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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 3  |  Page : 756-762

Role of microneedling in treatment of patients with striae distensae


1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Pathology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt

Date of Submission16-Jan-2018
Date of Acceptance24-Apr-2018
Date of Web Publication17-Oct-2019

Correspondence Address:
Hanan A E Mahmoud
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shebeen El-Kom
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_36_18

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  Abstract 

Objective
The aim of this work was to elucidate the efficacy and safety of microneedling in the treatment of striae distensae (SD).
Background
SD is a common form of dermal scarring that appears on the skin as violaceous, erythematous, or hypopigmented linear striations. Microneedling therapy or collagen induction therapy is a minimally invasive, nonsurgical, and nonablative procedure that involves the use of a microneedling device to create controlled skin injury.
Data sources
Medline databases such as PubMed, Medscape, Science Direct, and EMF-Portal and all materials available on the Internet from 2010 to 2017 were searched.
Study selection
The initial search presented seven articles that have studied the role of microneedling in the treatment of SD.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls mentioned, adequate information provided, and assessment measures defined.
Data synthesis
Comparisons were made by structured review with the results tabulated.
Findings
The use of skin microneedling is found to be effective in the treatment of SD.
Conclusion
This study concluded that the use of skin microneedling is effective as a new modality for the treatment of SD.

Keywords: microneedling, striae alba, striae distensae, striae rubra, therapy


How to cite this article:
Hagag MM, Samaka RM, Mahmoud HA. Role of microneedling in treatment of patients with striae distensae. Menoufia Med J 2019;32:756-62

How to cite this URL:
Hagag MM, Samaka RM, Mahmoud HA. Role of microneedling in treatment of patients with striae distensae. Menoufia Med J [serial online] 2019 [cited 2019 Nov 21];32:756-62. Available from: http://www.mmj.eg.net/text.asp?2019/32/3/756/268825




  Introduction Top


Striae distensae (SD), also known as stretch marks, represent a cosmetically undesirable and a very common problem present in most healthy women. These dermal scars are usually located on the thighs, buttocks, breasts, and lower back [1]. Striae initially appear erythematous with red to pink color and are named striae rubra; over time, the lesions become atrophic and hypopigmented and receive the name striae alba [2]. Although the precise etiology of SD is not still understood, cellular and extracellular matrix alterations are present. Damages to collagen bundles and elastic fibers are some of the various alterations present in all stages of SD [3]. The treatment of SD has included many therapeutic modalities. A variety of treatment modalities have been used for the treatment of SD, but there is not a simple and definitive treatment. Topical treatments such as tretinoin cream and a combination of tretinoin and glycolic acid or ascorbic acid and glycolic acid have some effects in the early stages [4]. Recently, several lights and laser modalities such as intense pulsed light, which stimulates the growth of new collagen and elastin fibers in the skin [5]; pulsed dye laser; copper bromide laser; fractional laser; radiofrequency device; and excimer laser have been demonstrated to achieve some effects in treating SD [6]. Treatment with skin needling might be able to promote the removal of old damaged collagen and induce more collagen growth beneath the epidermis. Puncturing the skin multiple times in acne scars increases the amount of collagen and elastin deposition [7]. Thus, they hypothesized that skin needling would also be useful in SD treatment because they seemed to be dermal scars with epidermal atrophy [8]. The aim of this work was to elucidate the efficacy and safety of microneedling in the treatment of SD.


  Materials and Methods Top


The guideline for conducting this review was according to guidance developed by the center for review and dissemination. It was used to assess the methodology and outcome of the studies.

Search strategy

Papers on the role of microneedling were reviewed in the treatment of SD from Medline databases such as PubMed, Medscape, and Science Direct and also some available materials on the Internet. We used SD and microneedling as searching terms. In addition, we examined references from the specialist databases EMF-Portal (http://www.emf-portal.de) and reference lists in relevant publications; the search was performed in the electronic databases from 2010 to 2017.

Study selection

All the studies were independently assessed for inclusion. They were included if they fulfilled the following criteria:

Inclusion criteria

The following were the inclusion criteria of the published studies:

Published in English language.

Published in peer-reviewed journals.

Focused on the role of microneedling in the treatment of SD.

Data extraction

Data from each eligible study was independently abstracted in duplicated using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Conclusion and comments on each study were made.

There was heterogeneity in the collected data. It was not possible to perform meta-analysis. Significant data were collected. Thus, a structured review was performed with the result tabulated.

The analyzed publications were evaluated according to evidence-based medicine (EBM) criteria using the classification of the US Preventive Services Task Force and UK National Health Service protocol for EBM in addition to the Evidence Pyramid.

US preventive services task force

The US preventive services task force classification is as follows:

Level I: evidence obtained from at least one properly designed randomized controlled trial.

Level II-1: evidence obtained from well-designed controlled trials without randomization.

Level II-2: evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

Level II-3: evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Level III: opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Quality assessment

The quality of all the studies was assessed. Important factors such as study design, attainment of ethical approval, evidence of a power calculation, specified eligibility criteria, appropriate controls, adequate information, and specified assessment measures were included. It was expected that confounding factors would be reported and controlled for, appropriate data analysis made, in addition to an explanation of missing data.

Data synthesis

A structured systematic review was performed, with the results tabulated.


  Results Top


Study selection and characteristics

Of the 156 potentially relevant publications that were identified concerning the role of microneedling in the skin, 149 articles were excluded as they did not focus on the role of microneedling in the treatment of SD.

All of the remaining seven studies were included in the review as they were deemed eligible by fulfilling the inclusion criteria. All these studies were human, case–control studies and examined the effect of microneedling on SD. These studies were analyzed with respect to the study design using the classification of the US Preventive Services Task Force and UK National Health Service protocol for EBM.

All of the included studies showed clinical improvement of patients with SD after microneedling therapy [Table 1].
Table 1: Summary of percutaneous collagen induction therapy in treatment of striae distensae

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Park et al. [9] conducted a study on 16 patients with SD using a disk microneedle therapy system. The device consists of a plastic body and head part. The head is a sterile plastic cylinder with 540 needles protruding 1.5 mm from the surface. Patients received three treatments using a disk microneedle therapy system at 4-week intervals. Three months after the last treatment, improved skin texture, tightness, and color were observed in all patients. It was marked that excellent improvement was noted in seven patients and minimal to moderate improvement in the remaining nine (43.8%). None of the patients reported a lack of change in or worsening of their SD. The mean improvement score was 2.4 [Table 2].
Table 2: Quality rating scheme modified from the Oxford Centre for Evidence-Based Medicine for ratings of individual studies

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Additionally, Khater et al. [11] conducted a study on 20 patients with SD, and 10 of them were treated with microneedling using a microneedle dermaroller (disk needle therapy). The device consists of a plastic body and head part. The head is a sterile plastic cylinder with 540 needles protruding 1.5 mm from the surface. The other 10 patients were treated with carbon dioxide (CO2) fractional laser. Of all the patients who were assessed, nine (90%) patients in the microneedle-treated group demonstrated overall clinical improvement, which was greater than the five (50%) patients in the (CO2) fractional laser-treated group. The difference between the two modalities was statistically significant (P < 0.001).

Nassar et al. [10] conducted a study on 40 female patients with SD, and 20 of them were treated with microneedling using a microneedle dermaroller (disk needle therapy). The device consists of a plastic body and head part. The head is a sterile plastic cylinder with 540 needles protruding 1.5 mm from the surface. Considering all the patients who were assessed, 18 (90%) patients in the microneedle-treated group demonstrated overall clinical improvement, which was greater than the 10 (50%) patients in the microdermabrasion with sonophoresis-treated group. The difference between the two modalities was statistically significant (P < 0.001).

Ali et al. [12] conducted a study on 15 patients who were treated with microneedling as group I. The microneedle used had a width of 2 cm, and was studded with a fine needle of medical-grade stainless steel. The needle length was 1.5 mm. According to the pressure applied, the needle penetrated the skin from 0.1 to 1.3 mm. Group II included 15 patients who were treated with microdermabrasion. In terms of the degree of improvement of SD, in group I, three (20%) patients showed minimal improvement, two (13.3%) patients showed moderate improvement, four (26.7%) patients showed marked improvement, and six (40%) patients showed excellent improvement. In group II, two (13.3%) patients showed no improvement, six (40%) patients showed minimal improvement, four (26.7%) patients showed moderate improvement, and three (20%) patients showed marked improvement. There was a statistically significant clinical improvement in microneedling than microdermabrasion (P = 0.005).

The clinical trial by Sanad et al. [13] included 30 female patients with abdominal striae rubra treated with microneedling alone on the left side of the abdomen (group I) and with microneedling +15–30% tricholoroacetic acid on the right side of the abdomen (group II). The dermaroller used possesses 24 circular arrays of eight needles each (total 192 needles of 2 mm length) in a cylindrical assembly. Patients were treated for six sessions at 3-week intervals. A comparison between group I and group II at the follow-up session revealed statistically significant differences in length (P = 0.002), width (P < 0.001), color, and texture (P = 0.049 and 0.041, respectively). More improvements in the striae were noted in group II, as 19 (63.3%) patients showed a good to an excellent improvement compared with 10 (33.3%) patients in group of microneedling alone (group I).

Agamia et al. [14] conducted a study done on 20 patients with SD who underwent four sessions with a 2-week interval by microneedling alone on the right side of the body and by microneedling with platelet-rich plasma on the left side. The roller needles measured 3 mm in length and were 300 in number.

The results of microneedling alone were as follows: 20% showed marked improvement, 40% showed moderate improvement, and 40% showed minimal improvement with significant increase in collagen in microneedling with platelet-rich plasma groups.

Aust et al. [15] conducted a clinical trial on 22 patients with SD by microneedling alone in one session, and the results revealed improvement in skin texture, tightening, and dermal neovascularization.


  Discussion Top


Needling therapy can be safely performed on striae of all skin colors and types without the risk of depigmentation that makes it a promising treatment of SD [16].

SD (stretch marks) are a common skin problem. SD has no medical consequences, but they are frequently distressing to those affected.

A variety of treatment modalities have been used for striae, but there is no definitive treatment [4],[17]. Needling therapy uses microneedles that penetrate a maximum of 2 mm and causes localized damage and minor bleeding by rupturing fine blood vessels [18]. A day after needling therapy, keratinocytes begin to proliferate and release growth factors to promote collagen deposition by the fibroblasts and elastin deposition [19].

A study was done by Park et al. [9] on patients with SD treated with a microneedling, and assessment of the results revealed better skin texture, tightness, and color. The treatment was well tolerated, and no serious adverse effects were observed. This is in agreement with the study conducted by Sanad et al. [13], where in group I, which was treated with microneedling alone, there were statistically significant differences between the first and follow-up sessions with respect to length, width, color, and texture of the striae in all patients. Another study done by Ali et al. [12] showed a statistically significant clinical improvement of microneedling than microdermabrasion in the treatment of SD. Moreover, there was a statistically significant increase in clinical efficacy and improvement in striae rubrae than striae alba, which disagreed with the study by Park et al. [9].

Kim et al. [20] showed that a microneedle therapy system induced larger increases in collagen deposition than intense pulsed light. Ryu et al. [21] found that treatment of SD with a combination of microneedle and fractional CO2 laser was well tolerated. It has been postulated that needles have their own electrical potential that triggers the proliferation of fibroblasts [22].


  Conclusion Top


The study concluded that skin microneedling appears to be a promising, safe, and effective treatment for SD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
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Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg 2008; 121:1421–1429.  Back to cited text no. 8
    
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Nassar A, Ghomey S, El Gohary Y, El-Desoky F. Treatment of striae distensae with needling therapy versus microdermabrasion with sonophoresis. J Cosmet Laser Ther 2016; 18:330–334.  Back to cited text no. 10
    
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Ali BMM, El-Tatawy RA, Elfar NN, Ali DAM. A comparative clinical and histopathological study of micro needling versus microdermabrasion (aluminum oxide crystals) in the treatment of striae distensae. J Egypt Women Dermatol Soc 2017; 14:92–99.  Back to cited text no. 12
    
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Sanad EM, Aginaa HA, Sorour NE. Micro needling system alone versus microneedling system with trichloroacetic acid in the management of abdominal striae rubra: a clinical and histopathological study. J Egypt Women Dermatol Soc 2015; 12:96–101.  Back to cited text no. 13
    
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Agamia NF, Embaby MH, El-Sheikh DS. Comparative study between micro needling alone and microneedling combined with platelet-rich plasma in the treatment of striae distensae using clinical and histopathological assessment. J Egypt Women Dermatol Soc 2016; 13:187–193.  Back to cited text no. 14
    
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