Effectiveness of Combination Fractional CO2 Laser and Topical Centella

Asiatica
Therapy on Striae Distensae (Stretch Marks)
Yuli Kurniawati, Yulia Farida Yahya, Aryati Fadhila, M. Rezi Rahmanda
Department of Dermatology and Venereology
Dr. Mohammad Hoesin Central General Hospital Palembang

BACKGROUND
Striae distensae (SD), also known as stretch marks, is a skin disorder characterized by linear
atrophic dermis caused by stretching of the skin.1 Striae distensae has negative effects, increases
psychological and emotional stress, including lack of self-confidence and decreased quality of
life (QoL).2 Management of SD are challanging, several therapeutic modalities can reduce
clinical symptoms, so knowledge about the current management of SD is needed.3

OBJECTIVES
To assesst the effectiveness combination therapy of fractional CO 2 laser and topical Centella
asiatica as a alternative treatment for SD.

METHODS
This study is an assessment of the effectiveness combination therapy of fractional CO 2 laser and
topical Centella asiatica with a randomized clinical trial design with a prospective design in 22
SD patients at outpatient Dr. Mohammad Hoesin Central General Hospital for 12 weeks follow
up. Inclusions criteria are SD patient, age between 18-40 years old, and accept the study
protocol. The exclusions criteria area pregnancy, breastfeeding, active infection, using
anticoagulan therapy, patient with keloid and diabetes melitus history. The comparative
improvement therapy assest by Visual Analogue Scale (VAS) score, INA score, and
Dermatology Life Quality Index (DLQI) at baseline and endpoint. Statistical analysis using
Statistical Package or the Social Sciences (SPSS) versi 22.0 (SPSS,Inc., Chicago, Illinois).

RESULT
Distribution based on lesion characteristics including Fitzpatrick skin type, location, and type of
striae. Based on the results, it was found that Fitzpatrick III skin type was the most common, 19
patients (86.4%), most on the abdomen 14 patients (63.6%), and striae alba was the most
frequently found, 18 patients (81.8%) (Diagram 1).
The results of the analysis of differences in INA score, DLQI score, and VAS score in SD, it was
found that the mean INA score between baseline and week 12 had decreased. Based on the
results of statistical analysis using Wilcoxon test, it was found that INA score decrease
significantly between baseline and week 12 (p=0.014). Meanwhile, based on the results of
statistical analysis, there was a significant difference in DLQI score between baseline and week
12 (p=0.000). Based on statistical analysis there was a significant difference in mean VAS score
between baseline and week 4 (p=0.000) (Table 1).
 Diagram 1. Clinical characteristics distribution.

Fitzpatrick skin type Striae location

Axilla Abdomen Fe
Poplitea

Type III Type IV

Type of striae

Striae alba Striae rubra

Table 1. Differences in INA score, IKHD score, and VAS score.

Parameter Baseline 12th week p value
Mean ± SD Mean ± SD
INA score
7,04 ± 1,21 6,77 ± 1,06 0,014
DLQI score 9,72 ± 1,88 3,18 ± 1,78 0,000
Baseline 4th week p value
Mean ± SD Mean ± SD
VAS score 4,36 ± 0,95 3,00 ± 1,02 0,000
DISCUSSION
There has not been much research about combination of fractional CO2 laser and topical
Centella asiatica as a treatment for SD.4 Both are treatment of choice for SD. Apart from
improving the integrity of the dermis and epidermis, CO2 fractional laser also plays a role in
helping the penetration of topical drugs through the Laser-assisted Drug Delivery (LADD).5,6
Combination of fractional CO2 laser and Centella asiatica has a synergistic effect as a treatment
for SD in the form of improving skin integrity and helping better topical drug absorption. The
results of this study report that the combination of CO2 fractional laser and Centella asiatica
provided an improvement in the degree of SD based on the mean INA score from the baseline of
7.04 ± 1.21 which decreased significantly to 6.77 ± 1.06, especially in the characteristics of size
and itching. DLQI improvement from the baseline range of 9.72 ± 1.88 (moderate effect) to 3.18
± 1.78 (mild effect) in endpoint. The mean pain scale based on the VAS score during the first
laser procedure (baseline) was found to be 4.36 ± 0.95 and the mean VAS score during the
second laser procedure (4th week) was 3.00
± 1.02. The results of this study indicate that the combination of fractional CO2 laser and
Centella asiatica is a alternative treatment modality that can be used as a treatment for SD with
pain side effects that can be tolerated quite well by patients. The application of topical anesthesia
before fractional CO2 laser can reduce the scale of pain during the procedure.6
CONCLUSION
• Combination therapy with fractional CO2 laser and Centella asiatica for SD resulted in
significant clinical improvement at the 12th week (p=0.014), especially the size of the lesion
and itching that occurred starting at the 4th week.
• DLQI score decreased significantly (p=0.000) from moderate effects at baseline to mild
effects at 12th week.
• The mean VAS score for the CO2 laser procedure at a dose of 5 J/cm2 as a treatment for SD
is mild-moderate which can be tolerated by patients.

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