Clinical evaluation of the effi cacy of trichloroacetic acid and subcision , combined or isolated , for abdominal striae

Introduction: Striae are frequent complaints in dermatology, however most studies are based on the use of laser, and the effects of other treatment modalities are observed by few doctors. Objective: To compare three therapeutic modalities: Subcision alone, trichloroacetic acid (TCA) 20% alone, and subcision combined with application of TCA 20% in treatment of striae. Materials and Methods: Eleven female patients, skin phototype II-IV with striae gravidarum, had their lower abdomen divided into 4 quadrants. One stria of each quadrant was selected to be subjected to one of 3 procedures and 1 quadrant was the control. Objective evaluation was performed by the physician and subjective evaluation was performed by the patient. Results: Reduction in width with subcision and in length with TCA 20% were observed by measurement. In the subjective evaluation, improvement was observed mainly with the subcision-TCA 20% treatment. Photografi c evaluation was disregarded. At statistical analysis, there was no signifi cant difference between treatments. There were no adverse effects related to treatments. Conclusion: Despite the reported improvement, especially with the subcisionTCA 20% treatment, there was no statistically signifi cant difference between treatments. INtRoDuCtIoN aND oBJECtIVE Striae is a quite common complaint in dermatology practice. However, there are only a few conclusive studies regarding effective treatments for this condition. Clinically, striae are linear or fusiform lesions of variable length and width according to the site and condition in which they develop. Striae gravidarum predominate in abdomen and breast and, associated with changes in weight, they predominate in arms and armpits. Lesions are usually asymptomatic and follow cleavage lines. They are always transverse to the direction of greatest tension: when major tension is horizontally applied, stria appears in vertical direction and vice versa. They may present slight burning and itching, but aesthetics is the main concern. Color of striae depends on combination of microvascular component and size and activity of melanocytes. Clinical appearance is infl uenced by the patient’s skin phototype and, in darkskinned individuals, these two perceptions can be changed, since the human eye detect the difference in color between striae distensae and the surrounded skin. Striae can be erythematous (red), bluish (cerulae), white (alba), and blackened (nigra). In fair-skinned individuals, striae begin as erythematous or pink lesions, with a smooth and tense surface (redish), and gradually lose pigmentation becaming atrophic and white (alba). Striae cerulae appear in individuals who have used steroids for a long time, and nigras in patients with skin phototypes IV and V. In this case, the color appears to be controlled by a mechanical-biological process that activates or inhibits melanogenesis in dark-skinned people. Histological fi ndings of striae are similar to a scar: fl attening of epidermis, attenuation of epidermal cones, and presence of thin collagen bands grouped mainly in the papillary dermis, which could also extend to deeper layers in horizontal direction to the epidermis. Special stains for elastic fi bers showed that striae have absent and fi ne elastic fi bers in some areas.