Stretch Marks - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Stretch marks are also called striae or striae distenae. They are scar-like lines that form when the skin stretches too much or too quickly, and are seen when one has fast growth or weight change. Stretch marks are very common and seen in 70% of teenage girls and 40% of teenage boys.[1] Approximately 75% of the pregnant women will develop stretch marks. They are also more common in Caucasians.[2] 

Symptoms

Stretch marks can be rough and raised, or they can be smooth and slightly caved-in. They range from several centimeters in length and a few millimeters to centimeters in width. There are two main types of stretch marks, striae rubra (red) and striae alba (white).

An early sign of stretch mark formation is when the skin becomes itchy, thinned, flattened and pink in color. Red stretch marks develop as these lines become more obvious and turn reddish purple. Over time the color fades into a lighter and whitish color and the stretch marks may become less obvious to form white stretch marks. White stretch marks are usually permanent. 

Causes

Stretch marks can develop due to several reasons. 

Medication Side Effects

  • Prolonged use of topical or oral corticosteroids: Chronic use of topical corticosteroids can cause thinning of the skin and stretch marks formation on locations where the medication is applied.[3] The skin folds such as the armpits and groin are more likely to develop stretch marks from topical steroid use. Stretch marks seen in long-term oral corticosteroid use are often larger, redder, and widely spread throughout the body.[4] 

Lifestyle

  • Weight gain: Stretch marks develop in those with weight gain. Stretch marks are one of the most common skin findings in overweight and obese people, especially when their body mass index (BMI) is ≥30 kg/m2.[5]   Stretch marks form on body-builders and athletes mainly over the shoulders, upper back and upper arms due to rapid muscle enlargement.[6] People using anabolic steroids are at even higher risk for developing stretch marks.[7]

Your body

  • Puberty: Stretch marks appear in areas where there is a rapid increase in size. Boys tend to get stretch marks on their shoulders, thighs and lower back. Girls tend to get them on their thighs, hips, buttocks, and breasts. Other less common areas are the abdomen, upper arms, neck, and armpits.[2,8]
  • Pregnancy: Stretch marks that form in pregnancy are called striae gravidarum. They are most commonly seen on the abdomen of pregnant women. The breasts and thighs are less common locations. The risk of developing stretch marks are directly related to the amount of weight gain and skin stretching during pregnancy. The risk is highest during the last trimester when the skin is stretched the most. They are more common in younger women and women pregnant for the first time because the skin has not had much stretching previously.[2] Not surprisingly, they are also more common in women who have gained more weight during pregnancy or are carrying twins/triplets and babies with higher birth weights.[2] 
  • Swelling: Stretch marks can become elevated and “worm-like” when the body is swollen, such as in the case where the lymphatic vessels become blocked due to obesity, infection, surgery or radiation.[9] 
  • Rare disorders associated with abnormal cortisol hormone levels: Cushing syndrome, Acromegaly, and other cortisol hormone producing tumors [4,10,11] and cause widespread stretch marks.

Treatments

Avoiding rapid weight change may help to prevent the formation of stretch marks. Most topical products for treating stretch marks have limited benefit. Procedural treatments such as lasers, dermabrasion, chemical peels can make the stretch marks less obvious, but are not likely able to make them go away completely.

  • Moisturizers: Moisturizer use may improve the appearance and decrease itching of stretch marks.[12] However the scientific evidences on the benefit of skin moisturization in preventing and treating stretch marks are still inconclusive. 
  • Topical retinoids: Topical retinoids can improve the look of early stage stretch marks by decreasing their sizes.[13-15] 
  • Silicone gel: Silicone gels may help decrease the redness and darkness, and increase collagen on the stretch marks.[16]
  • Chemical creams and peels: Topical acids (glycolic, ascorbic) acids alone and in combination with topical retinoids can improve the appearance of stretch marks.[17,18] Chemical peels can sometimes make the skin appear tighter and less stretchy.[19]
  • Lasers: Various lasers can be used to smooth out or lighten the red/purple/brown colors of stretch marks.[20-25]
  • Radiofrequency technology: devices that send radiofrequency heating energy to the skin surface and upper fat layers. When used alone or in combination with other laser treatments, radiofrequency treatments may help collagen regeneration and improve the appearance of stretch marks.[26,27]
  • Phototherapy: Ultraviolet light therapy may help improve the light pigmented on stretch marks.[28]
  • Dermabrasion: Dermabrasion is a technique that uses tools to gently remove the uppermost layers of the skin. Dermabrasion alone in combination with chemical peels have been shown to improve the appearance of early stretch marks.[29,30] 
  • Microneedle: Microneedling is done by using a roller fitted with a rotating head, lined with tiny needles. Microneedle treatment alone or in combination with lasers can improve stretch marks, possibly by causing new collagen growth.[31,32]
  • Weight loss does not reverse stretch marks have already formed: Women engaged in exercise did not find any improvement in their existing stretch marks.[33] Although exercising and a nutritious diet are healthy, they will not improve stretch marks that are already present. 

1.    Ed Rook A WD, Ebling FJB, Champion RH, Burton JL. . Textbook of Dermatology. Fourth edition. Blackwell Scientific Publications. PMID.

2.    Jean Bolognia JJ, Julie Schaffer. Third Edition, Volume 2. Elsevier Publishing. Dermatology. PMID.

3.    Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol.2006;54(1):1-15; quiz 16-18; PMID: 16384751.

4.    Nieman LK. Cushing's syndrome: update on signs, symptoms and biochemical screening. Eur J Endocrinol.2015;173(4):M33-38; PMID: 26156970.

5.    Boza JC, Trindade EN, Peruzzo J, et al. Skin manifestations of obesity: a comparative study. J Eur Acad Dermatol Venereol.2012;26(10):1220-1223; PMID: 21929550.

6.    Wollina U, Pabst F, Schonlebe J, et al. Side-effects of topical androgenic and anabolic substances and steroids. A short review. Acta Dermatovenerol Alp Pannonica Adriat.2007;16(3):117-122; PMID: 17994172.

7.    Evans NA. Gym and tonic: a profile of 100 male steroid users. Br J Sports Med.1997;31(1):54-58; PMID: 9132214.

8.    Cho S, Park ES, Lee DH, et al. Clinical features and risk factors for striae distensae in Korean adolescents. J Eur Acad Dermatol Venereol.2006;20(9):1108-1113; PMID: 16987267.

9.    Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage.2006;52(6):34-36, 38, 40 passim; PMID: 16799182.

10.    Jabbour SA. Cutaneous manifestations of endocrine disorders: a guide for dermatologists. Am J Clin Dermatol.2003;4(5):315-331; PMID: 12688837.

11.    Kobayashi Y, Takei M, Ohkubo Y, et al. A somatotropin-producing pituitary adenoma with an isolated adrenocorticotropin-producing pituitary adenoma in a female patient with acromegaly, subclinical Cushing's disease and a left adrenal tumor. Endocr J.2014;61(6):589-595; PMID: 24705560.

12.    Rawlings AV, Bielfeldt S, Lombard KJ. A review of the effects of moisturizers on the appearance of scars and striae. Int J Cosmet Sci.2012;34(6):519-524; PMID: 22994859.

13.    Kang S. Topical tretinoin therapy for management of early striae. J Am Acad Dermatol.1998;39(2 Pt 3):S90-92; PMID: 9703132.

14.    Kang S, Kim KJ, Griffiths CE, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol.1996;132(5):519-526; PMID: 8624148.

15.    Rangel O, Arias I, Garcia E, et al. Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study. Adv Ther.2001;18(4):181-186; PMID: 11697021.

16.    Ud-Din S, McAnelly SL, Bowring A, et al. A double-blind controlled clinical trial assessing the effect of topical gels on striae distensae (stretch marks): a non-invasive imaging, morphological and immunohistochemical study. Arch Dermatol Res.2013;305(7):603-617; PMID: 23579949.

17.    Ash K, Lord J, Zukowski M, et al. Comparison of topical therapy for striae alba (20% glycolic acid/0.05% tretinoin versus 20% glycolic acid/10% L-ascorbic acid). Dermatol Surg.1998;24(8):849-856; PMID: 9723049.

18.    Mazzarello V, Farace F, Ena P, et al. A superficial texture analysis of 70% glycolic acid topical therapy and striae distensae. Plast Reconstr Surg.2012;129(3):589e-590e; PMID: 22374035.

19.    Obagi ZE, Obagi S, Alaiti S, et al. TCA-based blue peel: a standardized procedure with depth control. Dermatol Surg.1999;25(10):773-780; PMID: 10594578.

20.    de Angelis F, Kolesnikova L, Renato F, et al. Fractional nonablative 1540-nm laser treatment of striae distensae in Fitzpatrick skin types II to IV: clinical and histological results. Aesthet Surg J.2011;31(4):411-419; PMID: 21551432.

21.    Goldman A, Rossato F, Prati C. Stretch marks: treatment using the 1,064-nm Nd:YAG laser. Dermatol Surg.2008;34(5):686-691; discussion 691-682; PMID: 18336578.

22.    Lee SE, Kim JH, Lee SJ, et al. Treatment of striae distensae using an ablative 10,600-nm carbon dioxide fractional laser: a retrospective review of 27 participants. Dermatol Surg.2010;36(11):1683-1690; PMID: 20840494.

23.    Hernandez-Perez E, Colombo-Charrier E, Valencia-Ibiett E. Intense pulsed light in the treatment of striae distensae. Dermatol Surg.2002;28(12):1124-1130; PMID: 12472491.

24.    McDaniel DH, Ash K, Zukowski M. Treatment of stretch marks with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg.1996;22(4):332-337; PMID: 8624657.

25.    Goldberg DJ, Sarradet D, Hussain M. 308-nm Excimer laser treatment of mature hypopigmented striae. Dermatol Surg.2003;29(6):596-598; discussion 598-599; PMID: 12786701.

26.    Manuskiatti W, Boonthaweeyuwat E, Varothai S. Treatment of striae distensae with a TriPollar radiofrequency device: a pilot study. J Dermatolog Treat.2009;20(6):359-364; PMID: 19954393.

27.    Ryu HW, Kim SA, Jung HR, et al. Clinical improvement of striae distensae in Korean patients using a combination of fractionated microneedle radiofrequency and fractional carbon dioxide laser. Dermatol Surg.2013;39(10):1452-1458; PMID: 23895146.

28.    Sadick NS, Magro C, Hoenig A. Prospective clinical and histological study to evaluate the efficacy and safety of a targeted high-intensity narrow band UVB/UVA1 therapy for striae alba. J Cosmet Laser Ther.2007;9(2):79-83; PMID: 17558757.

29.    Hexsel D, Soirefmann M, Porto MD, et al. Superficial dermabrasion versus topical tretinoin on early striae distensae: a randomized, pilot study. Dermatol Surg.2014;40(5):537-544; PMID: 24612027.

30.    Adatto MA, Deprez P. Striae treated by a novel combination treatment--sand abrasion and a patent mixture containing 15% trichloracetic acid followed by 6-24 hrs of a patent cream under plastic occlusion. J Cosmet Dermatol.2003;2(2):61-67; PMID: 17156058.

31.    Park KY, Kim HK, Kim SE, et al. Treatment of striae distensae using needling therapy: a pilot study. Dermatol Surg.2012;38(11):1823-1828; PMID: 22913429.

32.    Chantes A, Antoniou A, Leontaridou I. Clinical improvement of striae distensae in Korean patients using a combination of fractionated microneedle radiofrequency and fractional carbon dioxide laser. Dermatol Surg.2014;40(6):699; PMID: 24852477.

33.    Schwingel AC, Shimura Y, Nataka Y, et al. Exercise and striae distensae in obese women. Med Sci Sports Exerc. 2003;35:33.