الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Striae distensae or stretch marks are linear dermal scars accompanied by epidermal atrophy that occur due to tissue overstretching. Striae distensae is a common condition, which is of no medically importance, but may cause significant cosmetic concern and psychological distress. The prevalence of striae is as high as up to 80% in most populations.
Striae distensae frequently occur during pregnancy, adolescence or in conditions associated with corticosteroid excess, weight loss, cachexia, obesity, or body-building. At the onset, striae rubra are aligned perpendicular to the direction of skin tension, followed by the chronic phase, showing striae albae.
A variety of treatment modalities have been used for the treatment of SD, but there is no simple and definitive treatment. Some authors, have suggested that time is the only treatment for SD and that it returns to normal over years, which is not true. Topical tretinoin cream was shown to improve appearance, and glycolic acid and ascorbic acid have had variable outcomes.
Intense pulsed light was shown to be successful in the treatment of striae albae, but postinflammatory pigmentation occurred in 40% of patients. The 308-nm excimer laser has been shown to temporarily repigment striae albae without improving atrophy. Treatment of SD with pulsed dye, carbon dioxide, and 1,450-nm diode lasers, carboxy therapy, fractional photothermolysis, radiofrequency and platlet rich plasma have also been attempted
Microneedling is not a new procedure, but is a clinically proven and well-recognised aesthetic treatment for ageing, photodamaged skin and scar. The mechanism of action of microneedling is the controlled mechanical stimulation of the wound healing response with rapid closure of the micro-incisions.
The wound healing response is the result of mechanical stimulation of the dermis, which leads to higher concentrations of platelet growth factors and enhanced fibroblast infiltration. As the wound closes quickly, fibrosis is minimised and the safety profile enhanced. In particular, microneedling leads to the gene expression of a number growth factors, collagen type I and glycosaminoglycan.
The aim of this study was to assess the efficacy and safety of microneedling for treatment of SD.
This study was conducted on 20 patients with SD. Each patient had three sessions with four weeks interval between the sessions. Patients were observed every four weeks and for three months following the last session. Possible side effects of the procedure as erythema, edema, pain, prolonged downtime and hyperpigmentation were observed.
The results were evaluated by photographs taken with the digital camera and by histopathological evaluation at 1st session (base line) and three months after last session; by evaluating the final patient’s satisfaction and by the physician’s impressions.
The present study revealed a statistically significant overall improvement of skin texture, tightness, and color in all patients. Excellent improvement was noted in three patients (15%) very good improvement in 6 patients (30%) good improvement in 6 patients (30%) poor improvement in 5 patients (25%). None of the patients reported a lack of change in or worsening of their SD.
The average Atwal score before treatments was 3.65 ± 1.27, while after treatments it was , 2.5 ± 1.28 with an average percentage of improvement of 29.75%, which was statistically highly significant (p<0.01).
Mean length and mean width of striae distensae were 6.0 ±2.34 and 0.47 ± 0.21 at the striae site before treatment with microneedling, after 6 months, when patients had received all 3 sessions of dermaroller treatments, they were 4.15 ± 3.25 and 0.30 ± 0.25 respectively.
Regarding Patient satisfaction scores seven (35%) patients were highly satisfied, seven (35%) were somewhat satisfied, and six (30%) were unsatisfied. No permanent or serious side effects were noticed and pain was tolerable in nearly all patients.
Histopathological evaluation after treatment showed relatively thickened epidermis with more developed dermal papillae (rete ridges), that the epidermis was thickened, and the amounts of dermal collagen fibers were increased
Massion Trichrome staining showed a considerable increase in collagen deposition after the procedure. The collagen appeared to have been laid down in a normal lattice pattern, rather than in parallel bundles as seen in scar tissue.
Conclusion
Needling therapy is an effective treatment for striae distensae and can be safely performed on all skin types without the risk of dyspigmentation. It is a suitable treatment choice for persons with thin, sensitive, or ethnic skin type.