Advances in the Treatment of Striae Distensae.

BACKGROUND: Striae distensae (SD) is a common cutaneous condition with an estimated incidence of 56%, associated with rapid skin expansion, hormonal changes, and genetic factors. While traditional treatments (e.g., topical tretinoin, various lasers) exhibit limitations, non-ablative fractional laser (NAFL), injectable fillers, alpha hydroxy acids (AHAs), and combination therapies have emerged as promising modalities, though certain aspects require clarification. AIMS: This review aims to synthesize current evidence on the pathogenesis and management of SD, with a particular focus on evaluating the recent progress of 1565 nm NAFL to provide guidance for clinical practice and future research. METHODS: A systematic literature search was conducted across PubMed, Web of Science, and Scopus databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review prioritized randomized controlled trials, meta-analyses, and substantial clinical studies published between 2010 and 2025. RESULTS: Striae distensae (SD) arises from mechanical tension, hormonal imbalance, and inflammation-induced dermal matrix disruption. Efficacious treatments include alpha hydroxy acids, injectable fillers, 1540 nm Er:Glass laser, 532 nm Nd:YAG laser, picosecond lasers, intense pulsed light, and combination therapies (e.g., fractional microneedling/CO2 laser + PRP). 1565 nm NAFL exhibits favorable efficacy, safety, and tolerance, with enhanced outcomes in combinations. CONCLUSIONS: The management of SD is evolving towards individualized combination strategies. Fractional microneedling plus PRP and fractional CO2 laser resurfacing with PRP achieve good results in SD rubra and alba, while 1565 nm NAFL represents a significant advance in minimally invasive treatment. Future research should prioritize large-scale studies, standardized assessment methods, and exploration of novel combinations.