Evaluating CO2 laser and micro-needling therapies for striae distensae: a comprehensive meta-analysis and systematic review

Striae distensae (SD), commonly known as stretch marks, are a prevalent cosmetic concern, particularly among women, with potential psychological impact. This meta-analysis aims to compare the effectiveness, safety, and patient satisfaction of two common SD treatments: Fractional CO2 10,064 nm (Fr CO2) laser and micro-needling. The primary focus is on clinical improvement, post-inflammatory hyperpigmentation (PIH) incidence, and morphological changes, specifically the cross-sectional area of the largest striae. Six randomized controlled trials (RCTs), including 166 patients were analyzed. A comprehensive literature search was conducted using PubMed, Google Scholar, and Embase. Systematic statistical analysis was performed using Review Manager 5.4 to gauge the comparative effectiveness and safety of Fr CO2 laser and micro-needling. Meticulous Cochrane risk-of-bias assessments were conducted to ascertain the quality of included RCTs. Both Fr CO2 laser and micro-needling treatments demonstrated significant clinical improvements in SD appearance, benefiting over 70% of patients. However, no significant difference in clinical improvements (Relative Risk (RR) = 0.97 [0.74, 1.28], p = 0.85, I2 = 17%) and patient satisfaction scores (RR = 0.91 [0.52, 1.58], p = 0.10, I2 = 39%). A comparison of the cross-sectional area of the largest striae between the groups revealed no significant disparity (Mean Difference = 0.22 [-0.15, 0.58], p = 0.24, I2 = 0%). However, the CO2 group experienced significantly higher post-inflammatory hyperpigmentation (RR = 8.37 [1.42, 49.44], p = 0.02, I2 = 68%). Both treatments are effective for SD, with similar clinical improvements and patient satisfaction. Micro-needling emerges as the safer option due to its lower risk of PIH. Treatment choice should be tailored to individual patient needs and preferences. Future research should focus on long-term outcomes and patient-reported measures in aesthetic dermatology.