Striae

Striae are a completely independent nosology in terms of etiopathogenesis, clinical and morphological picture, and treatment.

Striae - "stretch marks", strip-like skin atrophy, strip-like atrophoderma, striae distensae, striae gravidarum - a unique skin atrophy in the form of narrow sunken wavy stripes, localized mainly in places of greatest skin stretching.

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

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Causes of stretch marks

Stretch marks can be a symptom of various diseases (hypercorticism, Itsenko-Cushing's disease, Marfan syndrome), can appear against the background of diencephalic syndrome, the use of anabolic hormones in athletes, adrenal hyperplasia, juvenile hypercorticism, and during puberty in children who are rapidly gaining weight.

It is believed that the main reason for the appearance of stretch marks in all cases is hormonal imbalance, with the predominant role of adrenocorticotropic, thyroid-stimulating hormones, hormones of the thyroid gland, adrenal glands and sex glands. However, overstretching of the skin is no less important, it is in these places that stretch marks form. In athletes, when building muscle mass, stretch marks appear in the shoulder girdle, hips; in women during pregnancy - on the abdomen, mammary glands (places of greatest skin stretching); in women who have suddenly gained weight - on the hips, waist, buttocks, etc.

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Pathogenesis of striae

It is assumed that one of the most significant factors in the pathogenesis of stretch marks is a decrease in the synthesis of collagen and elastin by fibroblasts while maintaining the ability to synthesize metalloproteases (collagenase, elastase). That is, fibroclasts predominate in the spectrum of fibroblast cells, synthesizing enzymes that destroy collagen and elastin proteins that maintain skin strength. As a result, when the skin is overstretched due to one of the above reasons, a rupture occurs, the reticular layer of the dermis is destroyed while the epidermis is preserved. Blood vessels, collagen and elastic fibers are torn, and a "gap" appears in the skin.

Histological picture of "young" striae

The epidermis has a normal structure and thickness. The basement membrane, papillae and ridges are well expressed.

The subepidermal and underlying layers have a monomorphic picture. Cellular elements are visible between the lumps of torn fibrous structures, among which fibroblasts of normal size and shape predominate. There is a large number of paretically dilated vessels, which explains the stagnant bluish-pink color of the striae. The histological picture, as well as that of scars, changes depending on the duration of the striae. The older the striae, the fewer vessels and cellular elements there are and the more fibrous component.

The histological picture shows that young striae and scars are different structures. In physiological scars, damaged dermal tissue is replaced by fibrous tissue consisting of collagen fibers lying parallel to the skin as a result of an inflammatory reaction. Stretch mark tissue is a torn fibrous framework of the dermis, that is, primarily, torn collagen fibers. As the striae "age", their histological structure approaches the structure of physiological scars.

Symptoms of Stretch Marks

In young people, red-blue stripes appear on the thighs, buttocks, chest, abdomen, located most often either radially (on the mammary glands, abdomen) or in parallel. Striae can be single or 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 stretch marks depends on the degree of stretching, morphological properties of the skin, hormonal background, concomitant pathology. The color of stretch marks gradually changes over several months from bright pink-blue to whitish with a pearlescent tint. Up to 6 months, stretch marks are considered "young", after 6 months - "old". The relief of the skin above the stretch marks can have a different configuration - either the stretch marks are flush with the skin, or have a sunken relief, or convex:. Most often, doctors encounter the first two options. The third variant in its clinical picture is in many ways reminiscent of anetoderma, since convex formations easily "fall" into the depths when palpated. The relief of striae depends on the area, degree and depth of damage to the fibrous structures of the dermis.

Treatment of stretch marks

Treatment of stretch marks is a complex task, but complex, long-term, consistent therapy always brings results. The earlier the treatment of "stretch marks" is started, the greater the probability of obtaining a therapeutic effect (similar to scars). Young stretch marks still have a sufficient number of vessels, and therefore good nutrition of damaged tissues is preserved. There are many cellular elements, among which the bulk is occupied by fibroblasts that secrete cytokines, biologically active molecules, growth factors, enzymes, structural proteins, etc. In other words, young damaged (torn) tissue retains the potential for partial recovery. Old stretch marks (after 6-8 months) have fewer vessels, cellular elements, fibroblasts in particular, that is, a significantly smaller potential, decreasing with age in geometric progression.

Methods and technologies used to treat stretch marks

All treatment methods are aimed at stimulating fibroblasts, their synthetic and proliferative activity, to restore the structure of the damaged dermis, to improve microcirculation, to eliminate oxidative stress and deficiency of microelements and vitamins. Optimal treatment is always complex treatment, and accordingly, this principle should be followed in the treatment of stretch marks.

Mesotherapy

If we arrange all methods of stretch mark treatment by their effectiveness, then mesotherapeutic methods will be in first place, as they allow to bring pathogenetically justified preparations directly to the area that needs them. I would like to immediately make a reservation about the unusual names of the preparations used for metotherapy. These are water-soluble imported products used for mesotherapy. All preparations are introduced to a depth of 2-3 mm into the tissue of stretch marks.

Blood supply to stretch marks should be improved at all stages of their existence, since tissue trophism is sharply impaired. Accordingly, micropapularly, using linear techniques, natshazh (techniques generally accepted in mesotherapy), it is necessary to introduce vasoactive drugs: pentoxifylline, nicotinamide, rutin melilot, ginkgo biloba in the form of monopreparations or in combination with procaine (novocaine), which also has a vasoactive effect along with immunomodulatory.

In the treatment of "young" stretch marks, an important factor is stimulation of synthetic and proliferative activity of fibroblasts. In this regard, it is necessary to introduce biostimulating preparations into the stretch marks: aloe extract, placenta, placentex, centella asiatica extract, hyaluronic acid, glycolic acid, keratinocyte complement, embryoblasts, NCTF-135, GAG and GAG complex. To stimulate collagen formation and neutralize free-radical stress in "young" stretch marks, it is recommended to introduce preparations of vitamins C, A; microelements Zn, Cu, Se, Si, polyvitamin BOH, organic silicon, conjonctil. Copper and zinc should not be introduced in one procedure, as there is data on their antagonism.

To additionally replenish the volume of stretch marks, the following preparations are used: x-ADN gel, hyaluronic acid, collagen, elastin, GAG and GAG complex.

On average, the course is 10-12 procedures with a frequency of 1 time per week. Vasoactive drugs with low molecular weight (pentoxifylline, nicotinamide) can be used 2-3 times per week. After 1-2 months of using other methods of stretch marks treatment, it is advisable to repeat the mesotherapy course. Recently, a specific drug for stretch marks reduction has appeared among mesotherapy drugs - StretchCare. This is a ready-made cocktail containing DMAE, hyaluronic acid, vitamin B5, microelements. Good aesthetic results can be achieved in 7-8 sessions of using this cocktail.

• Intradermal biostimulation (separation of striae with a needle or 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 with retinoic, glycolic or AHA acids, phenol in low concentrations.

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

There are peelings on the cosmetic market that are specially designed to treat stretch marks. For example, the peeling "Strnapil" by "Medic Control Heel". It is based on a modified Jessner solution (resorcinol, glycolic acid-50%, lactic and salicylic acids) and 5% retinoic acid. The peeling is quite comfortable, safe and effective. The combination of resorcinol, which coagulates proteins; AHA in high concentration, weakening the adhesion between corneocytes; beta-hydroxy acid, which enhances the effect of other components and retinoic acid, which improves regeneration, gives a pronounced improvement in skin relief. Stretch marks are leveled in relief and color due to intensive exfoliation, regeneration and skin hydration. The course includes 10-15 procedures, with an interval of 2 weeks between them.

• Therapeutic dermabrasion. Negative pressure should not exceed 3.5 Bar, the time of exposure of the tip on the skin should also be strictly controlled. The effect in the treatment of stretch marks is associated not only with the abrasive action, but also with elements of "vacuum massage" that stimulate the cellular elements of the dermis. The number of sessions depends on the thickness of the cellular layers removed per session. The course of treatment is from 8 to 10 sessions, once every 4-7 days:
• Surgical dermabrasion with erbium laser.

You need to be careful when working with stretch marks, as the skin on the body is thin and if you sand it until it is bloody, you can get scarring.

• Electrophoresis with enzymes (lidase, collagenase) preparations used for mesotherapy No. 10-15 daily or every other day;
• Phonophoresis with Curiosin, Mederma cream, Capilar cream No. 10-15 daily;
• Magnetic-thermal therapy No. 10-15 daily or every other day;
• Phototherapy No. 10-12 two to three times a week:
• Laser therapy with red laser No. 10-15 two to three times a week;
• Cryotherapy 2-3 times a week No. 10-15;
• Manual and vacuum massage, mild dermatonia is possible, a course of at least 10 procedures;
• Mud, algae wraps, parafango for a course of at least 10 procedures;
• Contour plastic surgery.

In cases where the stretch marks are “old”, with a depression and therapeutic work with them can practically no longer bring positive results, it is possible to use the technique of contour plastic surgery and injections of preparations based on stabilized hyaluronic acid 7% or 15% collagen gel. Preparations are injected evenly using a linear technique under the stretch mark at the border of the dermis and hypodermis. The results last from 6 to 10 months.

• Professional cosmetic procedures with external preparations.

Treatment of stretch marks with GERnetic cosmeceuticals

Striae on the body (abdomen, thighs)

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

Apply locally 2 times a week for 2-3 months, then 1 time per week as a maintenance course.

In addition, SYNCHRO cream is used twice a day. For old stretch marks, more than 6 months old, IMMUNO is applied over SYNCHRO cream in 2 times less quantity than SYNCHRO. For stretch marks more than 1 year old, SYNCHRO+IMMUNO are used in equal quantities.

You can use NUCLEA cream 2 times a day, apply locally to the stretch mark. For stretch marks of any age, in order to speed up the effect of using the above-mentioned preparations, you can use CYTOBI.

It is useful to apply a few drops of CELLS LIFE serum to areas of overstretched skin.

Stretch marks on the mammary gland

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

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

In addition to the above creams, good results are achieved when treating stretch marks with ANTI-STRIES cream.

Ingredients. Obtained through biotechnology: peptide stimulator of metabolism and cellular respiration; polypeptides and glycopeptides with a molecular weight of 1 to 5 kDa; natural antioxidant complex, including lactoferrin - an iron-containing protein with antioxidant, antimicrobial and stimulating effects; 2-thioxanthine and 8-hydroxanthine - components of nucleic acids that neutralize free radicals. Proteins, microalgae enzymes (chlorella and porphyridium cruentum), products of biotransformation of phosphocreatine precursors with glycine, arginine and methionine, palmitic acid.

So, we can say that aesthetic correction of stretch marks of various genesis and localization is possible. But to achieve positive results, a long time and patience are needed both from the patient and the doctor. At the same time, the use of combined technologies gives optimal results.

"Young" stretch marks respond best to treatment, which should be carried out taking into account the correction of existing endocrinopathies, together with endocrinologists. Treatment of "old" stretch marks is a difficult task for a dermatocosmetologist, but it is possible to improve their appearance. However, the best way to combat stretch marks is to prevent their appearance, that is, prevention.

Prevention of stretch marks

Most specialists in the field of aesthetic medicine agree that stretch mark prevention is necessary. For patients from risk groups (pregnant women, teenagers, people with endocrinopathies and sudden weight fluctuations, with a genetic predisposition), this means strictly following all the doctor's recommendations on proper nutrition, lifestyle, and preventing increased stress on the skin (for example, wearing special underwear during pregnancy). If your patient is a young woman with a gynoid body type, and both her mother and grandmother have stretch marks, she needs to take preventive measures during pregnancy.

Particularly careful home care is required for those areas where stretch marks usually appear. The skin there is thinner and less durable than in other areas of the body. Therefore, contrast showers, cold water dousing, massage with a hard "mitten" followed by lubrication of the skin with nourishing and moisturizing body products are very useful for preventing stretch marks. It is recommended to use external products that improve trophism, elasticity of the skin, stimulate the formation of collagen, provide long-term hydration. For example, products from the GERnetic line have such properties. To improve the properties of the skin, products with a regenerating effect are used. These products can be used both in the salon and for home care. To prevent stretch marks, SYNHRO regenerating base cream is applied to the stomach, thighs, and chest twice a day. It contains vitamins, microelements, wheat extracts, St. John's wort, and a biotechnological regenerating complex.

In the case when the stretch marks are old and occupy a large area, it is necessary to advise the patient to have plastic surgery. Full information about the course of the operation, the location of postoperative scars, the postoperative period and the final results may incline the patient to the surgical way of solving the problem of multiple stretch marks. At the same time, she should know what the outcome will be with therapeutic treatment of stretch marks.

Recommended methods for treating stretch marks depending on the duration of their existence.

Stages	How long has striae been present?	Preparations and methods
1.	Pregnancy and lactation: there are no stretch marks or only a few appear.	external preparations for prevention (creams, serums, wraps, light massage).
2.	“Young striae are bluish-red in color.	mesotherapy; electrophoresis or phonophoresis with collagen, hyaluronic acid, elastin, mesotherapy preparations; peelings, therapeutic dermabrasion, massage, magnetic thermal therapy, phototherapy, intradermal biostimulation, laser therapy, surface polishing with erbium laser, external preparations
3.	Formed "old" stretch marks.	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); topical preparations continuously throughout the treatment