title: Transepidermal retinoic acid delivery using ablative fractional radiofrequency associated with acoustic pressure ultrasound for stretch marks treatment.
abstract: BACKGROUND
  Striae distensae (SD) treatment still remains a therapeutic challenge to dermatologists. Ablative fractional laser and radiofrequency (RF) enhance skin-drug permeability for SD treatment.
  
  
  OBJECTIVE
  To clinically evaluate the efficacy and safety as well as patient's satisfaction in relation to a method using ablative fractional RF associated with retinoic acid 0.05% cream and an acoustic pressure wave ultrasound (US) in patients with alba-type SD on the breast.
  
  
  METHODS
  Eight patients with alba-type SD on the breast were treated with three step procedure: (1) fractional ablative RF for skin perforation; (2) topical application of retinoic acid 0.05% on the perforated skin; and (3) US was applied to enhance the retinoic acid penetration into the skin. Other eight patients with alba-type SD on the abdominal area were submitted to RF treatment isolated without retinoic acid or US. Three of them were submitted to skin biopsies.
  
  
  RESULTS
  Three patients with SD on the breast area improved from "severe" to "moderate;" two patients improved from "severe" to "mild;" two patients from "moderate" to "mild;" one patient from "marked" to "mild." Clinical assessment demonstrated significant improvement in the appearance of SD in all patients treated with RF associated with retinoic acid 0.05% cream and US (P = 0.008), with low incidence of side effects and high level of patient's satisfaction. Among the patients treated only with RF, two patients improved from "severe" to "marked;" one patient from "marked" to "moderate;" and one patient improved from "marked" to "mild." Four patients did not show any sort of improvement. Clinical assessment demonstrated no significant improvement in the appearance of SD treated with RF isolated with low incidence of side effects, but low-level of patient's satisfaction.
  
  
  CONCLUSIONS
  Ablative fractional RF and acoustic pressure US associated with retinoic acid 0.05% cream is safe and effective for alba-type SD treatment.
authors.affiliation: Dermatology, Fluminense Federal University, Praia de Icarai, 139/702 Niteroi, Rio de Janeiro, CEP 24230-001, Brazil. maria@mariaissa.com.br
authors.forename: Maria Cláudia Almeida
authors.initials: MC
authors.lastname: Issa
authors.forename: Luiza Erthal
authors.initials: LE
authors.lastname: de Britto Pereira Kassuga
authors.forename: Natalia Stroligo
authors.initials: NS
authors.lastname: Chevrand
authors.forename: Livia
authors.initials: L
authors.lastname: do Nascimento Barbosa
authors.forename: Ronir Raggio
authors.initials: RR
authors.lastname: Luiz
authors.forename: Luciana
authors.initials: L
authors.lastname: Pantaleão
authors.forename: Enoi Guedes
authors.initials: EG
authors.lastname: Vilar
authors.forename: Mayra Carrijo
authors.initials: MC
authors.lastname: Rochael
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D057896:Striae Distensae / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage* / Q000627:therapeutic use; D014464:Ultrasonic Therapy; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007641:Keratolytic Agents; D014212:Tretinoin