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The pulse-dye laser can be used in a standardized manner to reduce the size and discoloration of stretch marks (striae distensae) and increase the elasticity of the skin in most patients. Patients experienced approximately 65% improvement in elasticity and depression of stretch marks after treatment. The procedure is used on a small test site, to determine what fluence (amount of power delivered to the targeted area over time) to use, and then stretch marks over an entire abdomen or other area can be treated, usually in one sitting. Careful patient screening is necessary.
Stretch marks (striae distensae) are a common cosmetic skin problem seen after pregnancy, weight gain or when rapid growth spurt cause the skin to stretch too quickly. This rapid stretching creates irregular marks on the skin that can be shiny, pink, silver, red, or gray and/or indented. In women, stretch marks often occur during pregnancy or weight gain over the abdomen, thighs and breasts. In male body builders, striae can occur over the biceps or other enlarged muscle.
During the American Society for Dermatologic Surgery’s 24th Annual Meeting in Boston, Mass., Joshua L. Fox, M.D., indicated that he and Lance A. Barazani, M.D., have evaluated more than 300 patients whose stretch marks were treated with pulse-dye laser. The treatments varied in the amount of fluence used, based on small test treatments done on each patient. Pulse-dye laser treatment is known to increase the amount of collagen and elastin in the skin.
Classification System Established
Previously, Dr. Fox created a classification system for striae based on five components-color, surface texture, elasticity of the skin, depression and extent—each of which is graded on a four-point scale. This classification system allows for an objective measurement of striae for both physician and patient that can be repeated after treatment.
Patient Compliance and Expectations
According to Dr. Fox, the most important part of this treatment involves careful selection of patients. Patient evaluation and education is more important in treating striae than for other cosmetic procedures. Patients must have realistic expectations of outcome since striae may need several treatments separated by several weeks to obtain maximal response and they must also be willing to comply with instructions for preparation of the treatment site. Patients must also understand the need for a small test site procedure.
Performing a small test on one area of striae is key to success and reduction of side effects, Dr. Fox said. Using a test area helps identify patients who may incur pigment problems and also allow the physician to determine the amount of fluence needed for a given patient. By fine tuning the amount of fluence, the potential for blistering is minimized and has not occurred with treatment.
Patients are instructed to apply alpha-hydroxy acid in concentrations of 8% to 20% or retinoic acid cream to the treatment area for at least 2 weeks prior to the procedure and 3% to 4% hydroquinone for 1 week before the procedure. At the time of the test procedure, the striae are traced onto clear film similar to the kind used for overhead projectors. The tracing works better than photography for recording striae since striae often do not photograph well,Dr. Fox noted