Suggested therapeutic approach to striae distensae

* There is no therapeutic intervention that results in complete resolution of striae distensae. Patients should be informed that results of treatment vary and that the primary goal of treatment is to reduce the visual contrast between striae distensae and adjacent normal skin.
¶ Topical tretinoin is an effective treatment for striae rubra. Although it is considered the preferred topical treatment for striae alba in patients who decline procedural interventions, efficacy for striae alba is unclear.
Δ Most experts consider microneedling with radiofrequency (RF microneedling) the preferred form of microneedling therapy for striae distensae. Microneedling is less likely to cause post-treatment dyspigmentation than fractional laser therapy. Microneedling is preferred over fractional laser therapy for patients with Fitzpatrick skin phototypes IV, V, or VI because of the increased risk for laser-induced dyspigmentation in this population. Nonablative fractional laser therapy is generally preferred over ablative fractional laser therapy because of a lower risk for complications and faster recovery time.
◊ Typically, patients receive 3 to 6 microneedling or nonablative fractional laser treatments. Patients treated with an ablative fractional laser typically receive 1 to 3 treatments.
§ Pulsed dye laser therapy should be performed with caution in individuals with Fitzpatrick skin phototypes IV to VI because of increased risk for laser-induced dyspigmentation. Treatment with pulsed dye lasers in this population should be restricted to clinicians with expertise in this procedure.
¥ Some experts administer pulsed dye laser and fractional laser therapy simultaneously as initial treatment.
‡ Alternative topical agents have been utilized for striae distensae (eg, silicone gels, Centella asiatica); however, data are insufficient to recommend use of these therapies.