Dermatology · Medical Literature
Treatment of striae albae with combination of fractional radiofrequency and topical tretinoin: A randomized controlled trial.
Abstract
Mature striae distensae, called striae albae, are common but treatment-resistant dermal scars. Fractional radiofrequency (FRF) can potentially act as transdermal permeation enhancer for topical tretinoin (TT). This study investigated FRF and TT as a combination treatment for striae albae. Twenty patients were included, each with four anatomically comparable areas that were randomized to (i) TT (ii) FRF (iii) combination FRF + TT and (iv) untreated control. Three treatment sessions were performed one month apart, and TT was also applied in-between. The change in striae from baseline to 20-week follow-up (Δ) was assessed using the Patient Observer Scar Assessment Scale (POSAS, SUM: 6-60). At baseline, patients assessed the striae as moderate-severe (POSAS-PT: SUM medians 24-25) and at follow-up, they reported an improvement (POSAS-PT: ΔSUM 5-10 points), but only the combination treatment improved significantly better (FRF + TT vs. control p = 0.029). A blinded dermatologist confirmed a tendency towards treatment improvement (POSAS-OBS: ΔSUM: 0-2 point, all treatments vs control p≥0.269). A subtle tendency was observed in objective measures with 3D photographs. Combination treatment with FRF and TT was tolerable and improved patient-reported striae compared to control. Striae albae remain challenging, but the findings highlight a potential for future combination treatment approaches.Trial registration number: NCT05461755Date of registration: 15.07.2022.
Clinical relevance
Striae albae (mature striae distensae) represent a therapeutically refractory form of dermal scarring affecting a broad patient population, yet high-quality randomized controlled evidence guiding treatment selection has been lacking. This intra-individual RCT addresses the clinical gap by evaluating whether fractional radiofrequency (FRF) can serve as a transdermal permeation enhancer for topical tretinoin (TT), potentially augmenting an established keratinocyte-stimulating agent via controlled microchanneling. The findings are timely for dermatologists managing patients with cosmetically distressing striae albae who have exhausted monotherapy options.
Key findings
1. Study design: 20 patients, each serving as their own control across four anatomically comparable sites randomized to TT alone, FRF alone, FRF+TT combination, or untreated control; three monthly treatment sessions with interval TT application, assessed at 20-week follow-up. 2. Baseline severity: Patients self-rated striae as moderate-to-severe on the Patient Observer Scar Assessment Scale (POSAS-PT SUM medians 24–25 out of 60), confirming enrollment of a clinically meaningful striae albae population. 3. Patient-reported outcomes: All active treatment arms showed improvement from baseline (POSAS-PT ΔSUM 5–10 points across groups), but only the FRF+TT combination arm achieved a statistically significant superiority over untreated control (p = 0.029). 4. Observer-assessed outcomes: A blinded dermatologist identified only a non-significant tendency toward improvement across all treatment arms versus control (POSAS-OBS ΔSUM 0–2 points; all comparisons p ≥ 0.269), indicating that clinician-detected objective change was minimal and did not reach statistical significance. 5. Objective imaging: 3D photographic analysis demonstrated only a subtle, non-significant trend toward structural improvement, underscoring the limited magnitude of morphological change achievable within the study timeframe. 6. Safety and tolerability: The FRF+TT combination was reported as tolerable with no treatment-limiting adverse events described, supporting its feasibility for further investigation despite the modest effect sizes observed.
Practice implications
Clinicians treating striae albae may consider FRF combined with topical tretinoin as a combination approach, particularly for patients who have failed monotherapy, given that the combination—but neither modality alone—demonstrated statistically significant patient-reported improvement over no treatment (p = 0.029); however, effect sizes are modest (ΔSUM ~5–10 points on POSAS) and should be communicated transparently during informed consent. A protocol of three monthly FRF sessions with interval topical tretinoin application appears tolerable and can be adopted as a framework, though optimal device settings, tretinoin concentration, and number of sessions remain to be standardized in larger trials. Given the absence of significant blinded-observer or objective 3D imaging improvements, patient selection should prioritize those with moderate-to-severe patient-perceived burden, and realistic expectations regarding the degree of visible structural correction should be set prior to initiating therapy.