Güngör Sule, Sayilgan Tülay, Gökdemir Gonca, Ozcan Deniz
Department of Dermatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey.
Indian J Dermatol Venereol Leprol. 2014 Sep-Oct;80(5):409-12. doi: 10.4103/0378-6323.140296.
Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet.
We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae.
Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session.
Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies.
We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.
膨胀纹或妊娠纹是伴有表皮萎缩的萎缩性线性真皮瘢痕。有多种治疗方法可供选择，但目前尚无始终有效的治疗方式。
我们比较了1064 nm长脉冲（LP）钕：钇铝石榴石激光和2940 nm可变方波脉冲（VSP）铒：钇铝石榴石激光治疗膨胀纹的疗效。
招募了20名年龄在20至40岁之间、患有膨胀纹（3例为红色型，17例为白色型）的女性志愿者（Fitzpatrick皮肤分型为II - V型）。膨胀纹的病程为4个月至12年。除1例患者的膨胀纹位于手臂、2例患者的膨胀纹位于腰部外，所有患者的病变均位于腹部。对每位患者身体两侧进行随机分配治疗，一侧用VSP铒：钇铝石榴石激光治疗，另一侧用LP钕：钇铝石榴石激光治疗。所有受试者每月接受一次治疗，共治疗三次。从六名受试者身上取了两块3毫米的钻孔活检组织，均取自同一条膨胀纹，一块在第一次治疗前，另一块在最后一次治疗后4周。
通过照片对比进行临床疗效评估，发现17名受试者在LP钕：钇铝石榴石激光治疗侧和VSP铒：钇铝石榴石激光治疗侧的疗效均较差。所有这些患者的病变均为成熟型（白色膨胀纹）。三名受试者两侧均有中度反应；这些患者的膨胀纹为未成熟型（红色膨胀纹）。组织学上，与治疗前的皮肤活检相比，治疗后样本中的弹性纤维略有增加。
尽管观察到了组织病理学变化，但我们未观察到白色膨胀纹病变有令人满意的临床改善。我们认为可变方波脉冲铒：钇铝石榴石激光和长脉冲钕：钇铝石榴石激光对白色膨胀纹的治疗无效。
