الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 179 |  |  |
| | | from | 179 | | |
Abstract
Striae distensae, or stretch marks, are linear scars in the dermis
which arise from rapid stretching of the skin over weakened connective
tissue.
Striae may result from a number of causes, including but not
limited to, rapid changes in weight, adolescent growth spurts, pregnancy,
steroid induced (endogenous or iatrogenic witch may be topical or
systemic) and generally appear on the abdomen, buttocks, thighs, knees,
calves, breasts or lumbosacral areas.
Pathogenesis of striae distensiae includes retraction of collagen and
elastin fibers resulting in a lack of supporting material and an atrophy of
epidermis.
Various modalities of treatment have been used to treat striae
including topical retinoid therapy, chemical peels, ultrasound therapy,
micro-dermabrasion, IPL, and near infrared lasers and have shown
limited benefit to the patients especially those with striae alba.
Carboxytherapy affects the tissues mainly via decreasing affinity of
Hb to O2 (Bohr effect) resulting in higher release of O2 from Hb with
temporary vasodilatation and thus increasing blood flow to supply
oxygen and nutrients to the skin and subcutaneous tissue. All these
changes lead to neocollagenesis and skin rejuvenation.
Platelet rich plasma -beside the hemostatic function of the
platelets- affects the tissues via promoting tissue repair and releasing of
multiple growth factors.
The aim of this study is to compare the clinical efficacy and safety
of CT and PRP for the treatment of striae distensae.
The study conducted mainly on striae distensea in the area between
diaphragm and knees measuring the degree of change in diameter of the
striae lines in cm.
Regarding the age of patients in this study, it varied between 17
and 47 years old. This may be attributed to that striae distensae are mostly
occurs after pregnancy, weight loss and growth spurt.
Regarding the gender of the patients in this study; all patient were
selected to be females to decrease variables and to declare the hormonal
state as a factor in affecting the end result, and to gain their interest in the
cosmetic outcome to guarantee their compliance to treatment sessions,
however, three of them discontinued the treatment coarse due to long
duration of the treatment.
In the present study, the most common sites affected by striae
distensae were the abdomen, buttocks, flanks and thigh, and less
commonly breast, groin and knees.
In the present study, CT injection was done once/week for eight
treatment sessions while PRP sessions were once every two weeks for
four sessions and a follow up evaluation done after one month of the last
session.
By the use of CT injection as treatment, most of our patients
showed better skin condition with increased plumpness and positive
changes in the texture and appearance of the treated area in the form of
repigmentation and much smoother transition from scar tissue to normal
surrounding skin. Improvement after PRP injection was mild and referred
to the use of PRP as a monotherpy without adding any of the methods of
skin ablation and rejuvenation as microneedling, microdermabrasion,
fractional laser or RF as in previous studies. The fact that points that PRP
should be an adjuvant treatment and not a monotherapy.
In the present study, it was very obvious that carboxy therapy has
the upper hand on PRP injection in the treatment of striae distensea
regarding the results and patients satisfaction, where evaluation of clinical
results after treatment sessions showed that in group A (treated by CT)
there were five patients had excellent improvement, nine had marked
improvement, three had moderate improvement, two had minimal.
improvement and only one patient showed no improvement. With high
overall satisfaction rate While in group B (treated by PRP), no patients
showed excellent improvement, only one patient had marked
improvement, three had moderate improvement, ten had minimal
improvement and six patient showed no improvement (according to
Quartile grading scale) with low overall satisfaction rate.
Almost all high satisfactory results were for striae alba patients. By
the use of CT injection as treatment, most of our patients showed better
skin condition with positive changes in the texture and appearance of the
treated area in the form of repigmentation and much smoother transition
from scar tissue to normal surrounding skin. This was in disagreement
with previous studies who suggested treatment of striae distensae was
more effective during the active stage before scarring process is
completed.
Regarding to the side effects in this study; CT is safe and effective
treatment. The reported side effects were few and minor for most of the
patients and included pain at the injection site as well as immediate
erythema, edema and popping effect of the scar, which did not last more
than thirty minutes. Some needle-entry bruising was noted, which
resolved within seven to ten days. Platelet rich plasma injection showed
much tolerability and safety, but though it should be accompanied by
other methods as mentioned before.
Carboxytherapy was safe and cost effective therapy in treatment of
striae distensae, it has minimal side effects with no allergic reactions or
postinflammatory hyperpigmentation. However, sever pain should be
taken in consider to be managed during treatment sessions.