Am J Clin Dermatol

DOI 10.1007/s40257-016-0182-8

REVIEW ARTICLE

Laser and Light Treatments for Striae Distensae:

A Comprehensive Review of the Literature
Adam S. Aldahan1 Vidhi V. Shah1 Stephanie Mlacker1 Sahal Samarkandy1
Mohammed Alsaidan1,2 Keyvan Nouri1

! Springer International Publishing Switzerland 2016

Abstract Striae distensae (SD) are common dermatologic lesions that often arise as a result of rapid weight
change, certain endocrine conditions, or prolonged exposure to steroids. SD initially present as raised edematous
plaques (striae rubra), after which they become white and
atrophic (striae alba) owing to local breakdown and reorganization of collagen and elastin. There currently exists
no reliable treatment option, though numerous topical
applications have been attempted. Lasers and light represent emerging noninvasive therapies that have demonstrated some success targeting vascular chromophores in
striae rubra and stimulating collagen and elastin production
in striae alba. An extensive literature review was performed
to gather all available articles studying laser and light
treatments for SD. Lasers and light can significantly
improve the appearance of both striae rubra and striae alba.
Generally, striae rubra are more responsive to therapy and
can be treated successfully with a variety of lasers without
major adverse effects. Fractional lasers exhibit the strongest results for striae alba repigmentation and collagen
induction, and several other lasers produce temporary
repigmentation. Lasers in combination with other modalities such as topical agents and additional energy devices
have also demonstrated promising preliminary results;
however, large comparative studies are necessary to validate these outcomes.

& Adam S. Aldahan

aaldahan@med.miami.edu
1

Department of Dermatology and Cutaneous Surgery,

University of Miami Miller School of Medicine, 1475 NW
12th Ave., Suite 2175, Miami, FL 33136, USA

Department of Dermatology, Prince Sattam Bin Abdulaziz

University, Kharj, Saudi Arabia

Key Points
Lasers and light can improve the appearance of both
striae rubra and striae alba.
Striae rubra are generally more responsive to
treatment and can result in permanent resolution.
Fractional lasers exhibit the most promising results
for repigmentation and collagen induction in striae
alba.

1 Introduction
Striae distensae (SD), or stretch marks, are common dermatologic lesions that can cause considerable psychosocial
distress. Risk factors include childhood obesity, pregnancy,
rapid weight gain or weight loss, and exposure to steroids,
as well as endocrine conditions such as Cushings syndrome [1, 2]. Lesions usually present on the abdomen,
breasts, thighs, or buttocks [13]. Initially, they present as
edematous red or pink linear plaques called striae rubra [3,
4]. Over time, the color fades and the lesions become
hypopigmented and atrophic, at which point they become
permanent striae alba [24]. The pathophysiology is
thought to be owing to mast cell release of enzymes such as
elastases, which leads to elastolysis of the mid-dermis [5].
Reorganization of collagen and fibrillin also contributes to
the atrophic appearance [4, 6]. Because of the prevalence
and permanence of SD, there is substantial demand for a

A. S. Aldahan et al.

reliable treatment option; however, no method of prevention or treatment has shown consistent results.
Laser and light therapies offer a variety of wavelengths
that can target specific chromophores at varying fluences.
This poses a theoretical advantage by allowing individualized treatments based on SD type and location, as well as
patient skin type. Some wavelengths target blood vessels in
striae rubra to reduce the appearance [7]. In mature striae
alba, lasers and light work to induce collagen and elastin
production. They have also been used in conjunction with
other modalities in attempts to increase efficacy and reduce
adverse effects. Lasers with different parameters have been
studied for the treatment of striae rubra, striae alba, or both,
with vastly different results. In this review, we present the
clinical and histologic outcomes of various laser and light
therapies that have been studied.

2 Literature Search Methods

We sought to obtain all available published articles that
studied laser or light treatment of SD, including striae rubra
and striae alba. A broad literature search in PubMed,
Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE was performed in October 2015.
The following search terms were employed: stretch marks,
striae, lasers, light, and fractional. Only published articles
written in English and involving human subjects were
included. Titles and abstracts were screened for relevance
to our topic. Two authors then independently reviewed the
relevant full-text articles for accordance with our inclusion
criteria (Table 1). We excluded articles that did not involve
laser- or light-based approaches, such as those focusing on
radiofrequency (RF), ultrasound, or topical creams alone.
Articles comparing laser or light therapy with other
modalities, as well as those studying combination therapy,
were included. Review articles and commentaries were
also excluded. The references of each article were also
reviewed for completeness. Data were collected concerning
Fitzpatrick skin types, types of SD (rubra or alba), laser

Table 1 Inclusion and

exclusion criteria for article
selection

parameters, treatment protocol (number of sessions, intervals between sessions), objective clinical and/or histologic
treatment outcomes, and adverse effects. The search was
rerun in November 2015 to check for any recently published articles.

3 Results of Literature Search

The preliminary search returned 731 published articles.
After initially filtering the search based on above-mentioned criteria, 676 titles and abstracts were screened for
relevance. After screening, 47 full-text articles were
reviewed independently by two authors. A total of 36
articles were included in the review. Figure 1 depicts the
article selection process in detail. The selected articles
include: five randomized comparative studies, four nonrandomized comparative studies, 20 prospective one-arm
trials, one retrospective study, and six case reports. Table 2
provides a complete list of lasers and lights that have been
reported with their corresponding light wavelengths. The
remaining tables depict the details of each study design and
treatment outcomes.
3.1 Fractional Lasers
Fractional lasers deliver light energy into the tissue through
multiple microscopic columns surrounded by untreated
areas. Unlike single beam lasers that disperse energy from
a center point, these columns can be arranged into different
patterns, producing an array of microthermal zones
(MTZs). The alternation between treated and untreated
areas is thought to deliver energy more uniformly to the
skin. Fractionation is available in both ablative and nonablative lasers. Ablative lasers use long wavelengths to
target water in the epidermis and dermis, thereby vaporizing the cells. Available lasers in this category include the
10,600-nm CO2 laser, the 2940-nm erbium-doped yttrium
aluminum garnet (Er:YAG) laser, and the 2790-nm
yttrium:sapphire:garnet laser. Of these lasers, the Er:YAG

Inclusion criteria
Articles involving laser or light therapy for the treatment of striae distensae
Prospective clinical trials, retrospective studies, or case reports
Exclusion criteria
Articles involving non-laser or non-light interventions only (i.e., topical applications, radiofrequency,
ultrasound)
Review articles and commentaries
Articles not written in English
Articles involving non-human subjects

Laser and Light Treatments for Striae Distensae

3.1.1 Fractional Er:Glass Laser (Non-Ablative)

Fig. 1 Flow chart of the article selection process

Table 2 Wavelengths of lasers and lights that have been studied for
striae distensae
Laser/light

Wavelengths (nm)

UVB

290320

Excimer

308

UVA

360370

Intense pulsed light

565, 590, 645, 650

Copper bromide

577

Pulsed dye laser

585, 595

Infrared

8001800

Nd:YAG

1064

Diode
Er:Glass

1450
1540, 1550, 1565

Er:YAG

2940

CO2

10,600

UV ultraviolet, Er:YAG erbium-doped yttrium aluminum garnet,

Nd:YAG neodymium-doped yttrium aluminum garnet

produces the least surrounding thermal damage, but has

reduced hemostatic capacity. The CO2 laser produces the
most thermal damage and is the most hemostatic, but also
significantly increases the risk of scarring [8]. For the
treatment of SD, the fractional non-ablative Er:Glass and
ablative CO2 lasers have been studied (Table 3).

The erbium-doped fiber laser is one of the most reported

lasers for the treatment of SD, both striae rubra and striae
alba. Using the 1540-nm fractional erbium glass laser, de
Angelis et al. treated SD in 51 patients with skin types II
IV. Subjects received two to four sessions of laser therapy
spaced 46 weeks apart. All striae were reported by nonblinded investigators to have at least 50 % improvement.
Blinded evaluators rated 11 randomly selected images,
which averaged to moderate (5175 %) improvement.
Histologically, increased elastic fibers and neocollagenesis
were seen in the reticular dermis, supporting this positive
clinical finding. Adverse effects were predominantly erythema and edema; however, eight patients developed
transient postinflammatory hyperpigmentation [9].
Malekzad et al. studied the non-ablative fractional
1540-nm Er:Glass laser in ten patients with striae alba.
Patients received four treatments at 4-week intervals using
fluences of 5070 J/cm2. Fair improvement (2564 %) was
seen in only two patients, and poor improvement (124 %)
was seen in an additional five patients. One patient
developed minor postinflammatory hyperpigmentation, and
another developed acne in the treatment area. Although this
study demonstrated questionable results with the fractional
Er:Glass laser, the authors advocate that it is a safe
modality for treating striae alba owing to its low adverseeffect profile [10].
Alves et al. reported four cases of corticosteroid-induced
striae rubra that were treated using the 1540-nm fractional
erbium glass laser. Treatment sessions were performed at
1-month intervals. After three sessions, two of the four
patients had marked improvement of their striae. The other
two patients achieved similar improvement after four and
six sessions, respectively. The only adverse effects noted
were local erythema and edema. This report demonstrated
a promising treatment modality for striae rubra [11].
Bak et al. treated SD in 22 Asian women with two
sessions of fractional thermolysis spaced 4 weeks apart.
Improvement in appearance was evaluated clinically and
histologically. After the final treatment, 27 % of subjects
demonstrated marked improvement (5175 % from baseline), all of whom had mature striae alba. Postinflammatory
hyperpigmentation was observed in two patients (9 %). An
increase in average epidermal and dermal thickness was
seen on post-treatment biopsy specimens, representing an
increase in collagen production. This change was mostly
seen in striae alba, whereas striae rubra had more inflammatory cells and not as much collagen production. The
authors suggested that fractional photothermolysis is most
effective for late-stage white striae owing to the significant
induction of collagen production [12].

CO2

Er:Glass

Laser

10,600

1565

1550

1540

Wavelength
(nm)
IIIV

SD

Striae
type

Adverse
effects
TEE

% Clinical improvementb
(% of pts)
[50 (100)

AlexiadesArmenakas [8]

Lee [18]

Tretti Clementoni
[17]

Katz [16]

Kim [15]

Guimaraes [14]

700750 ls dot
spacing

1415 watts;
600 ms PD

Density level 2;
300 Hz

10 mJ/MTZ

4055 J/cm2
150300 MTZ/
cm2

48168 MTZ/
cm2

2070 mJ/MTZ

125 MTZ/cm2

15 mJ/MTZ

100 MTZ/cm2

80100 mJ/MTZ

110f

NR

812

NR

NR

NR

NR

NR

NR

1218 J/cm2

Stotland [13]
125250 MTZ/
cm2

NR

30 mJ/MTZ
Density level 6

Bak [12]

10

NR

34

35

48

36

N/A

45

N/A

23

27

12

10

14

22

10

IVI

IV

IIIII

II

IIIIV

IIV

IIV

IIVI

IV

IIV

SA

SA

SD

SR

SA

SR

SAd

SD

SR

SA

2/4 (20)g

3/4 (20)

2650 (33)

5175 (52)

[75 (7)

5075 (100)

75 (100)

NS

8.4/10e

NR

PIH

Scaling

TEE

TEE

PIH
(50 %)

PIH
(10 %)

PIH

blistering

TEE

PIH (9 %)

5175 (27)c
2650 (63)

TEE

Acne
(10 %)
NS

2564 (20)
124 (50)

70 mJ/MTZ;
15 ms PD

51

Skin
typea

Alves [11].

46

No. of
pts

PIH
(10 %)

24

Intervals
(weeks)

5070 J/cm2

23

1015

No. of
sessions

Malekzad [10]

No. of
passes

Spot size
(mm)

PIH
(16 %)

1255 mJ/MTZ

Energy settings

100320 MTZ/
cm2

de Angelis [9]

Author

Table 3 Fractional lasers in the treatment of striae distensae

A. S. Aldahan et al.

Spot sizes varied based on the size of each striae

Improvement was rated based on a 4-point scale

g

All but one of the patients had striae alba

Average clinical improvement, rated based on a 10-point scale

Improvements were evaluated by blinded or unblinded dermatologists using objective standards

Only patients with mature striae alba had improvement

Fitzpatrick skin type, IVI

a

MTZ microthermal zone, N/A not applicable, NR not reported, NS not specified, PD pulse duration, PIH postinflammatory hyperpigmentation, pts patients, SA striae alba, SD striae distensae
(non-specific), SR striae rubra, TEE transient erythema and edema

None
NS
SA
IV
1
4
2
NR
NR
15 mJ/MTZ
Cho [19]

Density level 2;
300 Hz

Energy settings
Author
Wavelength
(nm)
Laser

Table 3 continued

Spot size
(mm)

No. of
passes

No. of
sessions

Intervals
(weeks)

No. of
pts

Skin
typea

Striae
type

% Clinical improvementb
(% of pts)

Adverse
effects

Laser and Light Treatments for Striae Distensae

Stotland treated 14 female patients with the 1550-nm

erbium-doped fiber laser. Thirteen had striae alba, and one
had striae rubra. Treatments were performed every
23 weeks for a total of six sessions. Eight striae were
randomly selected for evaluation, five of which had
2650 % improvement in pigmentation. Transient erythema and edema were observed in most patients, as well
as blistering in one and postinflammatory hyperpigmentation in another. This study advocates that fractional
photothermolysis is a safe and effective modality for the
treatment of SD [13].
Guimaraes et al. studied the 1550-nm fractionated
erbium glass laser in ten patients with striae rubra of the
breast after augmentation. Four to eight sessions were
performed at 4-week intervals. The mean improvement
score was 8.4 out of 10 after an average of 6.5 sessions.
Patients who had total improvement received at least six
laser sessions. Postinflammatory hyperpigmentation was
seen in one patient [14].
Kim et al. used the 1550-nm erbium-doped fractional
photothermolysis laser to treat six Asian patients with
striae alba. One treatment session was performed without
significant pigmentation improvement. Histopathology
demonstrated an increase in collagen, elastic fibers, and
epidermal thickness compared with baseline. Half the
patients developed transient postinflammatory hyperpigmentation [15]. Katz et al. reported two cases of striae
rubra treated with the 1550-nm erbium-doped fiber fractionated laser. Three to five treatments were performed at
4-week intervals. Both patients had at least 75 %
improvement in their striae rubra with no serious adverse
effects [16].
Tretti Clementoni and Lavagno tested the 1565-nm
fractional erbium glass laser on 12 subjects with SD. Each
subject received three treatments spaced 45 weeks apart.
Two passes of the laser were performed: the first using
high density within the margins of the striae, the second
using low density with a hexagonal shape to include the
margins. All 12 subjects had a 5075 % overall clinical
improvement. Significant erythema and edema were
reported after treatments, but resolved in all patients.
Postinflammatory hyperpigmentation was not observed
[17]. Based on the number of studies alone, it is clear that
the treatment of SD with non-ablative fractional lasers is
popular. Most of these studies agree that this approach is
generally safe and well tolerated by patients. Additionally,
the effectiveness on mature atrophic striae, observed in
many of the clinical trials, is essentially unique to these
lasers. From personal clinical experience, we can attest
that non-ablative fractional lasers exhibit the greatest
clinical improvement on white striae with a low risk of
adverse events.

A. S. Aldahan et al.

3.1.2 Fractional CO2 Laser (Ablative)

3.2.1 Excimer Laser

The fractional ablative CO2 laser has also been reported for
the treatment of SA. Compared with non-ablative lasers,
the CO2 laser is more painful and requires longer recovery
times. Nevertheless, three groups have reported varying
success in the treatment of SA.
Lee et al. retrospectively reviewed 27 women of skin
type IV with striae alba who were treated with one session
using the Ultrapulse fractional CO2 laser. Two patients had
near total improvement ([75 %), 14 had marked
improvement (5175 %), and an additional nine had
moderate improvement (2650 %). Common adverse
effects included scaling, oozing, and transient hyperpigmentation [18]. The fractional CO2 laser appears to be a
promising option for striae alba considering these compelling results without major adverse effects, although this
study was conducted retrospectively on a relatively small
scale.
Alexiades-Armenakas et al. treated striae alba in five
patients using the fractional CO2 laser. Patients received
three to four treatments at 4-week intervals, after which
only two patients had any change in striae. The authors did
not support the use of the fractional CO2 laser for striae
alba because of inconsistent results [8].
Cho et al. used the 10,600-nm Ultrapulse fractional CO2
laser to treat striae alba on the thigh of one Asian patient
with skin type IV. The upper two-thirds of striae were
treated and subsequently compared with the untreated
areas. Clinical improvement was noted after two sessions
separated by 4-week intervals. No adverse effects were
reported [19].
Although more invasive and less well tolerated by
patients, fractional ablative lasers essentially work similarly to fractional non-ablative lasers in regard to producing
MTZs surrounded by areas of untreated skin. The use of
fractional CO2 lasers is not as strongly supported in the
literature, and the available evidence suggests that this
approach may produce less consistent results than fractional non-ablative lasers.

Goldberg et al. used the 308-nm excimer laser to treat

mature striae alba in a study of 75 subjects with skin types
IIIV. Subjects were treated until they achieved a substantial ([75 %) increase in pigmentation, or for a maximum of 15 sessions. Each subjects minimal erythema dose
was determined prior to treatment and used for treatment
sessions. All 75 subjects achieved a substantial increase in
pigmentation after nine treatments or less. Notably, pigmentation in normal surrounding skin (splaying) occurred
in 31 % of patients. This study did not follow up patients
results, but the authors stated that the improvement in striae
pigmentation was most likely temporary [20].
Ostovari et al. also studied the excimer laser in ten patients
with striae alba. Patients received an average of 9.1 treatments at weekly intervals using 50 mJ/cm2 less than their
minimal erythema dose. Laser therapy was shown to increase
pigmentation, although only one patient had near complete
resolution and two had moderate improvement (2650 %).
Splaying of pigmentation was a notable adverse effect. The
authors concluded that the excimer laser is a poor treatment
option for repigmentation of striae alba [21].
Alexiades-Armenakas et al. used the excimer laser to
treat nine patients with striae alba. They subtracted 50 mJ/
cm2 from each subjects minimal erythema dose for use
during treatment. Subjects received a total of nine treatment sessions spaced 2 weeks apart. Three observers then
clinically assessed the increase in pigmentation, which
averaged to a 68 % increase. These improvements were
well maintained at follow-up visits 2 months after treatment. No adverse effects were reported other than transient
erythema, which was their desired end point [22].
The excimer laser seems to consistently produce temporary pigmentation in mature white striae; however, the
splaying of pigment on normal skin seems to be an
inevitable consequence. Additionally, the literature suggests that excimer lasers require many treatment sessions
before significant improvement can be seen. Considering
all these factors, the excimer laser appears to be markedly
inferior to fractional lasers, but may be reserved as a second-line option.

3.2 Non-Fractional Lasers

Traditional non-fractioned lasers predate fractional lasers
by decades. They deliver one beam of high-energy light
into the skin, with the surrounding thermal damage progressively decreasing from a single center point. This
approach causes a more uneven distribution of energy as
compared with fractional lasers; however, a wider variety
of single beam wavelengths have been studied because of
their sustained availability (Table 4).

3.2.2 Pulsed Dye Laser (PDL)

The PDL is one of the oldest and most widely used vascular lasers. Its potential value in both types of SD has been
tested, although the results of the reported studies appear
relatively unfavorable.
McDaniel et al. treated 39 female patients with SA using
the short-pulsed (0.4-ms pulse width) 585-nm PDL. After

585

1064

577

1450

590

PDL

Nd:YAG

Copper
bromide

Diode

IPL

UVB/
UVA

308

Excimer

360370

296315

645i

650i

Wavelength
(nm)

Laser

292
18 9 18
NR

3.2 cm2
710
10
10
2.5

50 mJ/cm2 less
than MEDd
50 mJ/cm2 less
than MEDd
2.54.0 J/cm2;
0.45 ms PD
3 J/cm2; 0.45 ms
PD
4.25 J/cm2;
0.45 ms PD
80100 J/cm2

Ostovari [21]

AlexiadesArmenakas [22]

McDaniel [23]

Jimenez [24]

Nehal [25]

Sadick [31]

Hernandez-Perez
[30]

Al-Dhalimi [29]

Tay [28]

Longo [27]

Goldman [26]

NR

10

0.5

15

20

IIVI

IIIIV

IIIIV

IVVI

SA

SA

SR

SD

4/5 (20)

5/5 (40)

650 nm: 100 (6)j

590 nm: 100 (9)

5099 (53)
NCI

2650 (33)

5175 (22)

23 9 23

11

MEDd; 1.33.7 s
PD

NR

SD

3/5 (40)k

NR

10 9 50

IIIII

2 pulses, 20 ms
delay

30 J/cm2; 2.74.0 ms PD

2 pulses, 20 ms
delay

13.015.5 J/cm2;
6 ms PD

15

[70 (40)

NCI

NSh

NS

68e

2650 (20)

[75 (10)
5175 (10)

[75 (100)

% Clinical
improvementb
(% of pts)

SR

SA

SD

SAf

SA

SA

SA

SD
type

120150 ms delay
412 J/cm2

15

IIIV

NR

IIVI

NR

NR

IIV

IIIV

Skin
typea

100 (33)

NR

20

20

39

10

75

No. of
pts

1.5

36

N/A

NR

Intervals
(weeks)

48 J/cm2

3.45

6.6

9.1

8.4

No. of
sessions

3070 (40)

NR

NR

NR

No. of
passes

1520 ms delay;
2 Hz

100250 Hz

200900 J/cm2

Goldberg [20]

Spot size (mm)

Energy settings

Author

Table 4 Non-fractional lasers and light in the treatment of striae distensae

Erythema
(33 %)

PIH (33 %)

PIH (40 %)

PIH (8 %)

Erythema
(30 %)

PIH (64 %)

Scabbing

TEE

PIH

PIH (5 %)

PIH (5 %)g

TEE

Splaying of
pigmentc

Splaying of
pigmentc

Adverse
effects

Laser and Light Treatments for Striae Distensae

8001800

Infrared

Trelles [32]

Author

15 9 40

31 J/cm2; 36 ms
PD
20 ms delay;
0.5 Hz

Spot size (mm)

Energy settings

NR

No. of
passes
4

No. of
sessions
2

Intervals
(weeks)
10

No. of
pts
IIIV

Skin
typea
SA

SD
type

25 (40)

50 (20)

% Clinical
improvementb
(% of pts)
None

Adverse
effects

One patient developed hyperpigmentation; one developed hypopigmentation

Clinical improvement was only seen in patients with striae rubra

These correspond to cutoff filters for intense pulsed light

These correspond to the percent of individual striae that completely disappeared after treatment. No discrete or continuous scale for incomplete striae improvement was utilized

Improvement was rated based on a 5-point scale

All but one of the patients had striae alba

Minimal erythema dose was determined prior to beginning treatment by testing various doses on untreated sites

Average percentage of pigment correction relative to control

Splaying of pigment refers to pigmentation of the normal skin surrounding the treatment area

Fitzpatrick skin type, IVI

Improvements were evaluated by blinded or unblinded dermatologists using objective standards

IPL intense pulsed light, MED minimal erythema dose, MTZ microthermal zone, NCI no clinical improvement, N/A not applicable, NR not reported, NS not specified, PD pulse duration, PDL
pulsed dye laser, PIH postinflammatory hyperpigmentation, pts patients, SA striae alba, SD striae distensae (non-specific), SR striae rubra, TEE transient erythema and edema, UV ultraviolet

Wavelength
(nm)

Laser

Table 4 continued

A. S. Aldahan et al.

Laser and Light Treatments for Striae Distensae

one treatment session, shadow profilometry of silicone

impressions of SA were compared before and after treatment. This modality compares the ratio of shadows in one
direction with shadows in the perpendicular direction. This
ratio should be close to one in normal skin but larger than
one in striae with unidirectional tension. Overall, the shadow ratios significantly decreased after treatment, signifying a more uniform surface texture. Additionally,
increased elastin fibers were seen on histopathologic
evaluation after treatment, even in striae that had minimal
clinical improvement. The authors also noted a correlation
between post-treatment erythema and resolution of striae.
The 10-mm spot size with a fluence of 3 J/cm2 produced
the best results. The only adverse effects reported were
transient pigmentation changes that occurred in two
patients [23].
Jimenez et al. studied the short-pulsed 585-nm PDL in
20 patients with SD. Subjects received two treatments at
6-week intervals and were clinically and histologically
analyzed 6 weeks after the second treatment. Only four
striae rubra had a pigmentation change after treatment,
including one that responded completely. No improvement
was observed in any of the striae alba; however, collagen
analysis showed a collagen increase in both striae rubra and
striae alba. Control striae had a net decrease in collagen
when compared with pre-treatment samples. One patient
developed postinflammatory hyperpigmentation after
treatment [24].
Nehal et al. reported no clinical improvement in five
patients with mature striae alba after treatment with the
short-pulsed 585-nm PDL. Patients received an average of
6.6 treatments spaced 2 months apart. Only three out of
five patients had any textural improvement measured via
optical profilometry. Histological analysis failed to show a
change in elastic fiber density or orientation, confirming the
poor clinical findings. The authors concluded that the PDL
is not an appropriate treatment for mature striae alba [25].
The PDL has minimal, if any, clinical effect on SA. Any
microscopic changes noted in the above studies are predominantly subclinical and most likely insufficient for
noticeable improvement, which is the main goal in attaining patient satisfaction. Although textural improvements
were noted in two studies, the primary endpoint for treating
SA is normalization of pigmentation, for which the PDL is
virtually ineffective. From personal clinical experience, the
PDL is significantly more effective for treating SR owing
to their increased vascularity. Additionally, the low
adverse-effect profile of the PDL makes this laser an
extremely reliable option for producing visible results
without concern for harming the patient.

3.2.3 Neodymium-Doped Yttrium Aluminum Garnet

(Nd:YAG) Laser
Goldman et al. studied the long-pulsed 1064-nm Nd:YAG
laser for the treatment of immature striae rubra in 20
patients. Subjects received an average of 3.5 treatment
sessions every 36 weeks. Overall, 40 % had excellent
improvement ([70 %), and another 40 % had good
improvement (3070 %). The authors noted that the best
results were observed after three sessions. No major
adverse effects were reported [26].
The results of this study further illustrate the value of
vascular lasers on SR; however, similar results cannot be
expected with Nd:YAG treatment of SA. Nevertheless, the
results of this study warrant a direct comparison between
PDL and Nd:YAG, using objective measurements, for the
treatment of SR.
3.2.4 Copper Bromide Laser
Longo et al. used the 577-nm copper bromide laser to
treat SD in 15 female patients. They chose this laser over
the 585-nm PDL owing to its greater range of parameter
settings and its higher absorption by hemoglobin [7].
Patients received up to five treatments using a 1.5-mm
spot size. Five patients achieved complete resolution of
their striae, and an additional eight had modest
improvement. The major adverse effects included scabbing that lasted about 1 week. Thirteen patients were
followed up for 2 years, and the results of treatment were
well maintained [27].
The lasting results reported here make this laser an
appealing choice considering the relatively weak long-term
follow-up data for most laser treatments in the literature.
The major downside to this study is the low number of
patients with each striae subtype. This drawback limits any
widespread claims about this lasers efficacy.
3.2.5 Diode Laser
The 1450-nm diode laser has been attempted for the
treatment of SD in dark skin types, although results were
unfavorable. Tay et al. used the diode laser to treat SD in
11 subjects with dark skin. Subjects each received three
laser treatments at 6-week intervals. Disappointingly, none
of the striae improved after treatment, but seven patients
(64 %) developed hyperpigmentation. The authors concluded that the 1450-nm diode laser is not effective for SD
in dark-skinned patients and causes significant adverse
effects [28].

A. S. Aldahan et al.

3.3 Light
3.3.1 Intense Pulsed Light (IPL)
Al-Dhalimi and Abo Nasyria studied IPL in 20 patients
with striae rubra, comparing 650- and 590-nm cutoff filters
(Table 4). Each treatment was assigned to either side of the
body. Five treatment sessions were performed at 2-week
intervals, with over 200 striae on each side were treated.
Both cutoff filters produced a significant reduction in visible striae, but the 590-nm filter was shown to be superior.
Not surprisingly, the 590-nm filter was also associated with
more adverse effects including erythema and postinflammatory hyperpigmentation [29].
Hernandez-Perez et al. conducted a study involving 15
patients with striae alba who were treated with IPL. Two
passes were performed with a 20-ms delay using a 645-nm
cutoff filter and a fluence of 30 J/cm2. Patients received a
total of five treatment sessions at 2-week intervals. Results
were clinically favorable with all patients having at least
moderate improvement. Epidermal and dermal thickness
were also increased histologically after therapy. Postinflammatory hyperpigmentation was seen in 40 % of
patients. The authors advocate IPL as an effective treatment for striae alba, and they suggest reducing the fluence
or increasing the interpulse delay to reduce the risk of
hyperpigmentation [30].
Like vascular lasers, IPL reduces the appearance of SR
but lacks the degree of selective photothermolysis and
small spot sizes afforded by lasers. Additionally, aside
from the ability to treat a large area, IPL does not seem to
have any real advantage over lasers to justify the increased
time requirement per session. The high rates of hyperpigmentation reported in the mentioned studies is also cause
for concern. Additional studies using lower fluences to
reduce the hyperpigmentation will be necessary to determine if the reported positive clinical outcomes can still be
achieved.
3.3.2 Ultraviolet (UV) Light
Sadick et al. conducted a study in nine patients with striae
alba combining high-intensity UVB (296315 nm) and
UVA (360370 nm) phototherapy. Treatments were performed twice weekly at each patients minimal erythema
dose. The first follow-up visit 4 weeks after treatment
demonstrated a high degree of repigmentation of striae alba
in almost all patients; however, after 12 weeks only two
patients still maintained 5175 % improvement from
baseline. Erythema and postinflammatory hyperpigmentation were each seen in three patients. The authors suggest
that high-intensity UVB/UVA therapy is safe and effective
for temporary clinical improvement of striae alba [31].

In this study, UV light demonstrated consistent results

with a low adverse-effect profile. For patients who are
willing to come to the clinic twice weekly, this may represent a viable option for maintenance treatment of white
striae, though it is important that patients do not expect
permanent results.
3.3.3 Infrared Light
Trelles et al. used broadband infrared light between 800
and 1800 nm to treat ten patients with striae alba. Four
treatments were performed at 2-week intervals. Evaluators
determined that two patients had 50 % improvement and
four more had 25 % improvement after treatment. Notably,
no adverse effects were reported. Owing to the low
adverse-effect profile, the authors suggest attempting extra
treatment sessions may produce more favorable results
[32].
This preliminary study demonstrated promising results
after only four treatments, although adjusting the treatment
protocol to include more sessions may produce better
outcomes. It will be interesting to follow up with the sustainability of these results to properly gauge treatment
intervals. A comparative study between UV and infrared
light would also be beneficial, as these two modalities had
similarly promising results in two individual small-scale
studies.

4 Comparative Studies
4.1 Fractional Er:Glass vs. Fractional CO2
Yang and Lee compared the 1550-nm fractional non-ablative Er:Glass laser with the fractional ablative CO2 laser
in a study involving 24 patients with skin type IV who
had bilateral abdominal striae alba (Table 5). Treatments
were randomized to either side of the body, and patients
received both laser treatments every 4 weeks for a total of
three sessions. Twelve patients had at least a 50 % clinical improvement of their striae in response to the CO2
laser, compared with only eight with the non-ablative
fractional laser. Both lasers reduced striae width and
increased collagen and elastic fiber production. Overall,
the CO2 laser was more painful, and postinflammatory
hyperpigmentation was noted in 82 % of striae receiving
the CO2 laser compared with 36 % receiving the nonablative fractional laser. Crusting was also reported with
both lasers but remained longer in the CO2 group [33].
Although the CO2 laser showed slightly greater
improvement in this study, the non-ablative fractional
laser was associated with significantly less pain and
adverse effects.

Fx Er:Glass
(1550)

Yang [33]

Gungor
[34]

Gauglitz
[35]

Goldberg
[36]

Shokeir
[37]

Nouri
[38]

Fx Er:Glass vs. Fx
CO2

Nd:YAG vs.
Er:YAG

Fx Er:YAG vs.
PDL

Excimer vs. UVB

light

PDL vs. IPL

CO2 vs. PDL

3

10

350400 mJ

3 J/cm2

PDL (585)

5070 ms
PD

17.5 J/cm2
10 9 20

10

2.5 J/cm2
0.5 ms PD;
1 Hz

NR

NR

1.5 s PD
MED
MED

NR

7.0 J/cm2

300 Hz

Density level
2

72 J/cm2

1.0 J; 0.3 ms
PDf

3.2 J;
250 ms
PDe

50 J/cm2
50 ms PD

898

5 9 10

Spot size
(mm)

4050 mJ
75100
spots/cm2

100 spots/
cm2

50 mJ

Energy
settings

CO2 (10600)

IPL (565)g

PDL (595)

UVB
(290320)

Excimer
(308)

PDL (585)

Fx Er:YAG
(2940)

Er:YAG
(2940)

Nd:YAG
(1064)

Fx CO2
(10600)

Treatment
groupa

Author

Study design

Table 5 Comparative studies in the treatment of striae distensae

NR

NR

NR

NR

NR

NR

NR

NR

No. of
passes

10

35

No. of
sessions

N/A

NR

45

Intervals
(weeks)

20

10

20

22

No. of
pts

IVVI

IIIIV

IIIV

II

IIIV

IV

Skin
typeb

SA

SD

SA

SR

SD

SA

SD
type

NCI

NCI

NS

NS

NS

NS

NS

NS

3366 (15)d

3366 (15)d

PIH (50 %)

Pink plaque
(50 %)h

PIH (50 %)

PIH (25 %)

PIH (20 %)

NR

NR

PIH (50 %)

PIH (50 %)

PIH (30 %)

Erythema
(30 %)

None

PIH (82 %)

PIH (36 %)

[50 (36)

[50 (55)

Adverse
effects

% Clinical improvementc
(% of pts)

Laser and Light Treatments for Striae Distensae

Naeini
[39]

Fx CO2 vs. Topical

creami

Topical
creami

Fx CO2
(10,600)

Treatment
groupa

N/A

Pixel pitch
0.8
N/A

NR

16 J/cm2
Dot cycle 5

Spot size
(mm)

Energy
settings

N/A

No. of
passes

NR

No. of
sessions

Nightly

24

Intervals
(weeks)
6

No. of
pts
IIIIV

Skin
typeb
SA

SD
type

5j

27j

% Clinical improvementc
(% of pts)

NR

PIH (17 %)

Adverse
effects

PIH occurred in two patients with skin type VI. Pink plaque occurred in two patients with skin type IV

Topical 10 % glycolic acid ? 0.05 % tretinoin cream

Average percentage of clinical improvement of individual striae

This corresponds to the cutoff filter for IPL

Settings used for the first pass

Settings used for the second and third passes

Improvements were evaluated by blinded or unblinded dermatologists using objective standards

Clinical improvement was only seen in patients with striae rubra

Fitzpatrick skin type, IVI

Wavelengths in parentheses are measured in nanometers

Fx fractional, IPL intense pulsed light, MED minimal erythema dose, NCI no clinical improvement, N/A not applicable, NR not reported, NS not specified, PD pulse duration, PDL pulsed dye
laser, PIH postinflammatory hyperpigmentation, pts patients, SA striae alba, SD striae distensae (non-specific), SR striae rubra, UV ultraviolet

Author

Study design

Table 5 continued

A. S. Aldahan et al.

Laser and Light Treatments for Striae Distensae

4.2 Ablative Er:YAG vs. Nd:YAG

Gungor et al. compared the ablative 2940-nm Er:YAG
laser with the 1064-nm Nd:YAG in the treatment of SD in
20 women with skin types IIIV. Each laser was randomized to either side of the body. Treatment with the Er:YAG
laser included three passes, compared with two passes of
the Nd:YAG laser on the opposite side. Treatments were
performed every 4 weeks for three total sessions. Moderate
improvement, defined as 3366 % improvement, occurred
on both sides in three patients with striae rubra. All patients
with striae alba had poor improvement (less than 33 %).
Histopathology showed slightly increased elastin fibers, but
an increase in epidermal thickness was not appreciated. Six
patients developed erythema and hyperpigmentation as a
result of Er:YAG therapy. No adverse effects were reported
in the Nd:YAG group [34].
4.3 Ablative Er:YAG vs. PDL
Gauglitz et al. compared the fractional ablative 2940-nm
Er:YAG with the 585-nm PDL in two patients with axillary
striae rubra. Each laser was assigned a side of the body, and
treatments were performed every 45 weeks. The Er:YAG
was more effective in the first patient after five sessions;
however, both lasers produced hyperpigmentation in the
second patient, so treatment was stopped after three sessions with moderate improvement of striae on each side.
The authors advise to seriously caution patients of the risk
of hyperpigmentation before beginning treatment with
either of these lasers [35].
4.4 Excimer vs. UVB Light
Goldberg et al. conducted histological study in ten patients
with striae alba who each received up to ten treatment
sessions with either the 308-nm excimer laser or a UVB
lamp with wavelengths of 290320 nm. Biopsies taken
6 months after the final treatment demonstrated an increase
in number and size of melanocytes as well as increased
melanin content. Thus, the authors concluded that after
multiple treatments, both the excimer laser and UV laser
produce long-lasting, but not permanent, pigmentation
changes for the treatment of leukoderma in SD [36].
4.5 PDL vs. IPL
Shokeir et al. directly compared the 595-nm PDL to IPL
with a 565-nm cutoff filter in 20 patients with SD. Treatments were assigned to either side of the body and were
performed at 4-week intervals for five sessions. Improvement in texture was seen in both sides, although there was
no difference between the two. Both sides also resulted in a

significant reduction in striae width, but the IPL was found

to be superior. Interestingly, PDL was found to have
greater increase in collagen production histologically.
Overall, striae rubra was more responsive to treatment than
striae alba. Postinflammatory hyperpigmentation was noted
in 25 % of the IPL cases and 20 % of the PDL cases [37].
4.6 Non-Fractional CO2 vs. PDL
Nouri et al. reported poor results comparing the shortpulsed CO2 laser with the 585-nm PDL in four dark-skinned patients with striae alba. Two passes with the CO2 laser
caused significant lasting hyperpigmentation in two
patients with skin type VI as well as the development of
pink plaques in two patients with skin type IV. Hyperpigmentation was also seen with the PDL. Striae were not
improved in any of the patients, and thus the authors
concluded that these lasers should be avoided in patients
with skin types IVVI [38].
4.7 Fractional CO2 vs. Topical Glycolic Acid
and Tretinoin
A randomized study was performed by Naeini and Soghrati
comparing the fractional CO2 laser with topical cream
consisting of 10 % glycolic acid plus 0.05 % tretinoin in
six patients with a total of 92 striae alba. Each treatment
was randomly assigned to either side of the body. Laser
treatments were performed every 24 weeks for five sessions. Topical cream was applied to the contralateral side
nightly. Both treatments had positive results; however,
laser therapy led to a greater surface area reduction as well
as a better overall improvement of striae than the topical
group. Postinflammatory hyperpigmentation was seen in
one patient [39].

5 Combination Therapy
5.1 Ablative Fractional CO2 Plus PDL
In a randomized clinical trial, Naeini et al. compared the
effectiveness of the fractional Ultrapulse CO2 laser alone
with the same laser in combination with the 585-nm PDL
for the treatment of striae alba (Table 6). Three patients
with 88 striae had each treatment randomly assigned to the
right or left side of the body, with 44 striae on each side.
One side received three sessions of the CO2 laser at 4-week
intervals. The other side alternated CO2 laser with the PDL
at 2-week intervals for a total of five sessions, three with
the CO2 laser and two with the PDL. Overall, the combination group had significantly greater clinical improvement
than
the
CO2
laser
group.
Postinflammatory

Ryu
[41]

Fx CO2 vs. RF vs. CT

Suh [44]

RF

PDL

CT

Fx CO2
(10,600)

CT

RF

Fx CO2
(10,600)

PDL (585)

Fx CO2
(10600)d

Treatmenta

No.
Pts
IIIIV

Skin
typeb
SA

SD
type
Fx CO2:

% Clinical improvementc
(% of pts)

5397 J/cm

NR

10

3 J/cm2
0.5 ms PD

N/A

12 9 12

N/A

200 spots/cm2

50 mJ

Conduct time
70130 ms

Intensity 47

NR

NR

Depth 1.53.0 mmh

7001000 ms PD

NR

Density 0.7 mm

0.5 ms PD

57 J/cm

23

NR

N/A

NR

NR

NR

N/A

Twice daily

37

12

10

10

10

IIIVI

IIIIV

IV

IV

IV

SAk

SA

SD

SD

SD

5175 (60)

[75 (30)

PIH (3 %)

CT: Purpura
(16 %)

CT: NR
CT:

Collagen: NR
CT: NSj

PIH (75 %)

Fx CO2: TEE
(100 %)

CT: PIH (30 %)

RF: PIH (20 %)

Fx CO2: PIH
(20 %)

CT: none

Fx CO2: PIH
(33 %)

Adverse effects

Collagen: NCI

Fx CO2: NSj

CT: 3.4/4g

RF: 2.0/4g

Fx CO2: 2.4/4g

2650 (39)e

5175 (41)

CT:

2650 (48)e

Intervals
(weeks)

Pixel pitch 0.8

NR

No.
sessions

5175 (20)

NR

16 J/cm2

No.
passes

Dot cycle 5

Spot size
(mm)

Energy settings

Average clinical improvement, rated based on a 4-point scale

All but one of the patients had striae alba

RF was used prior to PDL in the first treatment session. Only PDL was used in subsequent sessions

Both the laser group alone and the combination group had clinical improvement; however, there was no significant difference in outcome between the two groups

Collagen was applied topically

Microneedle penetrating depth

Investigators alternated lasers between sessions, beginning with the CO2 laser. Overall, 3 sessions were performed with the CO2 laser and 2 were performed with the PDL

These correspond to the improvement of individual striae

Parameters used for the Fx CO2 laser were identical in the Fx CO2 group and the combination group

Improvements were evaluated by blinded or unblinded dermatologists using objective standards

Fitzpatrick skin type, IVI

Wavelengths in parentheses are measured in nanometers

CT combination therapy, Fx fractional, NCI no clinical improvement, N/A not applicable, NR not reported, NS not specified, PD pulse duration, PDL pulsed dye laser, PIH postinflammatory
hyperpigmentation, pts patients, RF radiofrequency, SA striae alba, SD striae distensae (non-specific), TEE transient erythema and edema

PDL ? RF

Fx CO2 vs. collagen

vs. CT

Shin
[43]

Naeini
[40]

Fx CO2 vs. Fx
CO2 ? PDL

Author

Study design

Table 6 Combination studies in the treatment of striae distensae

A. S. Aldahan et al.

Laser and Light Treatments for Striae Distensae

hyperpigmentation was observed in one patient on an area

receiving CO2 laser alone. The authors concluded that
alternating the CO2 laser with the PDL is more effective in
treating striae alba than the CO2 laser alone [40].
5.2 Ablative Fractional CO2 Plus RF
RF has emerged as a promising alternative or supplementary treatment for striae. The energy is thought to be
absorbed by dermal targets such as water and collagen,
thereby producing heat and recruiting growth factors [41].
Fractionated microneedle RF allows the device to penetrate
the epidermis with minimal damage and create
microthermal zones analogous to those produced by fractional lasers [42].
Ryu et al. conducted a three-arm trial comparing combination treatment with the fractional CO2 laser and fractionated microneedle RF to either treatment alone. Thirty
patients were each divided into one of three treatment
groups and received three sessions at 4-week intervals. All
patients had some degree of improvement, but the combination group produced significantly better outcomes. Four
patients in the combination group achieved greater than
80 % improvement, and the remaining six achieved
5180 % improvement. Postinflammatory hyperpigmentation was seen in 30 % of patients in the combination group,
compared with 20 % in each of the single-agent groups.
The authors support combination treatment with RF as a
more effective modality for treating striae than either
therapy alone without a significant increase in adverse
effects [41].
5.3 Ablative Fractional CO2 Plus Topical Collagen
In a study of 12 female patients with striae alba, Shin et al.
compared the fractional ablative CO2 laser with topical
collagen. The three treatment areas included laser alone,
collagen alone, and both in combination. Three laser sessions
were performed at 4-week intervals. Collagen cream was
applied twice per day to the appropriate treatment areas. All
areas receiving laser therapy, either alone or in combination
with collagen, demonstrated clinical improvement as well as
increased epidermal thickness on histology; however, there
was no significant difference in clinical or histological outcome between laser alone and combination therapy. All
patients receiving laser therapy developed transient erythema after treatment, and nine (75 %) developed postinflammatory hyperpigmentation [43].
5.4 PDL Plus RF
Suh et al. combined the 585-nm PDL with RF in a study
involving 37 patients with dark skin types. All but one

patient had striae alba. A total of three sessions were

completed at 4-week intervals, with RF used prior to PDL
therapy only for the first treatment session. PDL was used
alone for the remaining two sessions. After completion of
treatment, 30 % had very good improvement (76100 %),
and 60 % had good improvement (5175 %).
Histopathology showed an increase in collagen, although
epidermal thickness was not increased. Purpura was seen in
six patients and postinflammatory hyperpigmentation in
one. The authors suggest that the synergistic effect between
these two modalities contributed to the positive results with
fewer adverse effects. Nevertheless, a comparison between
PDL alone and in combination with RF is needed to verify
this hypothesis [44].

6 Discussion
A variety of laser parameters have been studied either
alone or in combination with other modalities for the
treatment of SD. In additional to producing clinical
improvement, many lasers have been shown histologically
to increase collagen and elastin production. Mature striae
alba have shown to be the most difficult to treat successfully, though fractional lasers seem to be the most efficacious owing to their even distribution of energy. They have
also shown to be more effective than topical agents for
striae alba [39, 43]. The non-ablative fractional lasers
appear especially promising with a reduced adverse-effect
profile and faster healing times. Concerning non-fractionated lasers, the excimer is a feasible option for temporary
improvement of striae alba, although splaying of pigmentation may be a concern. The PDL produces no clinical
improvement for striae alba and negligible histological
changes; however, there is evidence that PDL may provide
additional benefit in combination with the fractional CO2
laser [40]. Non-laser light sources also seem to be beneficial for striae alba with few adverse effects, though the
permanence of improvement is questionable.
Striae rubra are much more amenable to laser and light
therapy, which may be because of their predominant vascular components. They can be treated successfully with
fractional lasers, as well as the Nd:YAG, copper bromide,
PDL, and IPL. Improvement in striae rubra can also be
sustained, potentially preventing the progression to striae
alba. Some lasers, such as the diode laser, PDL, Er:YAG,
and unfractionated CO2 laser, may cause more harm than
good in darker skin types.
Other therapeutic options have been studied for SD,
including topical agents, chemical peels, dermabrasion,
RF, ablative and non-ablative laser therapy, and fractional
photothermolysis. These are thought to work by inducing
collagen production, increasing cell turnover, and reducing

A. S. Aldahan et al.

local inflammation [2, 4]. Topical creams have shown

insignificant results for the prevention of SD. Tretinoin,
glycolic acid, microdermabrasion, and RF have demonstrated increased collagen synthesis, but clinical outcomes
have been inconsistent [2, 4, 45].
6.1 Limitations
The main factor that limits head-to-head comparisons
between lasers is the striking variation between study
protocols. Consistency of parameters such as fluence, pulse
duration, and spot size is crucial to obtaining objective
results and realizing valid conclusions. Arguably as
important is the standardization of treatment intervals and
the overall number of sessions. As can be appreciated in
the tables, these factors are highly dissimilar between
studies. The few comparative and combinational studies in
the literature address this issue relatively well, but the
single-arm studies leave little opportunity for objective
comparisons. The use of different devices between studies
further complicates any direct comparisons. Notably, most
articles neglect to propose solutions to resolve this lack of
uniformity. For any legitimate associations to be made in
the future, strict standardization of study protocols will be
necessary.
Many studies incorporated blinded evaluations of photographs to reduce bias. Some even compared blinded
improvement scores with unblinded ones [9]. Nevertheless,
factors such as lighting and shadowing can be altered to
produce apparent improvement even in untreated striae.
There is also the concern of publication bias considering a
majority of articles had some positive results to report,
either clinical or histologic. The relatively low number of
patients in each study, with the lack of long-term followup, poses a potential limitation to drawing valid conclusions. Some studies that followed patients periodically
noted initial improvements that gradually trended toward
baseline, but the duration of temporary improvement is
unclear. Measurements of clinical improvement were not
standardized and scores were therefore dependent on the
subjective assessment of evaluators.
6.2 Future Directions
Combination therapy may be the future for treating SD.
Multiple simultaneous approaches may afford the use of
lower fluences, ultimately decreasing adverse effects. Strict
adherence to laser parameters and standardization of photography will be essential to ensure valid results. Although
combining lasers of different wavelengths and power may
work, it will be interesting to see how other energy devices

such as ultrasound and RF play a role when used alongside

laser therapy. The Er:Glass laser has been alternated with
micro-focused ultrasound for SD [46]. Combination treatment with laser and RF produced better treatment outcomes than laser alone in both of the studies we included
[41, 44]. A few studies have also demonstrated success
combining RF with modalities such as platelet-rich plasma,
retinoic acid, and ultrasound [4749]. In fact, RF alone has
also shown promising results for SD with few adverse
effects [50, 51]. While a variety of energy devices could
theoretically be used in combination, only a handful of
well-powered studies have been performed, so it is hard to
say which combination will be at the forefront. Other
agents such as topicals do not appear to add any benefit to
laser therapy, though there is a gap in the literature
addressing this topic. It will be interesting to see how laser
therapies and combination treatments evolve in clinical
practice.

7 Conclusion
Many lasers exist for the treatment of striae alba and striae
rubra. Improvement in color is likely temporary for striae
alba, whereas striae rubra may achieve long-term complete
resolution. Overall, fractional lasers seem to be the most
promising choice because they can evenly distribute energy
and can precisely limit the treatment area to within the
striae margins. Striae rubra can be treated successfully with
a variety of fractional and non-fractional lasers, although
there are insufficient comparative studies to decide which
laser parameters are most effective. Combination treatments may produce better clinical outcomes with less
adverse effects, but additional large-scale randomized trials
will be necessary to validate their use in practice.
Compliance with Ethical Standards
Funding

No funding was received for this manuscript.

Conflicts of interest AS Aldahan, VV Shah, S Mlacker, S Samarkandy, M Alsaidan and K Nouri declare that they have no conflicts of
interest.
Full disclosure Adam S. Aldahan had full access to all of the data in
the study and takes responsibility for the integrity of the data and the
accuracy of the data analysis. Study concept and design: Aldahan, Shah,
Mlacker, Samarkandy, Alsaidan, and Nouri. Acquisition, analysis, and
interpretation of data: Aldahan, Shah, and Mlacker. Drafting of the
manuscript: Aldahan, Shah, Mlacker, Samarkandy, Alsaidan, and
Nouri. Critical revision of the manuscript for important intellectual
content: Aldahan, Shah, Mlacker, Samarkandy, Alsaidan, and Nouri.
Statistical analysis: not applicable. Obtained funding: not applicable.
Administrative, technical, or material support: Aldahan, Shah, Mlacker,
Samarkandy, Alsaidan, and Nouri. Study supervision: Nouri.

Laser and Light Treatments for Striae Distensae

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