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PRP for Stretch Marks: Evaluating Treatment Effectiveness

Updated: May 2

Striae distensae, colloquially known as stretch marks, constitute dermal disruptions that arise after the expeditious elongation of the skin. These are predominantly observed during pivotal biological milestones, including gestation, puberty-induced growth surges, and episodes of marked weight variations. Although devoid of medical exigency, the presence of striae distensae can precipitate considerable aesthetic concern, thereby undermining the psychosocial well-being and self-perception of the affected individuals.


This article aims to delineate the multifaceted causes of striae distensae, assimilating the contributory factors and the underlying biological mechanisms. Furthermore, it seeks to expound upon the genetic and racial predilections that modulate susceptibility to this condition, along with elucidating the psychological ramifications borne by patients.


Subsequent to establishing a foundational comprehension of striae distensae, this paper will pivot to an examination of the application of platelet-rich plasma (PRP) therapy as a therapeutic intervention for the amelioration of striae distensae [1], scrutinize existing research for its effectiveness, and outline areas requiring further investigation. This analysis is intended to guide healthcare professionals in evidence-based decision-making regarding striae management.


Understanding Stretch Marks: Causes and Risk Factors


This section delves into the etiological factors behind stretch mark formation, offering healthcare professionals a deeper understanding of the biological and mechanical processes at play as well as the dermatological outcomes of these skin lesions.


prp for stretch marks

A. Contributing Factors and Biological Mechanisms


The integumentary system, comprising the epidermis, dermis, and hypodermis, serves as the body's primary barrier against environmental stressors. The epidermis, the outermost layer, provides a waterproof barrier and creates skin tone. Beneath lies the dermis, rich in collagen and elastin fibers, which confer tensile strength and elasticity, respectively. The hypodermis, or subcutaneous layer of human skin, consists of fat and connective tissue that houses larger blood vessels and nerves.


Striae, or stretch marks, emerge as a result of rapid dermal stretching that exceeds the skin's capacity for elastic deformation, leading to microtears in the connective tissue. This phenomenon predominantly affects the dermis, where the disrupted architecture manifests as visible striations on the skin surface. Central to this process is the perturbation of collagen and elastin, crucial fibrous proteins that maintain dermal integrity and elasticity. Disruptions in their synthesis or organizational structure compromise the skin's elasticity, predisposing it to striae upon stretching. [2]


Exacerbating factors include hormonal fluctuations, notably during pregnancy, where elevated levels of hormones like cortisol may weaken dermal fibers. Additionally, chronic inflammation can further degrade the collagen fibers and elastin, increasing the risk of stretch mark formation. [3]


B. Genetic and Racial Predispositions


Emerging evidence increasingly supports a genetic foundation for the predisposition to striae, intimately linked to polymorphisms in genes responsible for the synthesis and regulation of collagen and elastin. These proteins are pivotal to the dermis's structural integrity, influencing its elasticity and capacity to withstand stretching. Genetic variations can lead to disparities in the quality and abundance of collagen and elastin, thus affecting an individual's susceptibility to stretch mark development. For instance, mutations in genes encoding for collagen and elastin may result in a weaker dermal matrix, rendering the skin more susceptible to tearing under tension. [4]


Melanin production, another critical variable in this equation, offers photoprotection and may impact the appearance and recovery of stretch marks. Melanin's role extends beyond merely determining skin color; it also influences inflammatory responses and healing processes. The differential production of melanin among various racial groups could affect not only the visibility of stretch marks but potentially their healing trajectory. Preliminary observations suggest that melanin-rich skin types might display less prominent striae due to the camouflage effect of pigmentation and possibly different healing dynamics. However, the interaction between melanin levels and stretch mark formation and recovery is not fully understood, necessitating further research to elucidate these relationships comprehensively. [5]


C. Psychological Impact on Patients


In some cases, the cosmetic concern associated with stretch marks transcends aesthetic displeasure, manifesting as significant mental health challenges, including anxiety and depression. For many individuals, these dermal lesions elicit distress, adversely impacting self-esteem, body image, and self-confidence. This psychological burden can be profound, catalyzing feelings of dissatisfaction and self-consciousness. [6]


PRP for Stretch Marks: Background


PRP therapy, a procedure that concentrates platelets from an individual's own blood to enhance tissue healing, has recently garnered attention in the realm of aesthetic medicine for its potential applicability to a variety of dermatological conditions, including the treatment of striae. Despite its emerging role, the adoption of PRP as a routine therapeutic intervention for striae is hampered by its relatively elevated cost and the current paucity of conclusive evidence regarding its long-term efficacy. [7]


PRP: Concept and Preparation


PRP is derived through a process of centrifugation of the patient's blood, which separates it into distinct layers, allowing for the extraction of a concentration of platelets in plasma. This platelet-rich layer is reconstituted into a volume that can be injected into the tissue site requiring treatment. Platelets are a natural source of growth factors and cytokines, which play critical roles in wound healing and tissue health.


Mechanism of Action for Stretch Marks


The application of PRP therapy in the context of striae is predicated on several theorized mechanisms of action, including:


  • Increased Collagen and Elastin Production


PRP is thought to stimulate the proliferation of fibroblasts, which in turn enhances the synthesis of collagen and elastin fibers in the dermis. This could potentially improve the skin's structural integrity and elasticity, thereby mitigating the appearance of stretch marks. [8]


prp for stretch marks

  • Enhanced Angiogenesis


The growth factors present in PRP can promote the formation of new blood vessels (angiogenesis), improving blood supply to the affected areas. This increased perfusion may aid in the reparative processes of the skin, further supporting the healing of striae. [9]


  • Improved Wound Healing


By leveraging the body's innate healing mechanisms, PRP may accelerate the repair of the microtears in the dermis that manifest as stretch marks. The concentration of growth factors is believed to expedite the healing phases, including inflammation, proliferation, and remodeling. [10]


Comparison with Alternative Modalities


Alternative treatments for striae range from topical creams, which primarily aim to hydrate the skin and may contain active ingredients to promote new collagen and synthesis, to more invasive procedures like laser therapy, which works by inducing controlled damage to the dermis, prompting the skin's natural healing processes to generate new tissue. [11]


In contrast to these treatments, PRP therapy operates through a biological augmentation of the skin's healing capabilities. Unlike topical applications, PRP delivers growth factors directly to the affected area, potentially offering a more pronounced improvement in skin texture and appearance. Compared to laser therapy, PRP is less about inducing new damage for the sake of healing and more about directly stimulating tissue repair at the cellular level.


Current Evidence on PRP for Stretch Marks


The landscape of therapeutic interventions for stretch marks is continually evolving. The evidence base for PRP in the treatment of SD is currently limited by the quality and quantity of clinical studies. Despite this, two notable studies offer insights into the potential efficacy of PRP compared to traditional treatment modalities.


One study evaluated the effectiveness and safety of intralesional PRP injections versus topical tretinoin 0.05% in the treatment of striae distensae (SD) across a cohort of 30 patients, consisting of 27 females and 3 males. This comparative analysis involved treating selected areas of SD with PRP on one side and tretinoin on the other, with outcomes assessed through skin biopsies, digital photography, and evaluations by two blinded dermatologists in addition to patient satisfaction ratings. The findings revealed a statistically significant improvement in SD appearance with both treatments, with PRP demonstrating a superior therapeutic response compared to tretinoin, as evidenced by increased collagen and elastin fibers in post-treatment biopsies and higher patient satisfaction scores. [12]


prp for stretch marks

Another study aimed to compare the efficacy and tolerability of PRP against microdermabrasion for SD treatment. In this randomized trial, 68 patients were divided into three groups to receive PRP injections, microdermabrasion, or a combination of both treatments, with up to six sessions at two-week intervals. Histopathological evaluations conducted on skin biopsies before and after the treatments indicated significant clinical improvement in patients treated with PRP and those receiving the combined treatment, compared to microdermabrasion alone. Notably, the combination of both PRP treatments and microdermabrasion in the same session yielded better outcomes in a shorter period, suggesting that while PRP alone is more effective than microdermabrasion, employing both modalities concurrently may enhance efficacy and rapidity of results. [13]


Despite these encouraging findings, the studies in question are not without their limitations, including small sample sizes, the absence of control groups, short follow-up durations, and potential selection biases. The lack of standardized protocols for PRP preparation and application further complicates the comparison of outcomes across studies. Moreover, the reliance on subjective assessments of patient satisfaction and visual or histological improvements without uniform outcome measures introduces additional biases.


Factors Influencing Treatment Outcomes


The effectiveness of PRP therapy for striae distensae is contingent upon a constellation of factors, ranging from the characteristics of the stretch marks themselves to the specifics of the treatment regimen and patient behaviors post-therapy. The severity and chronicity of the striae significantly influence therapeutic outcomes, with newer, red-tinged marks (striae rubra) often responding more favorably than older, white-tinged ones (striae alba). The etiology of the striae, whether due to pregnancy, weight fluctuations, or hormonal changes, further impacts response rates, as do intrinsic factors such as patient age and skin health.


Treatment efficacy is also affected by the number of PRP sessions and the expertise with which they are administered. Techniques in PRP preparation and injection, along with the healthcare provider's skill level, play critical roles in maximizing therapeutic benefits. Additionally, patient compliance with prescribed post-treatment care, including skin hydration and protection measures, is essential for optimal results. [14]


Setting Realistic Expectations


Clear communication between healthcare providers and patients is paramount in setting realistic expectations for the effective treatment of striae distensae with PRP therapy. Medical professionals hold a pivotal role in elucidating the realistic outcomes of PRP treatment, emphasizing improvement in the appearance of the striae rather than promising complete eradication. Such transparency fosters trust and aligns patient expectations with probable therapeutic outcomes, mitigating potential dissatisfaction.


In discussions with patients, it's essential to address the nature of PRP therapy comprehensively, including the anticipated progression of treatment and the typical response of stretch marks to PRP interventions. Moreover, potential side effects, such as discomfort at the injection site, bruising, and swelling, should be candidly communicated. These side effects are generally transient and manageable, but awareness and understanding of them are crucial for patient preparedness and satisfaction.


prp for stretch marks

Potential Limitations and Risks


As PRP therapy garners attention across various medical and aesthetic fields, it's imperative for healthcare professionals to critically assess its limitations and the risks entailed. A thorough comprehension of these factors is pivotal for guiding informed patient consultations on PRP therapy's broad applications.


1. Limited Clinical Evidence


The employment of PRP therapy, while promising, is marked by a scarcity of extensive, longitudinal clinical studies. The substantiation of PRP's effectiveness across different treatment areas, along with a nuanced understanding of its potential side effects and the identification of optimally responsive patient profiles, is an active field of study. The variability observed in treatment efficacy, influenced by the health status and specific goals of individual patients, necessitates a prudent approach from practitioners. Staying abreast of emerging research and delivering a balanced evaluation of PRP therapy's potential and safety across its various applications is essential.


2. FDA Approval


The instruments and protocols for PRP preparation and application have received clearance from regulatory entities like the U.S. Food and Drug Administration. However, specific uses of PRP therapy lack explicit FDA endorsement. As PRP is derived from a patient's own biological materials, it falls outside the purview of drug regulation, affording healthcare providers discretion in its use, tailored to the unique requirements of their patients. [15]


3. Potential for Adverse Reactions


Despite PRP's autologous origin—which significantly reduces the chances of allergic reactions or rejection—there remains a possibility for adverse effects. These can encompass localized discomfort, injection site pain, infection risk, and other procedural complications. It is therefore crucial for healthcare providers to engage in detailed discussions with patients about these risks, ensuring a well-rounded understanding of the safety aspects of PRP therapy for diverse applications.


SELPHYL® Disclaimer


Instructions for the use of SELPHYL® can be found here and here.


SELPHYL® has not been approved by the FDA for subcutaneous, submucous, or intradermal injections in aesthetic medicine, and the safety and effectiveness of SELPHYL® for these conditions have not been established.


SELPHYL® is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma (PRP) from a small sample of peripheral blood at the patient's point of care. The PRP is mixed with autograft and/or allograft bone prior to application to a bony defect to improve handling characteristics.


As of the time of writing, SELPHYL® has no known serious, life-threatening, or fatal risks apart from the adverse reactions described above.


SELPHYL® Limitations, Restrictions, Cautions, and Warnings


  • Prescription only.

  • Do not use the kit if the sterile packaging is damaged or compromised.

  • Follow universal safety precautions for blood collection and sharps disposal.

  • During blood draw, failure to align and properly seat tubes in the tube holder can result in a loss of vacuum and a loss of blood draw.

  • During PRP transfer, failure to align and securely seat tubes simultaneously in assembled blood transfer device tube holders can result in a loss of vacuum and the failure of PRP to transfer to the red-top PRFM tube.

  • Do not initiate the transfer of PRP into the red-top PRFM tube until the physician is ready to complete the procedure.

  • Do not reuse.


SELPHYL® Contraindications


These are not in FDA-required labeling and are part of SELPHYL®’s clinical evaluation for EU CE requirements.

  • Direct connection to a patient’s vascular system of circulating blood volume.

  • Other health conditions and diseases may also contraindicate the use of autologous PRP, including but not limited to low platelet count, sepsis, localized infection in the treatment area, anemia, malignancy with hematologic or bony involvement, and anticoagulation therapy.


Conclusion


PRP therapy emerges as a compelling option for the treatment of stretch marks, showing promise in improving the appearance of stretch marks by enhancing collagen production and supporting dermal repair processes. Initial studies indicate a potential advantage of PRP over conventional methods, especially in the treatment of early-stage, red-hued stretch marks. However, the effectiveness of PRP is influenced by factors such as the severity and age of the stretch marks, the patient's age and overall skin condition, and the specifics of the PRP treatment protocol.


The need for comprehensive, high-quality research is critical to fully understanding the efficacy of PRP in SD treatment, underscoring the necessity for larger sample sizes, long-term follow-ups, and standardized treatment assessments.


Alternative treatments, including topical treatments, laser therapy, and microdermabrasion, remain valuable options, each with its own set of benefits and limitations. It is essential for healthcare professionals to stay informed about the latest developments in PRP research and advancements in stretch mark treatments to provide patients with accurate, evidence-based advice and to set realistic expectations regarding the outcomes of PRP therapy.


About the Author:


Dr. Ali is a medical journalist and copywriter currently partnering with Selphyl® in crafting medical-related articles.


References


  1. Selphyl. About PRFM. Selphyl. Published June 1, 2023. https://www.selphyl.com/about-prfm

  2. Sawetz I, Lebo PB, Nischwitz SP, et al. Platelet-rich plasma for striae distensae: What do we know about processed autologous blood contents for treating skin stretchmarks?-A systematic review. Int Wound J. 2021;18(3):387-395.

  3. Oakley AM, Patel BC. Stretch Marks. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 7, 2023.

  4. Schuck DC, de Carvalho CM, Sousa MPJ, et al. Unraveling the molecular and cellular mechanisms of stretch marks. J Cosmet Dermatol. 2020;19(1):190-198.

  5. Ongoro G, Avestruz Z, Stover S. Skin Inclusion: Addressing Deficits in Medical Education to Promote Diversity in Dermatological Diagnosis and Treatment. Clin Cosmet Investig Dermatol. 2023;16:3481-3485.

  6. Rotsztejn H, Juchniewicz B, Nadolski M, Wendorff J, Kamer B. The unusually large striae distensae all over the body. Adv Med Sci. 2010;55(2):343-345.

  7. Heitmiller K, Wang JV, Murgia RD, Saedi N. Utility of platelet-rich plasma for treatment of striae distensae: A current exploration. J Cosmet Dermatol. 2021;20(2):437-441.

  8. Huang Q, Xu LL, Wu T, Mu YZ. New Progress in Therapeutic Modalities of Striae Distensae. Clin Cosmet Investig Dermatol. 2022;15:2101-2115.

  9. de Castro Roston JR, Reis IB, Luzo ÂCM, Roston MO, Durán N, Fávaro WJ. Evaluation of the tissue repair process and immunomodulatory action of Platelet-Rich Plasma (PRP) in the treatment of abdominal stretch marks. Tissue Cell. 2023;83:102132.

  10. Oneto P, Etulain J. PRP in wound healing applications. Platelets. 2021;32(2):189-199.

  11. Shu X, Huo W, Zou L, et al. Treatment of Stretch Marks Using a New Formulation Combining Nanofractional Radiofrequency Plus Magnetic Nanofractional Radiofrequency. Dermatol Ther (Heidelb). 2023;13(6):1277-1288.

  12. Gamil HD, Ibrahim SA, Ebrahim HM, Albalat W. Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study. Dermatol Surg. 2018;44(5):697-704.

  13. Ibrahim ZA, El-Tatawy RA, El-Samongy MA, Ali DA. Comparison between the efficacy and safety of platelet-rich plasma vs. microdermabrasion in the treatment of striae distensae: clinical and histopathological study. J Cosmet Dermatol. 2015;14(4):336-346.

  14. Lokhande AJ, Mysore V. Striae Distensae Treatment Review and Update. Indian Dermatol Online J. 2019;10(4):380-395.

  15. Johns Hopkins Medicine. Platelet-Rich Plasma (PRP) Injections. Accessed April 8, 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment

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