Stretch Marks

Stretch marks are very common and are rarely a sign of a significant medical problem.

Stretch marks (striae distensae) appear as linear streaks on the skin that have been overstretched, and they run perpendicular to maximum lines of tension in the skin.

Stretch marks begin as flat red lines, and they appear as slightly depressed white streaks over time. They tend to occur near the armpits, on the thighs, abdomen, chest, buttocks, and groin, and they are more common in obese individuals and during pregnancy. Their appearance is similar to changes seen on the surface of rubber balloons that have been over-inflated. They are rarely painful.

Stretch marks may also occur as a side effect of certain medications and because of certain diseases.

Stretch marks can be divided into two categories based on how they form and look:

1. Striae rubrae: Stretch marks in their early phases of development are known as striae rubrae. They are linear, vein-like, and slightly elevated crimson lesions. These turn into pale striae after several months or even a year.
2. Striae albae: These are white, wrinkled, and depressed stretch marks and are essentially permanent. These are further categorized into the following four types:
   1. Striae atrophicans: Connected to thin skin and can develop when corticosteroids are used frequently or in combination with other medical diseases, such as Cushing's syndrome
   2. Striae nigra: Dark gray or black and are typically found on people with darker skin tones
   3. Striae caerulea: Dark blue-purple stretch marks that are typically found on people with darker complexions
   4. Striae gravidarum: Develop during pregnancy

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 atrophic scar-like changes.

• Excessive physical stretching of the skin appears to induce these changes.
• Several clinical situations will predispose the skin to the formation of striae, such as:
  • rapid and excessive increase in body mass (weight gain),
  • the excessive use of topical or systemic glucocorticoid drugs (steroids),
  • Cushing's disease (overproduction of glucocorticoids by the adrenal gland),
  • puberty,
  • Marfan syndrome and Ehlers-Danlos syndrome (two uncommon genetic diseases),
  • excessively large breasts or breast implants, and
  • pregnancy.

Excessive rapid weight gain and pregnancy are the two most common risk factors. Other risk factors include the conditions described above that predispose the skin to develop stretch marks.

Striae are rarely painful or itchy. They do not produce troublesome symptoms. They begin as linear red streaks and eventually mature into linear white lines.

Stretch mark varies depending on when they form, the cause, the location, and the type and color of your skin. They may appear as follows

• Slightly depressed, parallel lines or long, thin, rippled streaks on your skin
• With pink, red, black, blue, silver or purple hue
• Bright dark streaks that may fade to a lighter shade over time
• Whitish and scar-like appearance over time
• Several centimeters long and one to 10 mm wide, usually
• Different texture than your normal skin and may look wrinkled
• Stripes covering large parts of your body, especially the tummy, torso, breast, hips, buttocks or thighs
• Slightly raised and can be itchy especially early new marks

Since stretch marks are quite common, most people are familiar with their appearance. They are identifiable on visual inspection by patients and doctors.

Stretch marks are usually considered a cosmetic issue. Rarely, they can be extensive and may tear easily in an accident. Like any scar, stretch marks are permanent and may fade with time. Because stretch marks are caused due to a tear deep inside your skin, there is no absolute cure for it. However, some treatments may make them less noticeable. Some treatments can help you with the itch. There is no single treatment that works for everyone and some treatments don't work at all.

Stretch marks may diminish with the help of certain over-the-counter products or procedures, but will never disappear completely. If you are concerned about the look of the skin, then some treatments may be effective.

• Moisturizers: Hyaluronic acid-based cream is most often prescribed. If applied in the early stage of stretch marks, it may make the stretch marks less noticeable.
• Topical retinoid therapy: Tretinoin (retinoid) or retinol works best for some people. If applied in the early stage every night for 24 weeks, it may make them less noticeable. However, it may be associated with side effects if not used as directed. It should be avoided in pregnancy because it can be harmful.

To help reduce the appearance of stretch marks, a skin doctor (dermatologist) or plastic surgeon may suggest or perform one or more of the following procedures to give you the best results.

• Pulsed dye laser therapy: This is a painless blast of light used to relax blood vessels under your skin that cause stretch marks.
• Fractional CO2 laser therapy: Old white marks may smooth out with this therapy. It may be more effective than topical creams such as glycolic acid and tretinoin.
• Excimer laser therapy: Stretch marks are targeted by a safe ultraviolet-B light. It may take more than one to four months to correct the pigmentation of your stretch marks.
• Microdermabrasion: Tiny crystals or microneedles are used to rub off the upper layer of your skin to help fade new stretch marks. If combined with skin-peeling treatment, it may give better results.
• Chemical peels: Burning of the top layer of your skin with glycolic acid (an acidic solution) may boost new skin growth. This may provide a slight improvement in appearance, but it may not permanently get rid of stretch marks.
• Radiofrequency: Radio wave energy creates heat and triggers your body to produce more collagen. It is found to be safe and can improve the appearance of stretch marks.
• Ultrasound treatment: This works similarly to radiofrequency treatment. In this procedure, sound waves are sent deep into your skin to create heat and tighten and trigger your skin to produce collagen.
• Cosmetic surgery: Surgeries such as a tummy tuck may help to remove the skin with stretch marks. However, the surgery itself could leave a new, painful scar and surgery is expensive.

Popular home remedies for stretch marks include almond oil, cocoa butter, olive oil, or vitamin E. Some anecdotal reports and studies have found them helpful in fading stretch marks. However, in some studies, these have not worked. If you think, massaging with any of these oils is working for you, you can continue them.

Tanning using self-tanners cannot help you get rid of stretch marks. They can just help you camouflage early and mature stretch marks.

As the striae mature, they become less apparent but they rarely disappear. They do not cause any health problems.

Stretch marks can take anywhere between 6 and 12 months after pregnancy to fade. They are permanent marks that can become less noticeable with treatment.

Aside from maintaining a normal weight and avoiding the long-term use of potent topical steroids under occlusion (wrapping and securing the skin after application of steroid preparations) or oral steroid drugs, little can be done to prevent stretch marks from developing.