A clinical and histopathological study comparing the efficacy and safety of carboxytherapy, platelet-rich plasma, and fractional carbon dioxide laser in the treatment of striae distensae

Background Striae distensae (SD) are linear scars that develop in the areas of dermal damage owing to overstretching of the skin. No gold standard line of treatment has been determined. Objectives To compare the efficacy and safety of carboxytherapy, platelet-rich plasma (PRP), and fractional carbon dioxide (CO2) laser in the treatment of SD clinically and histopathologically. Patients and methods The study included 37 female patients with SD, aged 18–50 years. Complete history taking and general and dermatological examinations were performed. The study population was randomly divided into three groups: group A was treated with carboxytherapy, group B was treated with PRP, and group C was treated with fractional CO2 laser. The groups were treated each for six sessions with 3-week intervals and followed up after a month from the last treatment session. The session showing the beginning of improvement and the overall improvement were recorded in each group. Adverse effects, as well as the satisfaction of patient and dermatologist, were also evaluated and graded. The pretreatment and posttreatment histopathological changes in each group were evaluated and recorded according to a modified scoring system. Masson’s Trichrome staining was performed to evaluate the collagen content. Results In the present study, the highest ratio of the overall improvement was observed in group C followed by group B and group A. Histopathological improvement was observed in the three groups with different mechanisms according to the applied treatment. Fractional CO2 laser showed more histopathological improvement than the other treatment modalities. Conclusions The present study concluded that carboxytherapy, PRP, and fractional CO2 laser were clinically and histopathologically effective and safe treatment options for mild to severe SD. Fractional CO2 laser was more effective especially in cases of moderate to severe striae albae. Although it is an expensive treatment method, it resulted in a higher satisfaction rate between the patient and dermatologist with a good safety profile and tolerability.