Stria

Striae is an absolutely independent nosology in terms of etiopathogenesis, both in terms of clinical and morphological picture, and in terms of treatment.

Strias - "stretch marks", stratified atrophy of the skin, striped atrophodermia, striae distensae, striae gravidarum - peculiar atrophy of the skin in the form of narrow, sunken, wavy bands localized mainly in the places of the greatest stretching of the skin.

Striae are a serious cosmetic defect, as they appear, as a rule, on the skin of young people, who are very concerned about the aesthetic appearance of their body.

[1], [2], [3], [4], [5]

Causes of striae

Strias can be a symptom of various diseases (hypercorticism, Itzenko-Cushing's disease, Marfan's syndrome), can appear against the background of a diencephalic syndrome, the intake of anabolic hormones in athletes, adrenal hyperplasia, juvenile hypercorticism, and in the puberty period, children gaining weight.

It is believed that the main cause of the appearance of striae in all cases is hormonal imbalance, with the predominant role of adrenocorticotropic, thyroid-stimulating hormones, thyroid hormones, adrenals and gonads. However, skin hyperextension is not less important, it is in these places that the formation of striae occurs. In athletes with the buildup of muscle mass, striae appear in the shoulder girdle, hips: in women during pregnancy - on the abdomen, mammary glands (the places of the greatest stretching of the skin); in women who gained weight sharply - on the hips, in the waist, buttocks, etc.

[6], [7], [8], [9], [10]

Pathogenesis of striae

It is assumed that in the pathogenesis of striae, one of the most significant factors is a decrease in the synthesis of collagen and elastin by fibroblasts while maintaining the ability to synthesize metalloproteases (collagenase, elastase). That is, fibroblasts, synthesizing enzymes that destroy collagen and elastin proteins, support the strength of the skin, predominate in the spectrum of cells of the fibroblastic series. As a result, with overstretching of the skin caused by one of the above reasons, a rupture occurs, the destruction of the mesh layer of the dermis while maintaining the epidermis. Vessels, collagen and elastic fibers are torn, a "failure" occurs in the skin.

The histological picture of "young" striae

The epidermis has a normal structure and thickness. The basal membrane, papillae and scallops are well expressed.

Subepidermal and underlying layers have a monomorphic pattern. Between the clumps of broken fibrous structures, cellular elements are seen. Among which the normal size and shape of fibroblasts predominate. There is a large number of paretically dilated vessels, which explains the stagnant cyanotic-pink color of the striae. The histological picture, as well as the scarring, varies from the life of the striae. The older the stria, the less there are vessels and cellular elements and more fibrous component.

From the histological picture it is clear that young striae and scars are different structures. In physiological scars damaged tissue of the dermis as a result of the inflammatory reaction is replaced by a fibrous, consisting of collagen fibers lying parallel to the skin. Stretch tissue is a torn fibrous dermis skeleton, that is, in the first place, torn collagen fibers. With the "aging" of the striae, their histological structure approaches the structure of physiological scars.

Symptoms of Stretch

Young people, on the hips, buttocks, chest, abdomen appear red-cyanotic bands, located most often either radially (on the mammary glands, abdomen), or in parallel. Striae can be single and multiple. Their length varies from 1-1.5 cm to 8-10 cm, width from 1-2 mm to 5-6 mm. The clinical picture of striae depends on the extent of stretching, morphological properties of the skin, hormonal background, concomitant pathology. The color of the striae gradually changes over a period of several months from bright pink-cyanotic to whitish with a pearly hue. Up to 6 months, striae are considered "young", after 6 months - "old". The relief of the skin over the striae can have a different configuration - either the striae are flush with the skin, or they have a retracted relief, or a convex:. Most often, doctors face the first two options. The third option in its clinical picture in many ways resembles an antedoderm, since convex formations during palpation easily "fall through" in depth. Depends on the relief of the striae from the area, degree and depth of damage to the fibrous structures of the dermis.

Treatment of striae

Treatment of striae is a complex task, but complex, long-term, consistent therapy always brings its fruits. The earlier the treatment of "stretch marks" is started, the greater the probability of obtaining a therapeutic effect (by analogy with scars). In young striae, there are still enough vessels, and thus good nutrition of damaged tissues is preserved. Many cellular elements, among which the major part is occupied by fibroblasts that release cytokines, biologically active molecules, growth factors, enzymes, structural proteins, etc. In other words, young damaged (torn) tissue retains the potential for partial restoration. Old stretch marks (after 6-8 months) have fewer vessels, cellular elements. Fibroblasts in particular, that is, a much smaller potential, decreasing with age in a geometric progression.

Methods and technologies used to treat striae

All methods of treatment are aimed at stimulating fibroblasts, their synthetic and proliferative activity, to restore the structure of the destroyed dermis, to improve microcirculation, eliminate oxidative stress and deficiency of trace elements and vitamins. Optimal treatment is always a complex treatment, and accordingly, in the therapy of striae, this principle must be observed.

Mesotherapy

If you arrange all the methods of treatment of striae by their effectiveness, then in the first place will be mesotherapy methods, since they allow you to bring pathogenetically justified drugs directly to the zone that needs them. At once I would like to make a reservation about the unusual names of the drugs used for the treatment. These are water-soluble imported agents used for mesotherapy. All preparations are injected at a depth of 2-3 mm into the tissue of the striae.

Blood supply to the striae should be improved at all stages of their existence, as trophism of tissues is sharply disrupted. Accordingly, micropapulnal, linear techniques, natshazh (generally accepted in mesotherapy machines) must be administered vasoactive drugs: pentoksifillin, nicotinamide, rutin meliloto, ginkgo biloba in the form of monopreparations or in combination with procaine (novocaine), which also has a vasoactive effect along with immunomodulating.

In the treatment of "young" stria an important factor is the stimulation of the synthetic and proliferative activity of fibroblasts. In this regard, it is necessary to introduce biostimulating preparations in the striae: aloe extract, placenta, placentene, Ascent extract, hyaluronic acid, glycolic acid, keratinocyte complement, embryoblast, NCTF-135, GAG and GAG complex. To stimulate collagen formation and neutralization of free radical stress in "young" striae, it is recommended to administer preparations of vitamins C, A; microelements Zn, Cu, Se, Si, multivitamin BOH, organic silicon, conjonctyl. Copper and zinc are not desirable to be introduced into one procedure, since there is evidence of their antagonism.

To complement the volume of the striae used drugs: x-ADN-gel, hyaluronic acid, collagen, elastin, GAG and GAG-complex.

On average, the rate is 10-12 procedures at a frequency of 1 time per week. Vasoactive drugs with low molecular weight (pentoxifylline, nicotinamide) can be used 2-3 times a week. 1-2 months after the application of other methods of treatment of striae, it is desirable to repeat the course of mesotherapy with. Recently, among the preparations for mesotherapy appeared a specific drug to reduce the stria - StretchCare. This ready-made cocktail containing DMAE, hyaluronic acid, vitamin B5, microelements. For 7-8 sessions of using this cocktail you can get good aesthetic results.

• Intradermal biostimulation (separation of striae with a needle or a thread from the underlying parts of the dermis), 8-10 procedures with an interval of 7-10 days;
• Computer ridolysis. 8-10 procedures with an interval of 7-10 days;
• Peelings retinoic, glycolic or ANA-acids, phenol in low concentrations.

These types of peelings not only reduce the thickness of the epidermis, but also stimulate the basal keratinocytes and dermal fibroblasts, which leads to the restoration of damaged structures.

On the cosmetic market, there are peelings, designed specifically for the treatment of striae. For example, peeling "Strnapil" produced by "Medic Control Heel". It is based on a modified solution of Jessner (resorcinol, glycolic acid-50%, lactic and salicylic acid) and 5% retinoic acid. Peeling is quite comfortable, safe and effective. The combination of resorcinol, coagulating proteins; AHA in high concentration, weakening the adhesion between the corneocytes; beta-hydroxyl acid, which enhances the effect of the remaining components and retinoic acid, which improves regeneration, gives a marked improvement in the relief of the skin. Striae are expressed by relief and color due to intensive exfoliation, regeneration and moisturizing of the skin. The course includes 10-15 procedures, the interval between which is 2 weeks.

• Therapeutic dermabrasion. Negative pressure should not be created more than 3.5 bar, the exposure time of the tip on the skin should also be strictly controlled. The effect in the treatment of striae is associated not only with the abrasive action, but also with the elements of "vacuum massage", which stimulates the cell elements of the dermis. The number of sessions depends on the thickness of the cell layers removed during the session. The course of treatment - from 8 to 10 sessions, 1 time in 4-7 days:
• Operative dermabrasion with erbium laser.

With striae you need to work cautiously, since the skin on the body is thin and when grinding to the bloody dew can get scarring.

• Electrophoresis with enzymes (lidase, collagenase) with preparations used for mesotherapy № 10-15 every day or every other day;
• Phonophoresis with curiosin, cream of mederma, capillar cream №10-15 daily;
• Magneto-thermal therapy No. 10-15 daily or every other day;
• Phototherapy №10-12 two or three times a week:
• Laser therapy with red laser No. 10-15 two or three times a week;
• Cryotherapy 2-3 times a week № 10-15;
• Manual and vacuum massage, soft dermotonia is possible, for a course of at least 10 procedures;
• Mud, algal wraps, parafango for a course of at least 10 procedures;
• Contour plastic.

In the case when striae are "old", with westernization and therapeutic work with them practically can not bring any positive results, one can use the technique of contour plasty and injections of preparations based on stabilized hyaluronic acid 7% or 15% of collagen gel. Preparations are introduced by uniformly linear technique under the striae at the border of the dermis and hypodermis. The results are maintained for 6 to 10 months.

• Professional cosmetic procedures with external agents.

Treatment of stria with the help of cosmeceuticals GERnetic

Striae on the body (abdomen, thighs)

The MITO cream is used on old stretch marks that last more than a year.

It is applied locally 2 times a week for 2-3 months, then once a week, as a supporting course.

In addition, 2 times a day, SYNCHRO cream is used. With old striae. More than 6 months, on top of the SYNCHRO cream, IMMUNO is used 2 times in less quantity than the SYNCHRO. For stretch marks with a duration of more than 1 year, use SYNCHRO + IMMUNO in equal quantities.

You can apply NUCLEA cream 2 times a day, apply locally on stretching. For stretching any prescription to accelerate the effect of using the above drugs can use CYTOBI.

In areas of overgrown skin, it is useful to apply a few drops of CELLS LIFE serum.

Stretch on the mammary gland

The drugs used are SYNCHRO, NUCLEA, CYTOBI, CELLS LIFE.

The course of treatment is from 6 months to 1.5 years, depending on the result.

In addition to the above creams, good results are obtained when treating streas with ANTI-STRIES cream.

Composition. Obtained by biotechnology: a peptide stimulator of metabolism and cellular respiration; polypeptides and glycopeptides with a molecular weight of 1 to 5 kD; natural antioxidant complex, including lactoferrin - iron-containing protein, which has antioxidant, antimicrobial and stimulating effect; 2-thioxanthin and 8-hydroxyanthine are components of nucleic acids that neutralize free radicals. Proteins, microalgae enzymes (chlorella and porphyridium kroentum), biotransformation products of phosphocreatine precursors with glycine, arginine and methionine, palmitic acid.

So, we can say that aesthetic correction of striae of different genesis and localization is possible. But to achieve positive results, it takes a lot of time and patience from both the patient and the doctor. At the same time, the use of combined technologies gives optimal results.

"Young" striae are best suited for treatment, which must be done taking into account the correction of existing endocrinopathies, in conjunction with endocrinologists. Treatment of "old" striae is a difficult task for the dermatocosmetologist, but it is possible to improve their appearance. However, the best way to deal with striae is to prevent their occurrence, that is, prevention.

Prophylaxis of striae

Most experts in the field of aesthetic medicine agree that it is necessary to prevent streas. For patients at risk (pregnant women, adolescents, people with endocrinopathies and sudden fluctuations in weight, with genetic predisposition), this means - strictly follow all the doctor's recommendations for proper nutrition, lifestyle and prevention of increased skin strain (eg wearing special underwear during pregnancy). If your patient is a young woman with a gynoid type of build, and her mother and grandmother have striae, during pregnancy, she needs to carry out their prevention.

You need especially careful home care for those areas where stretch marks usually appear. The skin there is thinner and less durable than on other parts of the body. Therefore, contrasting showers, dousing with cold water, massage with a hard "mitten", followed by lubrication of the skin with nutritious and moisturizing media for the body are very useful for prevention of striae. It is recommended to use external means, improving trophic, elasticity of the skin, stimulating the formation of collagen, providing long-term moisturizing. Such properties, for example, have preparations of the GERnetic line. To improve the properties of the skin used drugs with regenerating effect. These drugs can be used both in the salon and for home care. For the prevention of strezii 2 times a day on the stomach, thighs, chest applied regenerating base cream SYNHRO. It consists of vitamins, trace elements, wheat extracts, St. John's wort, a biotechnological regenerating complex.

In the case where the striae are old and occupy a large area, it is necessary to advise the patient of a plastic operation. Full awareness of the progress of the operation, the location of postoperative scars, the postoperative period and the end results may lead the patient to the operational way of solving the problem of multiple striae. At the same time, she must know what outcome will be in the therapeutic treatment of striae.

Recommended methods of treatment of striae depending on the time of their existence.

Stages	Presence of stria	Preparations and techniques
1.	Pregnancy and lactation: no striae or single appear.	preparations of external action as a prophylaxis (creams, whey, wraps, light massage).
2.	"Young strias are cyanotic red.	mesotherapy; electrophoresis or phonophoresis with collagen, hyaluronic acid, elastin, preparations for mesotherapy; peelings, therapeutic dermabrasion, massage, magneto-thermal therapy, phototherapy, intradermal biostimulation, laser therapy, surface grinding with an erbium laser, preparations of external action
3.	Formed "old" stria.	Step-by-step combined application of the following methods: peelings (preferably enzyme, possibly trichloroacetic, retinoic). mesotherapy with vasoactive, enzymatic, biostimulating drugs, massage, intradermal biostimulation electrophoresis with lidase, collagenase. Filling techniques (collagen 15%, hyaluronic acid 24 mg / ml); drugs of external action are constant throughout the treatment