Introduction
Many people will be distressed to find that they have stretch marks. Stretch marks are purple or flesh coloured streaks of skin that feel less firm, like tissue, and sit between normal areas of skin.
What are Stretch marks?
Stretch marks come from a breakdown in some of the ‘glue’ structures in the skin that make skin firm. The dermis is the layer of the skin that has elastin and collagen; these help pull the skin together and make it tight.
Sometimes, the elastin and collagen will snap or be broken in one area and will stop holding the skin tight and firm. This results in an area of skin that is less elastic, less firm and less deformable. Light scatters differently in this area and so the stretch marks appear a different colour (red or pale) and less elastic. They are harmless but unsightly. They are most often found on the abdomen, breast, thighs or arms.
What causes stretch marks?
Stretch marks are generally caused by conditions that stretch the skin or by some hormone related diseases.
Conditions where the skin stretches:
- Pregnancy: 50-90% of women develop stretch marks during pregnancy. This is because there is rapid expansion of the contents under the skin that overloads the ability of the collagen and elastin to stretch. Hormonal influences play a role as well.
- Bodybuilding: Body builders often have rapid growth of muscle which results in stretch marks
- Rapid weight gain: e.g. obesity, puberty, growth spurts
- Breast Augmentation
Endocrine or Hormonal conditions
- Corticosteroids are known to cause stretch marks if used too long on one area of skin.
- Cushing’s disease is another cause of stretch marks. The body makes its own corticosteroid in the adrenal gland. When the body has too much corticosteroid either from using the drug form or from a disorder or production internally, a patient can develop stretch marks. There are usually other signs including weight gain, buffalo hump and hair loss to name a few.
Stretch marks often start red (striae rubrum) due to more blood vessels in the area and then mature to white as the long term version. It is generally held that it is easier to treat stretch marks when they are still in the red phase rather than the white phase.
How are stretch marks diagnosed?
Stretch marks are easy to diagnose simply by looking at them and no tests are necessary
Can stretch marks be prevented?
As yet, there is no persuasive evidence that stretch marks can be entirely prevented. A randomised controlled clinical trial showed some benefit to using a moisturiser on the pregnant abdomen to lessen the severity of stretch marks in women at risk. It is unclear whether additional ingredients other than moisturisers provide any benefit.
Many women are at risk of stretch marks due to younger age when falling pregnant, family history etc. however the only risk factor which can be modified is weight. It is recommended to maintain a healthy body weight and regular use of moisturisers are, in general, a good habit to prevent the effects of ageing on the skin.
Can stretch marks be treated?
There is no guaranteed cure for stretch marks but treatments are effective at minimising the cosmetic effect. At present, there is a lack of clear data on which treatment gets the best results but often a combination of treatments are used tailored for an individual’s needs.
Most treatments for stretch marks target an increase in collagen, minimisation of pigment differences and if need be, fillers to mask a deficit in skin volume created by the furrow of the stretch mark.
The principles of treatment are to:
- Add Volume: Restore collagen and elastin, or use filler injections
- Hide the colour; deal with any pigment in the stretch mark
- Fix the skin texture: Resurface using laser or microneedling to give a smooth appearance to the skin
Options include:
- Tretinoin 0.05%
Tretinoin is a retinol (Vitamin A derived drug) that promotes collagen growth, regulates keratinocytes and decreases skin roughness. It is used widely to ‘precondition’ skin before a chemical peel as it thickens the epidermis and stabilises various skin components. Studies have shown improvements to stretch marks by using tretinoin but not better than other treatments.
- Microdermabrasion
Microdermabrasion is an exfoliative technique to remove epidermal layer tissue. Studies have shown that microdermabrasion is as effective as tretinoin however further studies also show that microdermabrasion combined with Platelet Rich Plasma have superior results still.
- Platelet Rich Plasma
PRP is a proliferative treatment that aims to provide growth factors obtained from a concentration of a patient’s own platelets suspended in plasma (fluid component of blood). It is used widely in a range of clinical settings (see article on hair loss). It has been evaluated in stretch marks and was found to be superior to tretinoin however another study has shown that the combination of microdermabrasion with PRP is superior to either alone.
- Microneedling
Microneedling is also called percutaneous collagen induction therapy and involves tiny needles being inserted to the papillary dermis to stimulate collagen and elastin growth. A study of 40 participants showed better results from microneedling but the addition of PRP to this has not been studied. Endymed involves microneedling
- Laser
Lasers and light therapy work by targeting a tissue in the skin to heat up and then cool down and thus stimulate its destruction and repair. This is called ‘targeted thermolysis’. Light will be absorbed by different ‘targets’ based on its shape, size and composition thus making the use of targeted light therapy possible.
Lasers have been used for stretch marks
- Filler
Filler is the use of hyaluronic acid in an injection to parts of the body to add volume. It is typically used in the face to add lift in the temples and cheeks however it has been used in stretch marks. Its main role is to fill out skin defects
Summary
A combination of treatments are usually used to deal with stretch marks. Deep microneedling can be used to stimulate new tissue with a subsequent resurfacing effect. Filler should be used if there is a defect in tissue volume; finally tretinoin or laser can be used to obtain a good skin texture and even pigment.
