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Nonablative fractional photothermolysis improves postpartum striae rubra

Article-Nonablative fractional photothermolysis improves postpartum striae rubra

Key iconKey Points

  • Postpartum striae rubra in Asian skin can progress to hyperpigmented striae distensae
  • Timely intervention with laser treatment favorably alters the remodeling process by accelerating early wound-healing stages

Nonablative fractional photothermolysis using a 1,550 nm erbium:glass laser (Fraxel re:store, Solta Medical) is safe and effective treatment for striae rubra in Asian patients, according to Victoria G. Belo, M.D., a private practitioner in the Philippines.

Dr. Belo
In late 2009, Dr. Belo presented her experience using this laser-based approach in six patients with postpartum striae rubra of one to two months' duration at the Joint Meeting of the American Society for Dermatologic Surgery (ASDS) and American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).

The protocol consisted of a series of six treatments at four-week intervals and included a topical treatment regimen applied for one week after each session to mitigate the development of postinflammatory hyperpigmentation, which is a particular risk in Asian skin.

Hyperpigmented striae distensae before (left) and after six sessions of treatment with the Fraxel re:store laser.
RESULTS Clinical and photographic evaluation showed all women benefited, with progressive improvement in the appearance of the striae rubra and overall skin texture without significant adverse effects. The assessments showed decreases in lesion color, length, width and depth, as well as increased elasticity of the treated skin.

Histologic evaluations correlated with the clinical findings and supported a theory regarding the mechanism of action for fractional photothermolysis using the erbium:glass laser for treating striae rubra.

The same patient, one year after the sixth Fraxel laser treatment. Note that the striae further reduced in length and width. They also blended in with the natural skin color, making them less visible.
"In Asian women, postpartum striae rubra can progress to become permanent hyperpigmented lesions. We have tried multiple interventions to improve the appearance of striae rubra and prevent their worsening, but the various modalities have had limitations in terms of efficacy, side effects and/or tolerability," Dr. Belo says.

"We have had good success using fractional photothermolysis with the 1,550 nm erbium:glass laser for various off-face indications, and are excited to see it is a valuable tool for treating postpartum striae rubra, considering it is a very common cosmetic concern," she says.

STUDY DETAILS The women enrolled in the study had Fitzpatrick skin type III-V. Standard laser parameters were used, consisting of an energy level of 30-40 mJ/cm2 , depth of 900 to 1,120 microns, treatment level 4 (200 MTZ/cm2 ) and eight passes (25 MTZ/cm2 ).

Post-treatment, women applied two topical creams twice daily for five days: an anti-inflammatory cream combining hydrocortisone with erythromycin cream and a tyrosinase inhibitor cream containing arbutin, kojic acid and vitamin C.

Changes in striae rubra appearance were rated using a well-established, five-point quartile grading system, where 0 = no improvement or worsening, and 4 = greater than 75 percent improvement. In addition, biopsies were obtained at baseline and at one, three and six months for histological analysis.

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