Skin stretch marks occur in a significant portion of the population, and this problem places a high psychological burden on those who develop this skin lesion. There are many studies currently underway in pregnant women and other people with RC to develop methods to prevent or treat these cosmetically undesirable lesions.
In the process of conducting research on the causes and management of RCs, it has been determined that there are currently no high-quality, large, double-blind RCTs that support the use of creams and lotions in preventing pregnancy-related RCs, and most studies point to lack of effectiveness of local prophylactic agents. In addition, most of the articles that evaluate the use of lasers for the treatment of RC have a level of evidence of 3-5. Significant side effects may occur with topical and laser treatments.
Treatment of skin stretch marks
To date, there is no treatment that is consistently effective with minimal side effects. The therapeutic result depends not only on the type of RK, but also on the Fitzpatrick skin type. Most side effects, in particular when using lasers, occur in patients with darker skin (III-IV skin types according to Fitzpatrick). Such a factor as lifestyle does not have any influence on the RC (Table 7).
Tretinoin is thought to work by its affinity for fibroblasts and induction of collagen synthesis. It has maximum efficacy in red RCs and is ineffective, with unpredictable reactions, in white RCs. In a double-blind, randomized trial, Kahn et al. treated PK with 0.1% tretinoin cream or base cream as controls. The cream was applied once a day for 24 weeks. After 6 months, there was a marked improvement of 80% (n=8) in the tretinoin 0.1% cream group compared to 8% (n=1) in the bulk cream group.
Up to 78% of pregnant women at risk of developing striae use creams, lotions and ointments during pregnancy, thus incurring considerable expense. A 2012 Cochrane review evaluated six topical agents in more than 800 women and found no statistically significant evidence to support their use in the prevention of RC. The studies included in the review were relatively small and included women at various stages of pregnancy.
Buchanan et al. evaluated the effectiveness of cocoa butter cream in 150 women. There was no significant effect and no difference between RK patients treated with cocoa butter and placebo. Uddin and others. conducted a double-blind RCT evaluating the effects of topical silicone and placebo gel on both sides of the abdomen in 20 women. The results showed an increase in melanin and a decrease in hemoglobin, collagen and plasticity over a 6-week period in both groups. Separate studies point to the beneficial effects of massage on the PK.
Chemical/mechanical debridement
Acid therapies such as glycolic acid (HPA) and trichloroacetic acid (TCA) are thought to work through their ability to increase collagen synthesis. Mazzarello and others. conducted a double-blind RCT in 40 women to evaluate the effect of topical therapy with 70% HPC in RK on the thighs. After treatment, the red PK group showed a significant decrease in PK and hemoglobin. The white PK group showed the same reduction in PK and an increase in melanin. The correct concentration must be used, as higher concentrations may result in irreversible scarring. The use of alumina microdermabrasion to increase type I collagen in the treatment of white RCs has been reported.
Non-ablative laser techniques
Lasers alter the levels of hemoglobin or melanin and some of them have been used in PK research including: 585nm pulsed dye laser (PDL), 1064nm neodymium YAG (Nd-YAG), 308nm xenon -chloride (XeCl) excimer laser and 577 nm copper bromide laser.
Thus, treatment regimens developed should take into account PK type and Fitzpatrick skin type in order to minimize possible side effects. Double-blind RCTs with a large number of patients are needed to fully evaluate the evidence for local therapy and therapy using laser devices in the prevention and treatment of RC.
According to http://www.dermatology.ru/
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