Striae (Stretch Marks)

When speaking about skin problems in my blog, I’m afraid I can also draw from my own experiences. Wrinkles, pigmentation spots, rosacea or pimples; I have got to know all of these very well. Fortunately, I now know how to treat these or how to prevent them from getting worse. A skin problem which I haven’t yet encountered is striae. Evidently I belong to the “lucky few” because a high percentage (71% according to a recent study) of women with children suffer from these rotten stretch marks on the tummy, breasts, bottom or upper legs… As I often receive questions for advice on what can be done about these stretch marks, I have done some literature research and I have asked for some scientific advice.

Striae (or stretch marks) are mainly seen in pregnant women and the probability of getting stretch marks is a lot higher if you become pregnant before the age of 30. Men can also suffer from straie, especially if they gain weight quickly. Along with this, intense growth (in teenagers) and excessive muscle growth (in weight trainers) can cause striae. Although we still know little over the exact aetiology or cause of the condition, we do know that factors such as hormones, genes and skin type can all contribute towards those troublesome subcutaneous scars. Striae are also more common in people with darker skin and those who smoke.

In studies into the treatment, a distinction has been made between two types; striae rubra (red striae) and striae alba (white striae). Striae rubra are red and have an irregular appearance. This variation can eventually turn into white pigment free lines and these striae alba are permanent. As you may expect, striae rubra are easier to treat than striae alba.

Treatment: what can be done?
There are numerous creams and oils for sale in shops which could prevent or reduce stretch marks. It is apparent that 78% of pregnant women buy products and apply them in order to stop the appearance of marks. But do these lotions actually work? And are there any other effective treatments?

Creams
As far as I’m concerned the only cream which can help with striae is Vitamin A Acid. A number of scientists agree with me, a major investigation into the effects of various creams and oils on more than 800 people showed no result.
Vitamin A Acid is only available on prescription and is responsible for, among other things, the production of collagen and stimulates the production of elastin: this is capable of not only reducing wrinkles but also striae. Vitamin A Acid has been shown to be especially effective in the treatment of striae rubra, so striae which have recently appeared. A study by Kang showed that after 6 months of applying Vitamin A Acid, the marks became significantly smaller and shorter. Rangel confirmed this with his study. In another investigation it appeared that, after 24 weeks of use, 80% of the treated group saw an improvement in contrast to 8% from the control group. Apart from Vitamin A Acid there is no proof that creams or oils can improve stretch marks or even prevent them; olive oil or cocoa butter, for example, have not been shown to do anything for them… (ref)

Peeling
Studies have shown that a chemical peel treatment with Glycolic Acid or with TCA can improve both striae rubra and striae alba. In order to see results several treatments are necessary.

Laser and light therapy
Studies have also shown that treatment with IPL, ND-YAG laser, Erbium: glass fractional laser, pulsed dye laser and fractional CO2 laser can help. It mainly reduces striae rubra. In my experience striae can indeed become less visible following treatment with a laser but the results are difficult to predict beforehand. Also be aware that several sessions of laser treatment are required which is an expensive option with a limited chance of a good result.

Massage
There is no evidence that massaging the skin has a positive effect on the reduction of stretch marks.

Microdermabrasion
There is also little evidence for the effect of microdermabrasion. Though I have found a recent study (pilot study) whereby, for 16 weeks, a weekly microdermabrasion treatment was compared to the daily application of Vitamin A Acid cream. After 16 weeks the results were similar. But, because the effects of Vitamin A Acid are only seen after 24 weeks, perhaps the conclusion was a little premature. In addition to this a weekly microdermabrasion treatment would be extremely expensive…

Micro-Needling
Does it really work? The only research I could find about micro-needling on striae is a small pilot study. Whereby only 7 out of the 16 subjects had seen a noticeable improvement. I am still not convinced…

To summarise, there are most definitely treatments which can improve stretch marks, but it won’t be easy to get rid of them altogether. There is more chance of success if you catch them early. And as there is no ‘gold standard’, you will have to find out for yourself what actually works for you! I will be interested to hear about your experiences…

Regards Jetske

(Dr. Jetske Ultee – Research Physician Cosmetic Dermatology)