Published on May 13, 2022.

A consultant physician and dermatologist at the Edo State University, Uzairue and Edo Specialist Hospital, Benin City, Dr Aisha Sokunbi, tells ALEXANDER OKERE the causes, prevention and management of stretch marks

How would you define stretch marks?

Stretch marks, medically known as striae distensae, refer to the appearance of fine linear scar lines that often appear red, brown or whitish and, in some cases, purplish, usually in areas of marked skin stretching on the body. These lines arise from damages in the dermis, the middle portion of the skin, resulting in scarring of the dermis.

What are the causes?

There are several types of stretch marks, often related to the underlying cause. Overall, stretch marks occur due to rapid stretching of the skin which causes damage to the supporting framework and tissues of the skin in the dermal layer such as elastin and collagen. The commonest type, which is the striae distensae, is seen in puberty due to the rapid growth occurring in that phase of life with associated fat deposition in different parts of the body. In females, this is common around the breast, hip and buttocks, while in males, it can be seen around the pelvic area and on the shoulder in bodybuilders. There is striae gravidarum, which is due to rapid stretching of the skin of the abdomen and breast in pregnancy.

Stretch marks are also commonly seen in overweight or obese individuals and in people who abuse steroids – whether by oral intake or in creams – most commonly in skin lightening (bleaching) creams. Stretch marks can be caused by drugs that cause fluid retention, weight gain and stretching of the skin, most notably steroid medications – whether oral, injections or topical. Hormonal contraceptive pills and injections may also cause stretch marks.

Prolonged steroid use can lead to a condition known as Cushing’s syndrome, which also leads to a rise in the level of the hormone, cortisol, often associated with stretch marks. In this type, these stretch marks appear as large purplish bands or lines in areas of a rapid stretch, although it can occur all over the body even on the face. This type may rarely be associated with tears and bleeding from affected sites due to marked damage to the skin. Some studies have linked stretch marks to an underlying genetic predisposition.

What is collagen and what role does it play regarding stretch marks?

Collagen is a protein found in abundance in the dermis of the skin which serves to provide structural support for the skin framework. It forms a network of cells called fibroblast which is responsible for the regeneration of new cells in the skin and cell regrowth, replacing damaged cells of the skin. Stretch marks arise from the damage of these collagen fibres in the skin as a result of the rapid stretching of the skin over a short period.

What are the other risk factors?

The other risk factors for stretch marks also include the use of anabolic steroids by athletes, the female gender because of their body make-up, which causes the rapid deposition of fat in certain parts of the body during puberty; and pregnancy. Due to the paid stretch of the skin of the abdomen and breasts as the baby grows within, the breast ducts enlarge in preparation for breastfeeding. Others include having a family history of stretch marks, rapid growth during puberty, gaining and losing weight rapidly, which causes overstretching and breakage of the collagen support network of the skin; obesity, which leads to rapid and excessive fat storage underneath the skin, leading to rapid stretching of the skin; surgical procedures such as breast and butt enlargements that cause localised stretching of the skin in the affected areas, genetic conditions like Marfan’s syndrome and Ehlers-Danlos syndrome.

How does pregnancy cause stretch marks?

In pregnancy, due to the rapid stretch of the skin as the foetus grows within and the rapid weight gain which is experienced by mothers, there is a breakdown of collagen fibres in the skin leading to the appearance of stretch marks. Also, pregnancy hormones can lead to fluid attraction into the skin that causes relaxation and loosening of the bond between the collagen fibres resulting in stretch marks.

How can stretch marks be identified?

Stretch marks are easily identified by their common clinical manifestation on the skin. It appears commonly as fine linear lines or bands on the skin. They are reddish, brown or white in areas of rapid skin growth like the trunk, lower back, hips, breasts, thighs and shoulders and are often not cosmetically appealing. Those arising from the use of steroids and skin bleaching agents are usually larger, purple coloured and can occur anywhere on the body. The skin of the affected areas often feels thin and weakened.

Other conditions, like linear elastosis, can present with similar appearances on the body; however, they appear yellowish and the affected skin feels taut rather than thin.

What are the social and psychological challenges that come with stretch marks?

Stretch marks often do not cause any medical challenge but they are often a cause for concern because of the unsightly nature of the lines on the skin and lack of cosmetic appeal. Another problem is that they are difficult to treat.

This can cause problems with self-esteem, especially among adolescents; and psychologically, it can be damaging, especially in the setting of body shaming in this fashion-savvy generation. Many persons with stretch marks, especially females who are more conscious of their appearance, often have low self-esteem issues.

What forms of medical treatment can a person with stretch marks undergo?

Medical treatments include the use of topical and oral retinoids which must be done under a doctor’s supervision because of the risk of teratogenicity in females as well as liver damage and increase in blood cholesterol and lipids. Other methods include micro-needling of the skin, use of glycolic acids, laser therapy and dermabrasion of the skin.

Are there home remedies for the treatment of stretch marks?

It should be known that stretch marks often will fade off on their own without treatment, especially in the early stages. There are methods that have been tried in the treatment of stretch marks. Although best results are obtained when stretch marks are treated in their early stages when the lines still appear red or brownish. Results are often not satisfactory when treated in the late stages, especially when the colour begins to tend towards being white (striae alba). Few available home remedies include the use of retinol containing creams, pharmaceutical products, vitamin C, and fruit acids, plus a diet rich in proteins, vitamins A, C, E and D.

Are there other forms of treatments available to people with stretch marks?

Other forms of treatment that should be done under the supervision of a dermatologist are the application of tretinoin products on the skin. The use of retinoids, like adapalene, must strictly be by doctor’s prescription and monitoring because of its adverse side effects. There are no well-known effective therapies for stretch marks. On their own, they may fade off gradually over time.

Based on the causes you outlined, are stretch marks preventable?

Although they may not be completely avoidable because they can arise from normal body physiologic changes, they may be preventable in certain cases. They can be prevented by avoiding the use of steroids, whether oral drug, injectables or abuse of bleaching creams which often contain high potency steroids. Also, weight gain and weight loss should be approached gradually to allow enough time for the skin and its supporting structures to adjust to the ongoing changes in the body and the skin particularly. It is advisable to avoid cosmetic enhancement procedures, especially for people who already have background risks like familiar predisposition.

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