Striae Distensae Flashcards
Clinical features?
Colour: Purple-red
Texture: Slightly depressed pr wrinkled
Location: Stomach, buttocks, upper arm, thighs breast, lower back
Cause?
Progressive and rapid stretching of dermis
- Related to weight changes and pregnancy
- Genetics
- Cushing Syndrome: Body produce too much cortisol hormone for long time or via or or steroid medication = catabolism (break down/weak collagen and elastin = striae bruises and atrophy.
Pathophysiology?
- Initial Inflammatory phase (Striae Rubrae): Epidermis thins out due to changes of collagen, elastin and fibrillin
- Chronic (mature) phase (Striae Albae): Collagen fibres aligned parallel to epidermis, rete ridges flattened, reduce fibrillin in dermo-epidermal junction, reduce elastin in papillary dermis, reorganised fibrilin and elastic fibres in dermis
Treatment Plan?
Improve collagen production in dermis:
- Topicals; Retinoic acid, hyaluronic acid
- FP: Ablative or Non-ablative
- Chemical peels; TCA and GCA
Reduce vascularity:
- Vascular lasers: PDL, KTP, Nd:YAG
Acute phase: striae is red due to increase vascularity can be removed quicker if patient is bothered with <
Increase melanin:
- UV light: UVB/UVA = encourages melanin in hypopigmented area = reduce appearance of striae stripes
- Laser light: XeCL excimer laser
Other
- Injectables: dermal fillers
- Collagen induction therapy: skin needling - create micro wounds to acute phase to remodel the structure and increase collagen to area.
Types of Striae Distensae?
Striae Gravidarum: Occur due to pregnancy
- Connective tissue separation: Hormonal influence (increase cortisol, oestrogen), enlargement of uterus. Additional damage include; dilation of vessels - reddish/purple colour
Striae Rubrae: Early red stretch marks
- Papillary dermis - excessive fine elastic fibres and thick fibres in periphery
- Perivascular lymphocytes, dilated dermal and oedema
Striae Alba: Mature, whiter and depressed stretch marks
- Collagen fibres structural changes
- Epidermal atrophy
- Altered elastin an fibrillin fibres
How to do skin assessment?
Position patient: Lying down or standing up (gravitation changes of skin)
