of skin. Various topical treatments and procedures are available which helps in improving color and texture of skin by dermal regeneration and epidermal thickening. 

Treatment and Prevention:

Prevention: Although there is no significant data regarding the efficacy of the Emollient applications during the early months of pregnancy to prevent stretch marks but various preparations containing vitamin E, hyaluronic acid, olive oils etc.,are available in the market. Probably the emollient causes improvement in the dryness of skin and hence less scratching.


Vitamin C: Vitamin C is a potent antioxidant drug that can be used topically in Dermatology.  Vitamin C is essential for collagen biosynthesis, it influences quantitative collagen synthesis in addition to stimulating qualitative changes in the collagen molecule. Clinical studies have shown that the topical use of Vitamin C increases collagen production used as a topical preparation to reduce striae alone and in combination of glycolic acid and hyaluronic acid.

Hyaluronic acids: HA Is not an effective treatment Modality. But as an adjuvant in other topical preparation it helps in healing and collagenesis.

Glycolic acid: Glycolic acid used alone as a topical preparation or as a Chemical peeling agent to treat the striae but more effective when used as a topical preparation in combination with Vitamin C or retinoic acid. Againhelps in collagen synthesis.

Tretinoins:  Tretinoin works through its affinity for fibroblasts also induces collagen synthesis. It works maximally in striae rubra and the response is poor and unpredictable in striae albatretenoin promotes collagen and elastin production. When applied nightly into striae rubra, the appearance and texture of the lesions can improve significantly.


Micro-derma abrasions:  Microdermabrasion is effective, well tolerated, and safe for treating striae distensae having more beneficial effect on striae rubra than striae alba with ability to up regulate type I procollagen mRNA expression involved in dermal matrix remodeling. Weekly microdermabrasion treatments gives dermal remodeling and improves appearance of striae. Chances of PIH is very low in case of microdermabrasion. Histological evaluation shows thickening of epidermis and more collagen and elastin fibers in the dermis.

Micro needling: micro-needling by derma roller or derma pen is again collagen induction technique in which mechanical trauma is created in the affected area by fine needles. As of Result of which columns of damaged and healthy skin are formed in skin and as a result neo-cologenesis occurs. Process of wound Healing results in thickening of epidermis and new collagen and elastin synthesis in dermis, resulting in to bridging the gap in the dermis shows significant improvement can be combined with Vitamin C application or hyaluronic acid application during Microneedling.

Radio frequency:  Tripolar RF and intradermal RF both can be used.  RF increases collagen production by inducing collagen Type 1 mRNA expression. They produce heat, which converts electrical current to thermal energy which is uniformly dispersed into various tissue depths. Multiple sittings are required.  Also give improvement in telangiectasia present in striae rubra should be combined with other procedures to get good results as it has got minimal or no effect on epidermal atrophy.

Fractional Co2 with Embriyum Glass LASER:  The use of Ablative Laser diminishes the appearance of stretch marks and can provide safe and effective reduction in the appearance of both striae rubra and striae alba.

Fractional photothermolysis create small zones of thermal damage or injury leaving normal skin columns in between. Injury to the skin initiates cascade of events collectively known as wound healing which includes three overlapping stages of Inflammation, Granulation and remodeling. These sequential events result into proliferation and deposition of collagen into the dermis. Formation of new micro capillaries into the affected area and re-epithelization of the affected area. Fibroblasts activity gives tensile strength to the wound ultimately the resulting tissue as epidermal thickening, collagen deposits and fibroblasts and microvasculature of the area.

Multiple sittings of the fractional Co2 along with the topical applications results into overall improvement of the striae. Being it an invasive procedure the darker skin types are prone to develop PIH. Gradually due to the epidermal thickening and dermal remodeling with every sitting the skin quality improves. Ultimately the resulting tissue has epidermal thickening, dermal collagen deposits and fibroblasts and microvasculature of the area.


Complete remission of striae it is not possible as it is a form of scarring but with treatment the skin condition can be improved up to a great extent. It involves topical treatments as well as procedures. Many of them I have been explained earlier in the article, all of them worked on the ailment to some extent. Fractional Co2 lasers emerged as a best treatment modality for improving the overall skin condition as it involves dermal remodeling as well as epidermal thickening both. With repeated sittings and due precaution the results are very satisfactory to the patient and with proper sun protection the chances of PIH and other possible side effects are minimal.