Stretch marks are very common, asymptomatic, skin condition seen frequently in people beyond 12 years of age. Stretch marks generally develop in various physiological states such as pregnancy, growth spurt during puberty or rapid change in proportion of specific body region like in weight lifters, obesity or weight loss. They are usually seen on thighs, buttocks and breasts in girls where as in boys they often develop over lumbosacral region and outer aspect of the thighs. They may also involve areas like shoulders, upper arm, abdomens, neck and underarms.
Stretch marks are visible as linear scars which form in areas of dermal damage as a result of excessive stretching of the skin. They can be few millimetres to centimetre in width and measure several centimetres in length. Early lesions are smooth, raised, irritable, and erythematous to bluish in colour and are known as striae rubra. As the lesion ages it flattens, becomes pale, irregular and with finely wrinkled surface known as striae alba, which is usually permanent.
Stretch marks of pregnancy are also known as striae gravidarum, are commonly seen over abdomen followed by breast and thighs in the third trimester. They are more common in young primigravida and associated with higher weight gain in pregnancy and with large for gestational age babies
Topical corticosteroid abuse can also cause stretch marks when they are applied under occlusion over thinner skin of groin and underarms.
Stretch marks often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for treatment of stretch marks.
For stretch marks, the mantra ‘prevention is better than cure’ fits perfectly. Stretch marks can be best avoided by preventing rapid weight gain and weight loss and avoiding topical steroid abuse. During pregnancy, it’s a good choice to start using moisturizers with shea butter, cocoa butter from fourth month onwards as it prevents development of stretch marks. Also, one must avoid scratching the tummy, especially, towards the last months of pregnancy as it worsens stretch marks and avoid unhealthy weight gain. However, in the event that stretch marks develop, its best to treat them while they are still new and red because that’s the time when they are the most amenable to treatment.
Topical treatment- Tretinoin and retinoic acid creams have been used for years with variable success in patients with early stretch marks. However, they should be strictly avoided in pregnancy. They act by stimulation of fibroblasts leading to increased tissue collagen levels. Hyaluronic acid is also found to be effective in stretch as it increases collagen production.
In the recent years there has been a dramatic increase in minimally invasive nonsurgical skin rejuvenation procedures and technologies for stretch marks that offer minimal downtime and good results. The basic principle used by all procedures is induction of inflammation in dermis which results in stimulation of neocollagenesis by recruitment of fibroblasts. All these changes leads to modification of existing collagen structure along with production of newer collagen thereby improving the appearance of stretch marks. However, all the procedures need 3-6 sittings to achieve desired results.
- Lasers- Fractional CO2 lasers, Er:YAG and Er:glass lasers provide good results in stretch marks. They act by creating microtheraml zones which bring about collagen remodeling and new collagen formation. One can expect around 60-80% improvement over 3-6 sittings, usually done at 4-6 weeks intervals.
- Microneedling- Microneedling also helps in production of new collagen and improves the appearance of stretch marks.
- Microneedling RF- This technique delivers high energy to dermis and subcutaneous tissue which leads to stimulation of fibroblasts and new collagen
- PRP therapy- Full of growth factors for promotion of collagen formation, PRP when used in conjunction with microneedling and laser therapies greatly improves the results of these procedures.
- Chemical peels- for very superficial stretch marks chemical peel can be tried. The most commonly used agents are trichloroacetic acid, retinoic acid, glycolic acid.
These days the above mentioned procedures are being done fairly commonly with good success rates and minimal side effects. So, in case you long to wear your favourite dress without worrying about how to conceal your stretch marks, book an appointment with us today!
The author is a dermatologist practicing in tricity (Chandigarh, Mohali and Panchkula). For any queries related to this article or any other skin problem, please drop in a message in the comment section below.