Stretch marks, or striae distensae, are scar tissue in the skin's dermal layer that result from rapid growth or weight gain. These lesions, which can be found crisscrossing the breasts, abdomen, hips, thighs, buttocks, and arms, occur in females and males, particularly as a result of adolescent growth spurts, pregnancy, obesity, rapid muscle growth (from weight lifting, for example), and prolonged use of topical steroids.
In these instances or periods of growth, collagen and elastin are not produced fast enough to accommodate the expansion of other cutaneous layers, rendering the normally elastic dermis less flexible and manifesting in visible epidermal marks.
Initially, these dermal alterations present as pink, red, or purple lesions, known as striae rubra. If the lesions are untreated, they become white (striae alba) and the texture of the lesion may change from swollen to flattened or moderately depressed. A high proportion of teenage girls and pregnant women are beset with striae distensae.
Dermatologists now have a number of options to tackle this cosmetically stressful condition, including novel laser treatments for striae alba, but the primary focus here is on topical and cosmeceutical options.
Prevention
There is no surefire method to prevent stretch marks per se, but avoidance of a rapid gain or loss of weight improves one's chances of not developing these lesions.
Several topical agents have demonstrated efficacy in high-risk patients. For individuals who are pregnant or experiencing adolescent hormonal changes, moisturizing three or four times daily is recommended. Skin becomes more pliant and elastic when it is well hydrated. Moisturizers that contain cocoa butter, shea butter, or Centella asiatica (also known as gotu kola) as a prime ingredient are the best. To increase their efficacy, massage such formulations deeply into the affected areas. I recommend Belli Elasticity Belly Oil, which contains healthy amounts of both cocoa butter and C. asiatica, to my patients.
Treatment
Identifying striae distensae early is crucial. Patients should be advised to seek treatment when stretch marks are still red or purple because the lesions are most likely to respond to at-home products and in-office peels at this stage. Once stretch marks are white, treatment becomes more difficult and less successful.
Striae rubra may respond to the glycolic acid in various over-the-counter (OTC) lotions, most likely through the alpha-hydroxy acid's capacity to stimulate collagen synthesis. I recommend brands with the highest concentration of glycolic acid, such as MD Forté Glycare I and NeoStrata Ultra Smoothing Lotion.
Topical vitamin C, if formulated properly, also has the capacity to promote collagen synthesis. It can be used individually or in combination with glycolic acid. I recommend SkinCeuticals C E Ferulic and La Roche-Posay Active C. Supplementation with oral vitamin C 500 mg twice daily may also confer some benefit.
Relastin, marketed as an eye cream and a face cream, is touted by its manufacturer for its ability to increase elastic tissue, which may ameliorate stretch marks. Its efficacy is unconfirmed at this point.
Retinoids
In an early study of retinoids for the treatment of striae distensae, 16 of 20 patients with stretch marks from various causes completed the study, 15 of whom exhibited significant clinical improvement (J. Dermatol. Surg. Oncol. 1990;16:267–70).
Retinoids promote the production of collagen and elastin. When retinoids are massaged nightly into striae rubra, the appearance and texture of the lesions can improve significantly. In fact, the use of 0.1% tretinoin for the treatment of striae rubra has been established as effective for more than a decade (Dermatol. Surg. 1998;24:849–56). Retinoids are not as effective for the treatment of striae alba, however, and are contraindicated in pregnant and breastfeeding women.
In a study evaluating commercial topical products for the treatment of striae alba, investigators tested two regimens on 10 patients who had abdominal striae alba with skin types ranging from I to V. Patients applied 20% glycolic acid (MD Forté) to the whole treatment area on a daily basis for 12 weeks. Patients also were directed to apply 0.05% tretinoin emollient cream (Renova) to half of the treatment area, and 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine cream to the other half.
Improvement in the appearance of stretch marks, assessed at 4 and 12 weeks, was documented for both regimens. In addition, a comparison of treated striae alba with untreated lesions revealed that both regimens were effective in decreasing papillary dermal thickness and increasing epidermal thickness (Dermatol. Surg. 1998;24:849–56).
In another study evaluating the effects of a retinoid, 20 women applied tretinoin cream 0.1% to abdominal striae induced by pregnancy. In this open-label, multicenter, prospective study, researchers observed marked improvement in all striae after 3 months, compared with baseline, with an average 20% reduction in the length of the target lesion. Despite the emergence in 11 patients of erythema and scaling, topically applied tretinoin significantly ameliorated pregnancy-induced striae distensae (Adv. Ther. 2001;18:181–6).