Comparing fractional microneedle radiofrequency and fractional CO2 laser for striae distensae treatment: a systematic review and meta-analysis

Striae distensae (SD) are a prevalent dermatological concern of women and approximately 90% of pregnant women experience these stretch marks. Fractional microneedle radiofrequency (FMR) and fractional CO2 laser (FCL) have gained substantial attention in the treatment of SD. In clinical studies, a clear superiority between FMR and FCL treatments is not found due to limited studies and sample sizes. In this systematic review and meta-analysis, a search of English-language articles was performed on PubMed, employing various combinations of keywords "fractional CO2 laser," "microneedle radiofrequency," and "striae". Studies that compared the treatments of FMR and FCL for SD and provided data regarding professional evaluation of improvement, patient self-assessment, and/or the presence of post-inflammatory hyperpigmentation (PIH) were included. We analyzed the incorporated studies utilizing both random and fixed-effects models to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Professional assessments of improvement showed no statistically significant difference between the FMR and FCL groups (OR: 1.27; 95% CI: 0.49-3.31). Similarly, patient self-assessments of improvement did not exhibit a significant difference (OR: 0.72; 95% CI: 0.13-3.90). However, the development of PIH was significantly less frequent in the FMR group when compared to the FCL group (OR: 0.24; 95% CI: 0.08-0.70). Both FMR and FCL demonstrate comparable performance in terms of improving lesions, as assessed by both healthcare professionals and patients. However, FCL is associated with a higher risk of developing PIH. This finding can guide clinicians especially who prefer a single treatment.