The Real Deal about Stretch Marks

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Stretch Marks

Stretch marks: what works, what doesn’t, and what’s new?

I’ve developed a new interest in stretch marks (striae) lately, not because I’m having a baby, but several of my close friends are pregnant, I will eventually be pregnant in the next few years, and as doctors we want to be informed about how to prevent and treat stretch marks. We are all in our late 20’s and early 30’s, and the thought that our bodies are going to undergo huge changes is frightening! Being in dermatology I naturally wanted to look at the evidence behind prevention and treatment of stretch marks, and I figured many of you would be interested too. Here is what I found.

What are stretch marks and why do we get them?

Literally, the skin is being STRETCHED, and the dermis (layer of skin in between the top layer epidermis and the fat) is being torn. When you look at samples of striae under the microscope you find thinning of the epidermis, blood vessel changes, and reduced collagen fibers and a decrease in elastic fibers, which usually allow the skin to stretch. We get stretch marks whenever our skin is rapidly stretched such as during growth spurts in adolescence, rapid weight gain, or in pregnancy. In fact up to 90% of women get stretch marks during pregnancy so this affects us all. Things that make you at higher risk for getting stretch marks during pregnancy include maternal weight at baseline, weight gain during pregnancy, increased abdominal and hip girth, vitamin C level, as well as increased gestational age at delivery, birthweight, and head circumference of the baby. You also see stretch marks in patients who take steroids chronically, because steroids reduce the skin’s ability to stretch and make elastic fibers.

There are two types of stretch marks. When they first appear, stretch marks (striae rubra) are pink to purple, asymptomatic or slightly itchy, and puffy. Over years, these turn into white wrinkled thinned older stretch marks (striae albae). The distinction is more important in terms of treatment below.

Prevention

Topicals:

A review paper looked at 11 studies and evaluated the level of evidence supporting various therapies for prevention of stretch marks. Topical therapies claim to work by increasing collagen synthesis, decrease inflammation, and increase elasticity and rehydration of the skin. They found that Trofolastin and Alphastria (hyaluronic acid, vitamin A and E) creams may have some benefit, retinoids have varying effects depending on which study is examined (category C drug, NOT for use during pregnancy and lactation), and cocoa butter and olive oil have no effects. Another paper reviewing other studies found limited evidence for centella (a medicinal herb) and massage with almond oil, weak evidence for hyaluronic acid, and again, no evidence for cocoa butter and olive oil.

Diet and exercise

Since increased weight gain and abdominal girth may be associated with stretch mark development, some doctors believe that eating a healthy diet and engaging in regular exercise can be helpful. There is sadly no published evidence showing that lifestyle modifications have clinically significant outcomes for stretch marks, but I personally believe that a healthy diet and exercise is useful anyways for people regardless of pregnancy status, so I would keep this in mind if I were to become pregnant in the future.

Treatment

Treatments include microdermabrasion, microneedling therapy, platelet rich plasma therapy, intense pulsed light therapy, and, last but not least, laser therapy. Laser therapies have become more popular for treatment of stretch marks recently due to their ability to normalize the color and even the architecture of the treated skin. Pulse dye laser is a popular laser we often use in dermatology to treat vascular lesions such as port wine stains or cherry angiomas, and they can be used for striae rubra which are, as the name implies, red. One of our attendings Dr. Geronemus (my visit to his laser clinic here), in conjunction with Dr. Hale (her beauty expert picks here), published an article looking at fractional photothermolysis on striae, and found it to be effective especially in striae rubra. Striae albae, which are white stretch marks, remain challenging to treat. One paper concluded that nanofractional radiofrequency therapy is effective for striae alba, and other review papers suggest that radiofrequency in combination with other treatment modalities such as microneedling or platelet rich plasma therapy can be useful. In the end, it is somewhat difficult to compare the efficacy of all the lasers because each paper uses different protocols, laser settings, and number of treatments. If you are interested a great review paper looking at ALL the evidence out there using lasers for stretch marks can be found here.

What do I think?

Sadly there is a lack of great scientific data out there regarding both prevention and treatment of stretch marks, though I will say I was impressed by the recent increase in laser studies on striae rubra and striae albae. In terms of prevention, I would advise my pregnant friends to consider lifestyle modifications to maintain a healthy weight with diet and exercise (good for anyone’s health IN GENERAL, so why not) and to consider frequent emollient use. If stretch marks develop, I would advise treatment while the marks are still red (striae rubra) since these are much more amenable to therapy with lasers. If the stretch marks are white and atrophic (striae albae), I would still see a dermatologist to consider fractional laser treatment or radiofrequency therapy in conjunction with other modalities if your dermatologist offers it. As time goes on, I’m sure that we will have more and more data that will help us make our therapeutic decisions!

As usual, my caveat here is that while scientific evidence is lacking, if you have found something that works really well for YOU personally, then keep using it as long as it does not cause your body harm.

I hope this was a useful blogpost for you; feel free to leave questions and comments below! What has been useful for you, in your experience?

Sources

Aldahan AS et al. Laser and Light Treatments for Striae Distensae: A Comprehensive Revies of the Literature.Am J Clin Dermatol. 2016 Jun;17(3):239-56.

Korgavkar K, Wang F. Stretch marks during pregnancy: a review of topical prevention. Br J Dermatol. 2015 Mar;172(3):606-15. Epub 2015 Feb 8.

Pongsrihadulchai N, et al. An efficacy and safety of nanofractional radiofrequency for the treatment of striae alba. J Cosmet Dermatol. 2016 Oct 21. [Epub ahead of print]

Stotland M, et al. The safety and efficacy of fractional photothermolysis for the correction of striae distensaeJ Drugs Dermatol. 2008 Sep;7(9):857-61.

Ud-din S, McGeorge D, Bayat A. Topical management of striae distensae (stretch marks): prevention and therapy of striae rubra and albae. J Eur Acad Dermatol Venereol. 2016 Feb; 30(2): 211–222.

 

 

8 Comments on The Real Deal about Stretch Marks

  1. Ana
    January 23, 2017 at 1:44 pm (4 months ago)

    I recently found your blog/instagram and really love what you’re doing (especially as I’m starting med school in a few months and you are totally inspiring). Also, thank you thank you thank you for posting your sources and going straight to the literature. I have seen so many websites/podcasts/pamphlets about all this information (healthy living, macronutrients, ‘natural’ ingredients, etc.) and people rarely state their sources or even the details of the studies. So it’s awesome to just hear conclusions straight from the studies. You da best.

    Reply
    • Joyce
      January 23, 2017 at 4:56 pm (4 months ago)

      Thank you so much for your comment! Glad others appreciate hearing what’s out there published in the peer-reviewed scientific literature. Good luck in your medical school journey!

      Reply
  2. Marie
    January 23, 2017 at 8:58 pm (4 months ago)

    Thank you so much for posting! As a girl, the topic of stretch marks has always been ever present in my life. It’s refreshing to get recent knowledge concerning it, especially from a trusted Dermatologist :) I’ll also be starting med school in a few months! Love your blog & Instagram. Keep it up <3

    Reply
    • Joyce
      January 23, 2017 at 9:14 pm (4 months ago)

      Thank you Marie! So glad that you enjoyed this post. Good luck in medical school; it’s a challenging but rewarding time!

      Reply
  3. Natalie @ Obsessive Cooking Disorder
    February 15, 2017 at 12:07 am (3 months ago)

    Ah stretch marks. Luckily not planning on having a baby quite yet but it’s the bane of my mom’s belly (and she was tiny!). Thanks for the scientific refs – gotta love journals 😀 I’m working on a hematology review so seeing pubmed makes my head spin right now
    — Natalie

    Reply
    • Joyce
      February 15, 2017 at 9:33 am (3 months ago)

      Hey Natalie! I have a theory that smaller people may get more stretch marks (if their baby is normal sized) since their skin has to stretch MORE in order to accommodate their growing child. We shall see! Thanks for your comment about the pubmed refs; it definitely takes more time to write these evidence based articles but I think it’s important that I lay out the peer-reviewed details!

      Reply
  4. Faith
    February 27, 2017 at 3:20 pm (3 months ago)

    Hi Joy, one question. I’ve had patches of stretch marks near my hips on my thighs since I was in elementary school (I am in undergrad now). Is there any reason why they haven’t gone away by now?

    Reply
    • Joyce
      March 1, 2017 at 10:54 pm (3 months ago)

      Hi Faith, stretch marks are hard to get rid of and they unfortunately don’t go away with time because the skin has been damaged. You can try some of the treatments mentioned above in the article to see if they work!

      Reply

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