Fractional carbon dioxide laser monotherapy and its combination with topical platelet-rich plasma in the management of striae distensae

Background A variety of therapeutic approaches have been introduced for striae distensae (SD) with modest outcomes. Fractional carbon dioxide laser (FCL) and platelet-rich plasma (PRP) are effective separately in improving SD. Objective To assess the safety and efficacy of topically applied PRP combined with FCL in the management of SD. Patients and methods In this prospective, single-blinded, randomized, comparative intrapatient study, 24 patients with bilateral SD lesions were subjected to FCL on both sides and followed by topical application of PRP on one side only allocated by simple randomization. The sessions were performed biweekly for a total of six sessions. Overall clinical improvement was graded using the Quartile Grading Scale. Biopsies, before and after treatment, were stained with H and E, Masson’s trichrome, and Orcein stains. In addition, collagen I and elastin immunohistochemical staining were performed. Results In this study of 24 SD patients (19 females, 5 males; aged 19–39 years), topical PRP with FCL achieved moderate to excellent outcomes 3 months after the last session. Early striae rubra improved after the initial session, reaching marked excellent outcomes within a month after the second session. Manageable side effects were reported. Histological examination showed improved epidermal and dermal thickness, collagen, and elastic fiber quality after treatment, with the combined PRP and FCL side exhibiting more significant outcomes than the FCL-treated side. Conclusion Topical PRP application post-FCL proves to be a highly effective therapeutic approach for SD, expressing superior treatment outcomes, and heightened patient satisfaction compared with the use of FCL alone. In additio, topical application is preferred over intradermal injection, offering practicality, effectiveness, and noninvasiveness.