What's in this article?
- 1 What are stretch marks?
- 2 Where stretch marks occur?
- 3 Stretch marks often occur
- 4 Is Prevention Possible?
- 5 Who Is at Risk for Developing stretch marks?
- 6 What causes stretch marks?
- 7 Symptoms of stretch marks
- 8 Treatment and prevention of stretch marks
What are stretch marks?
Stretch marks are also called striae distensae, SD, striae, striae atrophicans and striae gravidarum. They are dermal scars or disfiguring lesions characterized by flattening and atrophy (wasting or degeneration) of the epidermis (the outermost layer of the skin).
Stretch marks are linear, smooth bands on the skin that, depending on skin color, can appear as red or purple and which fade over time to leave silvery pale marks.
Occurring in 40-90% of women, stretch marks appear following rapid repeated over-stretching of the skin over weak connective tissue. The most common areas affected are the:
Skin changes are common in pregnancy with stretch marks occurring in over 70% of pregnant women, usually after 25 weeks of gestation.
Stretch marks are not medically dangerous, but can be a cause of aesthetic concern and anxiety. For some people, stretch marks are such a significant cosmetic concern that they affect quality of life. They can be disfiguring, causing emotional and psychological distress, especially during puberty, the latter stages of pregnancy (when they are most prominent), in the postnatal period where they appear pale, or after significant weight loss.
This type of dermatological scarring is particularly challenging and tends to occur with:
- Rapid weight gain
- Numerous medical conditions
- Certain therapeutic interventions
Where stretch marks occur?
Stretch marks can occur anywhere where the skin has been stretched, but they usually affect areas where fat is stored, such as the:
- tummy (abdomen)
- upper arms
- shoulders (in bodybuilders)
Sometimes, particularly in teenage boys, stretch marks can develop on the back, overlying the spine horizontally (like the rungs on a ladder).
Stretch marks often occur
- during pregnancy
- after rapid weight gain
- during puberty
- if you have a family history of stretch marks
- if you have an underlying health condition or a syndrome, such as Cushing’s syndrome or Marfan syndrome
- after the prolonged or inappropriate use of corticosteroid medication
Is Prevention Possible?
Unfortunately, there’s no way to prevent stretch marks. There’s not a cream, lotion, or “mommy” balm that can do that and if that’s the claim on the bottle, don’t be fooled.
It’s always a good idea to keep your skin hydrated with a rich lotion or cream, especially if it makes your skin feel better, look smoother and more toned, and helps the itchiness that can come with your growing belly.
It also helps to keep your body hydrated with water, says Anne Chapas, MD, a clinical instructor of dermatology at Mount Sinai Medical Center.
Who Is at Risk for Developing stretch marks?
The following put you at greater risk for developing stretch marks:
- being a woman
- being Caucasian (having pale skin)
- having a family history of stretch marks
- being pregnant
- having a history of delivering large babies or twins
- being overweight
- having dramatic weight loss or gain
- using corticosteroid medications
What causes stretch marks?
There is some controversy over the precise mechanism by which striae occur. There seems to be damage to the elastic fibers of the dermis (the deeper layer of the skin) accompanied by inflammation which eventually results in scar-like changes. These changes appear to be induced by excessive physical stretching of the skin. There are a number of clinical situations which will predispose the skin to the formation of striae. These include rapid and excessive increase in body mass, the excessive use of topical or systemic glucocorticoid drugs (steroids), Cushing’s disease (overproduction of glucocorticoids by the adrenal gland), puberty, Marfan’s syndrome and Ehlers-Danlos syndrome (two uncommon genetic diseases), excessively large breast implants, and pregnancy.
Symptoms of stretch marks
Stretch marks don’t all look alike. They vary depending on how long you’ve had them, what caused them, where they are on your body, and the type of skin you have. Common variations include:
- Indented streaks or lines in the skin
- Pink, red, black, blue or purple streaks
- Bright streaks that fade to a lighter color
- Streaks on the abdomen, breasts, hips, buttocks or thighs
- Streaks covering large areas of the body
Treatment and prevention of stretch marks
Creams, gels, lotions, laser and cosmetic surgery have all been proposed as treatments for stretch marks, although there is little medical evidence to support the efficacy of such treatments. Current treatments are particularly limited in their ability to deliver long-lasting improvements for all skin types.
Often stretch marks fade over time and become unnoticeable. For people who developed stretch marks in pregnancy, these are usually less noticeable 6-12 months after giving birth. Cosmetic camouflage (makeup) can be used to temporarily conceal marks.
Advances in laser technologies and ongoing research mean that the future looks bright for developing effective treatments for stretch marks.
Creams, oils, topical preparations
Several studies have found little or no statistically significant difference in the development of stretch marks when comparing topical preparations (something applied to the surface of the body) that include active ingredients with a placebo (preparations without active ingredients) or with no treatment.
There is no high-quality evidence to support the use of topical preparations in the prevention of stretch marks during pregnancy.
Creams and oils do, however, help with skin dryness and may reduce itching.
Six studies involving 800 participants found no statistically significant average differences in the development of stretch marks with the use of preparations such as Alphastria, Trofolastin, Verum, olive oil and cocoa butter, all of which contain vitamin E (Alphastria and Verum also contain hyaluronic acid).
One study evaluated the use of an anti-stretch mark cream containing hydroxyprolisilane-C, rosehip oil, Centella asiatica triterpenes and vitamin E, which proved to be effective in reducing the severity of the stretch marks during pregnancy, preventing the appearance of new stretch marks and halting progression of those already present. In women with no stretch marks, use of the anti-stretch mark cream was more effective than placebo in preventing new stretch marks.
In studies of 300 and 175 women, application of a lotion containing cocoa butter did not appear to reduce the likelihood of developing stretch marks during pregnancy.
Bitter almond oil
A study aiming to identify the effect of applying bitter almond oil with and without massage for preventing stretch marks during pregnancy found that a 15-minute massage applied with almond oil during pregnancy reduced the development of stretch marks.
Applying bitter almond oil without massage had no apparent effect, however, leading the authors of this study to conclude that those who are pregnant should be informed of the positive effects of massaging with applied almond oil early in pregnancy.
Studies looking at the effects of olive oil on stretch marks occurring in the second trimester of pregnancy found the treatment ineffective in reducing the occurrence or severity of stretch marks.
Another study comparing 50 women applying topical olive oil twice a day with a control group applying none, showed that although olive oil reduced the frequency with which severe stretch marks developed, it did not significantly reduce the overall incidence and severity of stretch marks and could not be recommended for stretch mark prevention.
Tretinoin cream (retinoic acid)
Products containing retinoic acid are teratogenic (can result in congenital defects) and should not be used by anyone who is pregnant or breastfeeding.
Tretinoin is extensively used in the treatment of acne (as Retin-A) and in the treatment of stretch marks.
Studies indicate that the topical application of tretinoin significantly improves the clinical appearance of early stretch marks, although the process responsible for the clinical improvement is unknown.
In one study, tretinoin reduced the length of the stretch marks by 14% and the width by 8% after six months of treatment. In another study, 12-weeks of treatment decreased the length of stretch marks by 20%.
Note that products containing retinoic acid should not be used if pregnant or nursing.
Tretinoin helps to rebuild collagen, which makes stretch marks look more like “normal” skin.
A study of 20 volunteers who massaged silicone and placebo gels into separate sides of the abdomen daily for 6 weeks showed that the application of silicone gel increased collagen levels and reduced pigmentation compared with a placebo. These findings could provide preliminary evidence of the use of topical gels in the clinical management of stretch marks.
Microdermabrasion is a popular technique used in the treatment of several skin problems, including acne, acne scarring, stretch marks, and photoaging. The procedure appears to result in an improvement in skin contour irregularities with significant improvement in early stretch marks.
This treatment involves a device that blows crystals onto the skin, “polishing” the skin’s surface while a vacuum tube removes both the crystals and skin cells. The top layer of the skin is gently removed, stimulating growth of new elastic skin.
Side effects are less frequent with microdermabrasion and patients are more likely to stick with (adhere to) the treatment compared with topical tretinoin.
The use of lasers to diminish the appearance of stretch marks or in combination with other treatments can provide safe and effective reduction in the appearance of both red (early-onset) and white (late-stage) stretch marks. Many laser therapies require special measures for darker skin types as altered pigmentation can be more challenging in dark skin.
A doctor can give advice as to which form of laser treatment would be suitable. Laser therapies work by using wavelengths of light to stimulate growth of collagen, elastin or melanin production in the skin.
For early stretch marks, pulsed dye lasers have been shown to be effective, as has fractional laser treatment for older stretch marks.
Clinical improvements to stretch marks have been obtained with the following devices in studies by potentially stimulating new collagen and elastic fiber synthesis:
- 1,064-nm Nd:YAG laser
- 1540-nm fractional nonablative laser
- 1550-nm fractional nonablative laser
- Fractional CO2 laser
- Fractional photothermolysis
- Pulsed dye laser
- Copper bromide laser.