stretch marks- treatment in SLE pts

[PharmdA07]

Hello guys,
During rounding today (part of my shadowing hours), my team saw a SLE pt (newly dx'ed for about 1.5 year) on high dose prednisone (the higest s/he has been on was almost 80mg qd X 1 week) with terrible and angry red stretch marks (striae). S/he was in the late 20's and very body-conscious. I really felt the pain listening to his/er laments to the attending that after being discharged from the hospitals, s/he always have to cover the whole body and his/er youth faded away in shame/guilt. The MD just said there was nothing could be done except Retin-A microgel and cocoa butter. After getting home, I spent hours looking up stuffs and it seems there are a bunch of over-the-internet cream treatment (mostly herbals) and only Retin-A has been proven to be effective (for prolong therapy course >= 4 months). Any ideas or guidelines outthere on the treatment of this condition? How long does it take for them to fade away? (I couldn't find much on the pathophys of this in Diprio or GnG). Just a thought.... Thanks guys!

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[PumpkinSmasher]

How long does it take for them to fade away? (I couldn't find much on the pathophys of this in Diprio or GnG). Just a thought.... Thanks guys!

Unfortunately, they are not going to just fade away. Retin-A may be able to fade them away somewhat but most likely they will never fully dissapear. Retin-A is going to work best if she starts using it within 4-6 months of when the marks developed.
Patho- Glucocorts blocking the formation of elastin and collagen lead to skin that is able to stretch more easily and leads to tearing in the dermis and epidermis leading to scarring.
Cocoa butter may be cheap but I have never had any benefits from it nor have I read anything saying it works well but what the hell, give it a try.

 

[Aznfarmerboi]

Unfortunately, they are not going to just fade away. Retin-A may be able to fade them away somewhat but most likely they will never fully dissapear. Retin-A is going to work best if she starts using it within 4-6 months of when the marks developed.
Patho- Glucocorts blocking the formation of elastin and collagen lead to skin that is able to stretch more easily and leads to tearing in the dermis and epidermis leading to scarring.
Cocoa butter may be cheap but I have never had any benefits from it nor have I read anything saying it works well but what the hell, give it a try.

Me too. I heard that cocoa butter does wonders but it doesnt work for me. The advertisement says 2 weeks to see improvement but I think that is bull.

 

[PharmdA07]

I've read on StatRef a book (can't remember the name now) that for about 3 months pred-induced striae will chang from red to pink to eventually silver white, this is the point when they will permanently stamped into the skin dermal layer. That explains why retin-A initiated in the beginning when the angry red color presents works best ?? So technically if we d/c pred and pts keep using Retin-A + moisturizers qd (compliant), the marks will decreases to silver white in ~ 3months? I was asked about the treatment for this today at work (a retail chain) by a pregnant lady. Too bad she lift her blouse a bit to show me the marks ):... there went my lunch appitite. Keep posting your experiences with pt treatment if you don't mind. thanks people!👍

 

[Vitamin K]

Too bad she lift her blouse a bit to show me the marks ):... there went my lunch appitite.

How very unprofessional of you.

 

[PharmdA07]

How very unprofessional of you.

Dude... I could not help it. She was talking and talking and said "they look like this!!!" What am I supposed to do? 😀Anyhow... any other treatments insight would be appreciated. A friend of mine from another chain also told me this afternoon that she was asked the same thing. hmm... look like this is a pretty common problem

 

[PharmDstudent]

Maintain body weight, moderate exercise, moisturize, and avoid touching the area or aggravating it in any way- the skin is already weak and damaged.

 

[Old Timer]

I am I nuts or does this scream out for a consult from a Plastic Surgeon?

 

[PumpkinSmasher]

I am I nuts or does this scream out for a consult from a Plastic Surgeon?

If she has the money, then that is probably the option that will yield the results she is looking for.

 

[Old Timer]

If she has the money, then that is probably the option that will yield the results she is looking for.

Since this is due to her SLE, it may be covered. But the consult is the appropriate course of action.