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Fibrillin microfibrils are reduced in skin exhibiting striae distensae.

Striae distensae (striae: stretch marks) are a common disfiguring condition associated with continuous and progressive stretching of the skin--as occurs during pregnancy. The pathogenesis of striae is unknown but probably relates to changes in those structures that provide skin with its tensile strength and elasticity. Such structures are components of the extracellular matrix, including fibrillin, elastin and collagens. Using a variety of histological techniques, we assessed the distribution of these extracellular matrix components in skin affected by striae. Pregnant women were assessed for the presence of striae, and punch biopsies were obtained from lesional striae and adjacent normal skin. Biopsies were processed for electron microscopy, light microscopy and immunohistochemistry. For histological examination, 7 microns frozen sections were stained so as to identify the elastic fibre network and glycosaminoglycans. Biopsies were also examined with a panel of polyclonal antibodies against collagens I and III, and fibrillin and elastin. Ultrastructural analysis revealed alterations in the appearance of skin affected by striae compared with that of normal skin in that the dermal matrix of striae was looser and more floccular. Light microscopy revealed an increase in glycosaminoglycan content in striae. Furthermore, the number of vertical fibrillin fibres subjacent to the dermal-epidermal junction (DEJ) and elastin fibres in the papillary dermis was significantly reduced in striae compared with normal skin. The orientation of elastin and fibrillin fibres in the deep dermis showed realignment in that the fibres ran parallel to the DEJ. However, no significant alterations were observed in any other extracellular matrix components. This study identifies a reorganization and diminution of the elastic fibre network of skin affected by striae. Continuous strain on the dermal extracellular matrix, as occurs during pregnancy, may remodel the elastic fibre network in susceptible individuals and manifest clinically as striae distensae.

Actin Cytoskeleton↗

The cause of striae distensae.

Striae are always initiated by stretch whether the stretch is excessive or minimal: spontaneous striae do not occur. Cross-linkage of collagen appears to be more important than amount of collagen in permitting striae in response to stretch. An increase in cross linkage as in age increases the resistance to stretch deformation, but this rigidity leads ultimately to tearing of the skin and not striae. At the other extreme, the absence of crosslinkage leads to "elasticity" and excessive stretching with eventual rupture of the skin if the stretch goes beyond the elastic limit, but again, no striae. Striae appear to occur therefore only in skin in which the rigid cross-linked collagen and "elastic" unlinked collagen thus permitting a limited degree of stretch and a limited intradermal rupture, i.e. striae. (Although rigidity and elasticity are presented here in terms of collagen cross-linkage it seems probable that changes in interfibrillary materials such as glycosaminoglycans will prove important in this respect). This balance of stretch and limited tear is a continuous process and is an adaptation to the needs of growth in adolescence and change in body mass in early adult life and there are many many subclinical "striae" for each gross tear which is recognised clinically. An important factor likewise appears to be rate of stretch since if it is very slow, striae are less likely; there is "give" and new collagen formation. Although this working hypothesis is consonant with the facts only further work will show whether this smooth consonance is that of the fable or the weathered rock of fact.

Adrenal Cortex Hormones↗

Decreased expression of collagen and fibronectin genes in striae distensae tissue.

Striae distensae are characterized by a thinning of connective tissue stroma to produce linear, atrophic-appearing skin. Excessive adrenocortical activity, genetic factors and inherited defects of connective tissues, etc. are important causative factors in the formation of striae distensae, but the basic aetiology is not known. Total RNA was extracted from skin biopsies of five patients with striae distensae. The expression of genes coding for types I and III procollagen, elastin, fibronectin and beta-actin were studied and compared with those of four sex- and age-matched healthy individuals. The percentages of types I and III procollagen mRNA were 9.9 +/- 2.9% (mean +/- s.d.) and 10.6 +/- 1.6%, respectively, of the corresponding controls. The value for fibronectin mRNA in striae distensae was 7.3 +/- 1.8% of the control. The steady-state ratio fibronectin/type I procollagen mRNAs was 0.12 +/- 0.01 in striae distensae and 0.18 +/- 0.01 in the control. These observations suggest that expression of collagens, elastin and fibronectin genes are apparently decreased, and that there is a marked alteration of fibroblast metabolism, in striae distensae.

Adolescent↗

Contractile forces generated by striae distensae fibroblasts embedded in collagen lattices.

Striae distensae are characterized by linear, smooth bands of atrophic-appearing skin that are reddish at first and finally white. They are due to stretching of the skin, as in rapid weight gain, or mechanical stress, as in weight lifting. The pathogenesis of striae distensae is unknown but probably relates to changes in the fibroblast phenotype. In order to characterize striae distensae fibroblasts, alpha-smooth muscle actin expression and contractile forces were studied. Five healthy women with early erythematous striae and five healthy women with older striae were selected. Paired biopsies were taken from the center of lesional striae and adjacent normal skin. Fibroblasts were obtained by an explant technique and expanded in vitro in Dulbecco's modified Eagle's medium. Contractile forces generated by fibroblasts in collagen lattices were measured with the Glasbox device developed in our laboratory. Alpha-smooth muscle actin expression was studied by immunofluorescence labeling of cells and by flow cytometry. Fibroblasts from early striae distensae were the richest cells in alpha-smooth muscle actin filaments and generated the highest contractile forces. Their peak contractile force was 26% greater than normal fibroblasts. There was a 150% higher level of alpha-smooth muscle actin content in fibroblasts from early striae distensae compared with fibroblasts from normal skin. In contrast, there was no significant difference in force generation between old striae fibroblasts and normal fibroblasts with cells expressing no alpha-smooth muscle actin. The contractile properties of fibroblasts from striae distensae varies depending on the stage of the disease. In early striae distensae, fibroblasts acquire a more contractile phenotype, corresponding to that of myofibroblasts.

Actins↗

Linear focal elastosis: Keloidal repair of striae distensae.

Linear focal elastosis and striae distensae coexisted in a 32-year-old black man in their typical distribution on the lower back. Many striae appeared when he lost 50 lb in 1991. Only some of them became hypertrophic and others remained atrophic; striae distensae of the shoulders and buttocks remained atrophic, whereas most in the lumbosacral region became indurated and cordlike. Histologically, the former lacked elastic fibers and the latter showed a marked increase in thick elastic fibers. Linear focal elastosis in some patients may represent hyperplasia of elastic fibers in response to their damage. This "elastic fiber keloid" seems to be equivalent to collagen keloid, i.e., ordinary keloid, in the lumbosacral region.

Adult↗

Striae distensae after augmentation mammoplasty.

Three cases of striae distensae of the breast after augmentation mammoplasty are presented. The patients were all in their early 20s and nulliparous. The striae developed in the first few months after surgery. A review of the literature on striae distensae is presented. To the best of our knowledge, striae distensae occurring after augmentation mammoplasty have not previously been described.

Adult↗

Striae distensae of pregnancy. An in vivo biomechanical evaluation.

BACKGROUND AND OBJECTIVE: Striae distensae of pregnancy is a common finding. There is currently a lack of information about the rheological characteristics of such lesions. The purpose of this study was to compare the mechanical properties of striae distensae before and after delivery. PATIENTS AND METHODS: A total of 79 primigravid entered the study. Rheological properties of skin were evaluated in vivo using a Cutometer equipped with a 2-mm probe. RESULTS: Mechanical properties of striae distensae developing during pregnancy resembled those of the surrounding skin. By contrast, significant differences were yielded during post-partum. Extensibility of striae distensae was increased although parameters of elasticity remained normal. CONCLUSIONS: Rheological properties of striae distensae of pregnancy vary in time. This might reflect the changes in hormones and in the mechanical stresses normally setting the skin under tension.

Adult↗

Linear focal elastosis associated with striae distensae in an elderly woman.

We report the case of a 73-year-old woman with linear focal elastosis (LFE) associated with striae distensae. Yellow palpable striae were found extending horizontally in the lumbar region. The yellow striae appeared to be joined to striae distensae in the lateral sides of the yellow striae. Striae distensae were also present in regions other than the back but were not associated with yellow striae. Histologic examination of a yellow stria revealed a focal increase in elastic fibers in the dermis. Although there have been some unusual cases of LFE arising in women or in young persons, this disorder still predominantly affects aged men. A fairly uniform feature of LFE is its occurrence on the dorsal skin, suggesting involvement of this specific anatomical site in its pathogenesis. We suspect that LFE usually arises de novo in the skin, although striae distensae may also be a cause of it.

Aged↗

Elastic fibers in striae distensae.

Eight cases with striae distensae associated with obesity or prolonged corticosteroid intake were examined by light and scanning electron microscopy. Fine elastic fibers predominated in early lesions, while thick elastic fibers predominated in older lesions. In early lesions the periphery showed thick and tortuous elastic fibers, but in older lesions it was of normal appearance. It is suggested the elastic fibers in striae were newly synthesized and gradually increased and thickened with age.

Adolescent↗

Histologic and ultrastructural analysis of ultraviolet B laser and light source treatment of leukoderma in striae distensae.

BACKGROUND: Lasers and light sources emitting ultraviolet B (UVB) irradiation have been shown to repigment striae distensae. OBJECTIVE: The purpose of this study was to analyze the histologic and ultrastuctural changes seen after UVB laser- or light source-induced repigmentation of striae distensae. METHODS: Ten subjects with hypopigmented striae were selected. Five subjects were treated with an XeCl excimer UVB laser, and five subjects were treated with a UVB light device. Six months after the final treatment, the biopsies were evaluated for both standard and electron microscopic changes in melanocytes. RESULTS: Analyses of biopsied skin after treatment with both the UVB laser and light source showed increased melanin content, hypertrophy of melanocytes, and an increase in the number of melanocytes in all patients. CONCLUSIONS: Repigmentation of striae distensae with either a UVB laser or light source is due to an increase in melanin pigment, hypertrophy of melanocytes, and an increase in melanocytes.

Adult↗

Low-dose tretinoin does not improve striae distensae: a double-blind, placebo-controlled study.

Striae distensae occur on the abdomen and/or breast in 90 percent of all pregnant women and are the result of extrinsic and intrinsic factors. This study investigated the response of pregnancy-related abdominal striae to treatment with tretinoin cream (0.025 percent) applied daily for seven months. In this study, eleven subjects were randomly assigned to tretinoin or placebo treatment groups. Before and after photographs were evaluated by a standardized system. There was no difference or improvement in the treated group compared with control subjects. Tretinoin 0.025 percent cream was ineffective in improving striae distensae in these subjects.

Abdomen↗

Intense pulsed light in the treatment of striae distensae.

BACKGROUND: Intense Pulsed Light (IPL) is a noncoherent, nonlaser, filtered flashlamp, emitting a broadband visible light. Its efficacy has been reported recently in the treatment of photodamaged facial skin, promoting the production of neo collagen and ordering of elastic fibers. We don't know however, its efficacy in the treatment of striae distensae. OBJECTIVE: To assess gross and microscopical changes that occur in the striae distensae when treated by IPL. METHODS: A prospective study was carried out in 15 women, all of them having late stage striae distensae of the abdomen. Five sessions of IPL were performed in each one, once every two weeks. Skin biopsies and before and after photographs were taken of all the patients. Data concerning skin features (number of stretch marks in a square of 5 cm per side, sum of all the stretch marks to determine the total length, discolorations and general appearance) were all assessed before each session and at the end of the study. Microscopical changes were all carefully assessed. For the statistical analysis a "t" test for small samples was used. RESULTS: All patients showed clinical and microscopical improvement in each one of the parameters assessed. The "t" test for small samples showed a statistically significative difference (p < 0.01) in the post treatment dermal thickness. CONCLUSION: Striae distensae improved clinically and microscopically after IPL. It seems to be a promising method of treatment for this common problem with minimal side-effects, a wide safety margin and no downtime.

Abdomen↗

A case of edematous striae distensae in lupus nephritis.

A 17-year-old girl with systemic lupus erythematosus presented with painful edematous abdominal striae. She had been treated with systemic steroid for the systemic lupus erythematosus. At the time of presentation, she had abruptly gained 10 kg due to combined lupus nephritis. The histopathologic finding of the edematous striae distensae included dermal edema with separation of collagen fibers and small fragmented elastic fibers. Edematous striae distensae are uncommon but can develop from the combined effects of glucocorticoid and generalized edema.

Abdomen↗

Involvement of the legs in idiopathic striae distensae--a case report.

A case of idiopathic striae distensae (ISD) is presented. The patient was a healthy young adult with no history of weight lifting, use of systemic or local corticosteroids, infections or trauma. Horizontally disposed striae were located on the abdomen, back and legs. To the best of our knowledge this is the first report case of ISD where idiopathic striae were present below the knees.

Adult↗

Comparison of the 585 nm pulse dye laser and the short pulsed CO2 laser in the treatment of striae distensae in skin types IV and VI.

BACKGROUND: Striae distensae, or stretch marks, are a very common cosmetic problem. The successful management of stretch marks has long been a source of frustration and curiosity for both the clinician and the researcher. Recent studies suggest lasers may have a role in their management. As yet, no study has reported on the effects of either of these lasers in the treatment of stretch marks on persons with skin types 4 to 6. OBJECTIVE: To assess the efficacy of short pulsed CO2 laser and pulsed dye laser for the treatment of stretch marks in skin types 4, 5, and 6. METHODS: Four patients were initially enrolled in the study. All were female with abdominal stretch marks, present for a range of 8 to 19 years. The patients had skin types ranging from 4 to 6. The test area consisted of a stretch mark long enough to be divided into three contiguous 2 cm sections, labeled A, B, and C. Section A served as the short pulsed CO2 test site, section B served as a control, while section C served as the 585 nm pulsed dye site. Patients were seen for evaluation after 1 week, then every 4 weeks for a total of 20 weeks. Patients were evaluated subjectively by the investigators, and the patients' own self-evaluation was reported as well. RESULTS: Following the 585 nm pulse dye laser, at 20 week follow-up patients with type 4 skin showed no improvement, while type 6 skin showed hyperpigmentation. The short pulsed CO2 test site showed persistent erythema in type 4 skin and marked hyperpigmentation in type 6 skin. CONCLUSIONS: For patients with types 4, 5, and 6 skin, laser treatment of striae should be avoided or used with great caution.

Carbon Dioxide↗

Mast cell degranulation and elastolysis in the early stage of striae distensae.

The lesions of nine patients with early striae distensae (SD) during puberty were examined by light and electron microscopy. Specific changes were seen in very early stage SD, and in clinically uninvolved skin 0.5 to 3 cm remote from the edge of the long axis of the SD lesions. Sequential changes of elastolysis accompanied by mast cell degranulation appeared first, followed by an influx of activated macrophages that enveloped fragmented elastic fibers. The relationships among elastic fibers, mast cells, and macrophages seen in the present work suggest their critical roles in the process of SD formation, especially in the early stage. Our results also indicate that the elastic fiber is the primary target of the pathological process, and the abnormalities extend as far as 3 cm beyond the lesion into normal skin.

Adolescent↗

Striae distensae after tension-requiring skin sutures.

Three cases of striae distensae which developed along suture scars after skin surgery were described. The production of striae should be taken into consideration in surgery of the skin, especially in young woman.

Adolescent↗