The effectiveness of micro-needling in the treatment of stretch marks

Introduction: Stretch marks, also known as striae distensae (SD), are a fairly common, asymptomatic skin disorder that affects mostly girls between the ages of 5 and 50. It frequently results in substantial distress and cosmetic anxiety. For the treatment of SD, micro-needling has been suggested as an effective strategy


Introduction
Striae distensae (SD) is a common disfiguring cutaneous condition that affects pregnant women and obese people with rapid weight change.Its development is thought to be significantly influenced by a combination of genetic factors, endocrine changes, and mechanical stretching of the skin.A histological analysis of SD revealed fragmentation with collagen and elastic fiber degradation, flattened rete ridges, and epidermal thinning.laser (10600 nm).Yet there has been some interest in how striae are managed.
The most popular therapeutic methods for the treatment of striae with promising results have been laser therapy and IPL, which has caused frustration for both clinicians and researchers [1].
A recent method of treating scars, particularly stretch marks, is micro-needling [2].
Less invasive, non-surgical skin rejuvenation procedures have dramatically increased in popularity.They have little downtime, which increases patient compliance.The fundamental idea behind these treatment techniques is the regulated creation of inflammation in the dermis, which causes fibroblast recruitment and consequent activation of neocollagenesis [3].
The purpose of this study was to assess the effectiveness and safety of microneedling for treating striae distensae.

2.1.Subjects
The current prospective cohort study included 30 patients who were enrolled in this study, which was conducted on them at the Faculty of Medicine

2.3.Evaluation
Two fixed dermatologists evaluated each patient clinically before and one month after the final treatment.At baseline and following the last treatment, each lesion's widest striae were measured.The width difference was converted to a drop-in percentage from the starting point.A digital camera (Panasonic X9-Japan) was used to take digital pictures of patients before and after their last treatment.

2.4.Ethical consideration
The approval to conduct this study was obtained from the Department of Dermatology, Sexually Transmitted Diseases (STDs), and Andrology, Faculty of Medicine, Fayoum University.Prior to therapy, all patients provided written consent after being informed of the treatment plan.Each participant had the option to decline taking part in the study.All information gathered was kept private.When appropriate, treatment was recommended, along with an explanation of how to utilize it.
Each participant received a thorough description of the study's nature, risks, and goals.They were cautioned about the possibility of infection and hyperpigmentation following surgery.Any unanticipated danger that surfaces during the research were promptly disclosed to the participants and the ethical committee.There were sufficient safeguards in place to protect participants' confidentiality and privacy through the use a code number for every participant and by taking pictures of the affected site only.The results of the research will be used only for scientific purposes.

2.5.Statistical Procedures
Using the SPSS statistical computer tool version 22 to scientifically arrange, tabulate, and analyze the acquired data (SPSS Inc., USA).The standard deviation (SD), mean, and range of the data were calculated.For numerical data, the standard deviation (SD), mean, and range were calculated.The independent and dependent tests were used to determine significance.For qualitative data presented as numbers, Chi-square (2) was used as a significance test, and a P-value of 0.05 was used to determine statistical significance.

Results
Thirty patients from the outpatient clinic of the Fayoum Hospital for Dermatology and Sexually Transmitted Diseases (STDs), located in Fayoum, Egypt, participated in this study.Thirteen patients had striae rubra (43.3%) and seventeen had striae alba (56.6%) when patients were chosen at random.Patients ranged in age from 18 to 60, with a mean age of 22.77 ± 5.54.There were 24 female patients (80%) and 6 male patients (20%).These striae were found in the abdomen in 33.3% of patients (10 patients), the legs in 26.6% of patients (8 patients), the buttocks and lower back in 16.6% of patients (5 patients), the thighs in 13.3% of patients (4 patients), the axillae, forearms, and arms in 6.6% of patients (2 patients), and the breast and sub-mammary in 3.3% of patients (one patient).
In this group of patients, there were a number of factors that contributed to the development of striae distensae, including weight gain in 19 patients (63.33%), which was brought on by increased food intake (20%), steroid usage (30%), pregnancy (10%), and early adolescence with weight gain (3.33%).Five patients (16.66%) had weight loss, three (10%) had pregnancy with proportionate weight gain, and three (10%) had steroid use without weight gain (Table 1).Comparison of the various shades of striae before and after dermapen treatment.
We discovered that the striae were different and after treatment with dermapen, we noticed that there was highly significant difference (Table 3).

Discussion
The objective of the current study was to assess the effectiveness of micro-needling in treating SD patients.These striae were found in the abdomen in 33.3% of the patients (10 patients), the legs in 26.6% of the patients (8 patients), the buttocks and lower back in 16.6% of the patients (5 patients), the thighs in 13.3% of the patients (4 patients), the axillae, forearms, and arms in 6.6% of the patients (2 patients), and the breast and submammary in 3.3% of the patients (one patient).
For pregnancy-related striae, the typical anatomical places to be affected include the belly and breast; for adolescent boys, the outer thighs or lumbosacral regions; and for adolescent girls, the buttocks, thighs, upper arms, and breast.The belly accounted for 33.3 percent of the striae in this study, the legs for 26.6%, the thighs for 13.3%, the arms for 6.6%, the buttocks for 6.6%, and the breast and sub-mammary for 3.3%.In contrast, Cho and his coworkers' (2006) report on the locations affected by SD differed from those in the current study [4].
where the buttocks, which were the most common location of striae growth and were followed by the thighs and calves, showed SD in 77.1% of 48 Korean girls between the ages of 15 and 17.The discrepancy in regions between the present study and Cho et al. (2006) [4]  More than 90% of pregnant women who have SD do so as a result of a combination of hormonal variables, including increased lateral stress on connective tissue and hormones such as relaxin, oestrogen, and adrenocortical hormones (Lawley and Yancey, 2003) [5].According to Maia and her coworkers' [6] 2009 report, striae were more frequently seen in younger women, in women who gained more weight during pregnancy, and/or in women who had babies with higher birth weights, suggesting that maternal age may act as a preventative measure for striae during pregnancy.
Our result revealed that there was a high statistically significant improvement (P <0.001) concerning the width and score of the erythema after treatment with dermapen.There was a statistically significant difference (P <0.05) in regards to the Atwal score of the striae after treatment with dermapen.While there was a high statistically significant difference (P <0.01) between striae rubra and striae alba in regards to colour improvement in striae rubra patients after treatment with dermapen, Our findings showed that after using Dermapen, there was a very statistically significant improvement with respect to erythema width and score (P <0.001).After receiving dermapen treatment, there was a statistically significant difference (P <0.05) in the Atwal score of the striae.
The color improvement in striae rubra patients treated with dermapen was statistically significantly different (P <0.01) from that in striae alba patients.
Our research supports the findings of Mohamed Ali et al. ( 2017) study [7], which included 30 patients divided into two groups; the first group received micro-needling treatment, and the second group received microdermabrasion treatment.They discovered that micro-needling significantly improves SD.
Fifteen patients who underwent micro-needling and another 15 patients who underwent microdermabrasion participated in a study by Ali et al.They discovered that micro-needling significantly outperformed microdermabrasion in terms of clinical improvement (P = 0.005) [8].

Conclusions
Striae distensae (SD) is a common skin disorder that can be quite upsetting without posing any health risks.By collagen stimulation, Dermapen can improve the clinical picture, including striae breadth, color, and texture.When treated with dermapen, striae rubra responded better than striae alba, according to a clinical evaluation.Dermapen appears to be a promising therapeutic approach for striae distensae.More secessions, more sample size, using control groups and long-term follow-up are advised for proper study, according to the recommendation.Also advised are histopathologic and clinical connection.
shades of deep red, crimson, light red (pink), and white.Prior to receiving dermapen treatment, patients experienced deep red striae in six patients, red striae in seven patients, and white striae in seventeen patients.We discovered that the dermapen therapy, which consisted of four sessions, significantly altered the striae's color.Six individuals with deep red striae saw a transition to four light red (pink) and two red striae.However, the striae of seven patients who had red color changed into four patients who had normal color, two patients who had light red (pink), and one patient whose color stayed red as it was prior to dermapen treatment.It should be noted that despite receiving dermapen therapy, the color of the 17 patients with striae alba remained unchanged.Comparing Atwal score before

Table 1 :
The frequency and proportion of potential causes of striae distensae.

Table 2 :
A comparison of the striae's width before and after Dermapen treatment.

Table 3 :
A Comparison between Atwal score for SD before and after treatment by dermapen.
could be attributed to the patients' different ages, races, and other risk factors such as