Striae distensae are common dermatological complaint. Cold laser using low-level light/laser therapy (LLLT) offers healing and analgesic effects and was not yet compared to \'hot lasers\' efficacy. Study objective: to assess the efficacy and safety of LLLT in the management of stria alba compared to fractional carbon dioxide (FCO2) laser alone and to the combined use of both devices. Thirty patients with stria alba were randomized to receive either LLLT using diode 808 nm; 8-12 sessions, 2-3 sessions weekly (Group A) or FCO2 laser; 2 monthly sessions (Group B) or combined both devices simultaneously (Group C). Follow up was at 1 month and 3 months after last session. The efficacy of LLLT was statistically comparable to FCO2, despite numerical superiority of the latter. The combined group had the least numerical values in all efficacy outcomes. Patients in LLLT group did not experience any downtime. LLLT is effective in the management of stria alba comparable to the FCO2 laser. The lack of downtime with LLLT is reflected positively on patient\'s satisfaction. However, this is counterbalanced by the frequent weekly visits. Although adding LLLT to FCO2 laser palliates the laser side effects but it offers the least efficacy. Trial registration number NCT04165226 (clinicaltrials.gov).

Striae distensae or stretch marks are a common complaint among women and can be distressing. The present study aimed to assess the efficacy of a mixture of low molecular weight hyaluronic acid and six amino acids when applied with a specific intradermal injection technique known as intra-mural fluid technique. A clinical study was carried out in 32 patients (with a dropout rate by 9.4%) with striae distensae alba (SA) in one or more of the following anatomical areas: breast, abdomen, inner thigh, trochanteric area, gluteal area, posterior supra-iliac area, and lumbar area. Product efficacy was assessed by the investigator using the Global Aesthetic Improvement Scale, while a Likert scale was used to evaluate to score the treatment tolerability and a QoL stretch marks questionnaire was used to investigate the patients\' self-body image. The treatment was effective in improving the appearance of SA fifteen days after the second treatment and 6 months after the first treatment (and after a total of 4 treatments). The product efficacy and tolerability were also perceived by the patients during each treatment session. Our results suggest that the test treatment is a valid treatment option to decrease the appearance of SA. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266.

BACKGROUND: Striae distensae is a disfiguring atrophic skin condition that impairs the body\'s aesthetic image. Despite the variety of conducted studies, there is controversy regarding the best modalities. Human mesenchymal stem cells are considered a rich source for scar treatment. Skin needling is among the most efficient and safe aesthetic and therapeutic devices. This study aimed to evaluate the efficacy of the combination of needling and intradermal injection of mesenchymal stem cells compared to skin needling alone for treating striae distensae.
METHODS: This study was a randomized, double-blind clinical trial involving 10 women aged 18-60. Each striae lesion was divided into two parts, with one side receiving needling and intradermal injection of conditioned medium, while the other side received needling and intradermal injection of normal saline. This treatment was administered in three sessions with three-week intervals. Patients were evaluated before the first intervention and three months after the final session. Three months after the completion of the intervention, patients\' lesions were evaluated using biometric criteria, physician evaluation, and patient self-assessment.
RESULTS: The results demonstrated a significant improvement in dermal and complete thickness and skin density in patients treated with microneedling. All skin ultrasound parameters improved significantly in patients receiving the combination of needling and conditioned medium. When comparing the two groups, significantly higher physician and patient satisfaction was observed in the combination group. However, the comparison of biometric indices improvement wasn\'t significant between these groups.
CONCLUSIONS: The combination of human mesenchymal stem cells with microneedling could be considered a novel effective option for stretch marks.

BACKGROUND: Striae distensae (SD) is a challenging cosmetic condition. Ablative fractional laser (AFL) is an effective method for treating SD. Recently, fractional radiofrequency (FRF) has been shown to be a promising treatment for SD; however, few studies have shown the differences between FRF and AFL in the treatment of SD.
OBJECTIVE: This study aimed to evaluate and compare the clinical efficacy and safety of bipolar FRF with 2940-nm erbium yttrium aluminum garnet (Er:YAG) AFL in the treatment of SD.
METHODS: Twenty volunteers with abdominal SD were enrolled in this study. One half of the abdomen was treated with 2940-nm Er:YAG AFL, whereas the other half was treated with bipolar FRF, with three sessions at 4-week intervals. Photographic evaluations of clinical improvement were conducted by two independent investigators before and after treatment, and the patients provided self-assessments. Two participants underwent three punch biopsies, one before treatment and two obtained from bilateral representative skin lesions on the abdomen 3 months following the final treatment.
RESULTS: Clinical improvements were observed in SD on both sides of the abdomen after the two treatments. Post-treatment skin biopsies revealed increased thickness in the epidermis and dermis, and higher collagen and elastin density compared to those at the baseline. No statistically significant differences were observed in the clinical outcomes between the two treatment approaches.
CONCLUSIONS: The efficacy and safety of bipolar FRF treatment are comparable to those of 2940-nm Er:YAG AFL treatment, providing an alternative and effective treatment for SD.

OBJECTIVE: Skin resurfacing with fractional radiofrequency results in reepithelization, collagen shrinkage, fibroblast stimulation, and neocollagenesis which may be beneficial for the improvement of various skin lesions. This clinical study was conducted to evaluate the safety and efficacy of fractional radiofrequency device (FRF) for the treatment of striae.
METHODS: Seventeen subjects, totaling 67 treatment zones were evaluated. Subjects had 4 FRF treatment sessions to the striae areas, at 4-weeks interval. 3D-standardized photographs of the treatment area with a 3D camera were used to evaluate striae volumetric improvement from baseline to follow up (FU) visits at 12 and 16 weeks post-final treatment. A satisfaction questionnaire was completed by subjects at each of the follow-up visits. Additionally, the mean scores of the live investigator assessments of Global Aesthetic Improvement Scale (GAIS), Subject Satisfaction Scale, Pain Visual Analog Scale and Tolerability Score were calculated.
RESULTS: A total of 15 subjects completed the study (Fitzpatrick skin type I-III, average age 36.2 years) received 4 FRF treatments on multiple different body zones with multiple passes over stretch marks on the abdomen, inner arms, lower buttocks, inner thighs, and/or flanks. Analysis of 3D photographs of the striae affected zones at 16-week FU revealed an average reduction in the striae volume of 19.1%, a reduction of redness of 14.3%, a reduction of pigmentation of 11.2%, and a reduction of striae color of 8.82%. The GAIS improved by 1.7-points when compared to baseline. Treatments were well tolerated with subjects reporting a mean score of 3.8 out of 10 for pain and 3.1 out of 4 for tolerability (indicating the treatment was \"tolerable\"), with no occurrences of serious adverse events. The average subject satisfaction at 16-week follow-up was 3.1, out of a total of 4, which signified subjects were \"satisfied\" with their treatment.
CONCLUSIONS: 3D Image analysis of the treated zones presented overall reductions in the color and texture of striae after four treatments with FRF. A combination of ablation and coagulation introduced by FRF treatment resulted in improvement to the appearance of the treated striae.

BACKGROUND: Available current therapeutics modalities for striae distensae (SD) provide inconsistently effective outcomes. There is ongoing research on innovative treatment modalities to find better treatment solutions.
OBJECTIVE: To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of striae distensae.
METHODS: This study includes twenty-three patients with striae distensae. The body was divided into two halves. One side was randomly treated with CAP biweekly on the same treated side for five sessions with 30 days follow-up after the last session. Another half was left untreated. Efficacy assessment was done using patient and observer scar assessment scale (POSAS), patient satisfaction scales, and Antera 3D® skin imaging system. Safety assessment was evaluated using the visual analog scale (VAS) and adverse effects monitoring.
RESULTS: Patient and observer scar assessment scale, patient and observer overall opinion score, and patient and observer total score in a summary of all rated characteristics, comparing treated and untreated areas, showed a statistically significant reduction in all parameters after one treatment (*p-value <0.05). Patients rated satisfaction as a great improvement in 52.3%, moderate improvement in 39.1%, extreme improvement in 4.3%, and slight improvement in 4.3%. Adverse effects included small scabs, shallow wounds, and rash.
CONCLUSIONS: Cold atmospheric plasma is a safe and effective, innovative treatment modality for striae distensae with minimal side effects.

UNASSIGNED: The work aims to compare the effect of platelet-rich plasma versus fractional CO22 laser/radiofrequency versus both methods combined in treating striae distensae.
UNASSIGNED: The study included ten female patients with striae alba with Fitzpatrick IV skin. Three sites of striae were chosen; one was treated with platelet-rich plasma, another with fractional CO2 /radiofrequency (CO2/RF), and the third received both treatments. Every patient received three treatment sessions one month apart. Patients were photographed, and a skin biopsy was taken from each area before and one month after treatment.
UNASSIGNED: Assessment of the clinical photos showed that fractional CO2/radiofrequency gave a mild improvement in 22%, moderate improvement in 55.5% and marked improvement in 22.5%. Clinically, the combined treatment showed mild improvement in 44% of patients, moderate results in 33% and marked improvement in 23% of patients. The PRP as an only mode of treatment showed poor improvement in 22%, mild improvement in 23% and moderate improvement in 55% of patients. Biopsy results showed a decrease in collagen and elastin after treatment with the solitary methods, while the combined approach resulted in an increase in collagen and a reduction in elastin.
UNASSIGNED: Fractional CO2 laser/radiofrequency combined with PRP or either of them showed clinical improvement to variable degrees with superior results clinically and histologically with the combined method.

BACKGROUND: Cutaneous changes in obese adults have been investigated in numerous studies, but this issue has not been adequately investigated in children.
OBJECTIVE: We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children.
METHODS: A cross-sectional study was conducted between June 2017 and January 2019 in which 82 children with obesity and 86 normal-weight healthy control children were enrolled. Study participants had detailed full-body skin examinations performed by the same dermatologist; mycological and Wood\'s lamp examinations were performed when necessary. Sociodemographic and anthropometric measurements of the participants were recorded.
RESULTS: Striae distensae were the most common skin manifestation in children with obesity; striae were significantly higher in the obese than in the control group (72% vs. 26.7%, p < .001). The anatomical distribution of the striae distensae in the groups differed significantly. Striae distensae were most commonly observed on the buttocks in the control group, while the thighs were the most common site in the obese group. Acanthosis nigricans (63.4% vs. 3.5%, p < .001), acrochordons (17.1% vs. 1.2%, p < .001), keratosis pilaris (32.9% vs. 17.4%, p = .021), intertrigo (11% vs. 0%, p = .001), folliculitis (31.7% vs. 5.8%, p < .001), seborrheic dermatitis (12.2% vs. 3.5%, p = .035) and facial erythema (7.3% vs. 0%, p = .012) were found to be statistically significantly more common in the obese group compared to the control group.
CONCLUSIONS: Obesity in children is associated with numerous cutaneous manifestations. Further study is needed to identify whether weight loss can reduce skin manifestations in obese children.

BACKGROUND: Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life.
OBJECTIVE: To determine the efficacy of ablative fractional carbon dioxide (CO2 ) laser combined with autologous platelet-rich plasma (PRP) versus ablative fractional CO2  laser and placebo in the treatment of SG.
METHODS: Randomized, double-blinded, and placebo-controlled trial.
METHODS: The study was conducted in 16 patients with SG. The assigned treatment area (abdomen) was divided into two sides and was randomly assigned to the PRP side and the control side. All patients received ablative fractional CO2  laser. Immediately after each laser procedure, the PRP side received autologous PRP, while the control side received plain normal saline solution (pNSS) as a placebo. The study was done for three sessions, at intervals of 4 weeks. An independent assessor used the photographs taken at Weeks 6, 10, 14, and 16 to assess the clinical improvement. The patient satisfaction was reported at the same intervals. A quartile grading scale was used to measure both the clinical improvement and patient satisfaction. Data were analyzed using the Jonckheere-Terpstra test. Histopathology was done before treatment and at the end of the study period.
RESULTS: The combination of ablative fractional CO2  laser and autologous PRP had better clinical improvement and patients\' satisfaction compared with ablative fractional CO2  laser and placebo. However, both outcome measures were not statistically significant.
CONCLUSIONS: Ablative fractional CO2  laser combined with autologous PRP appears to be an effective treatment in SG.

BACKGROUND: Striae distensae (SD) or stretch marks, a common condition causing significant cosmetic concern and distress, are linear dermal scars associated with epidermal atrophy that occur due to overstretching. Recently, micro-needling with dermapen is considered as one of the therapeutic modalities for SD. Also, plasma skin regeneration with plasma jet has been recommended as an effective method for the treatment of SD.
OBJECTIVE: The aim was to compare between the efficacy of both methods in the treatment of SD.
METHODS: This study included 30 patients with striae distensae. Body was divided into two halves; one was treated with plasma jet for two sessions with 1 month interval and follow-up one month after the last session and the other half was treated with dermapen for four sessions with two weeks interval and follow-up one month after.
RESULTS: There was no statistically significant difference (p- value >0.05) between dermapen and plasma jet procedures as regard to width, Total Atwal Score, Atwal score component, score of erythema, and skin texture after treatment. There was high statistically significant difference (p value <0.01) between dermapen and plasma jet as regards pain with higher values with plasma jet while there were statistical higher values concerning hyperpigmentation and erythema with dermapen. There was high statistically significant difference (p value <0.001) between width of striae before and after treatment with dermapen.
CONCLUSIONS: Both lines of treatments are effective and promising therapeutic modalities for striae distensae with minimal side effects.