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Stretch marks

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"Stria" redirects here. For inner ear structure, seeStria vascularis of cochlear duct.For brain structure, seeStria terminalis.

Stretch marks
Other namesstria, striae distensae
multiple recent (reddish) and a few older (white) stretch marks
SpecialtyDermatology

Stretch marks,also known asstriae(/ˈstraɪiː/)[citation needed]orstriae distensae,[1]are a form ofscarringon theskinwith an off-color hue. Over time, they may diminish, but will not disappear completely. Striae are caused by tearing of thedermisduring periods of rapid growth of the body, such as duringpubertyorpregnancy,in which they usually form during thelast trimester.Usually on the belly, these striae also commonly occur on the breasts, thighs, hips, lower back, and buttocks. Pregnancy-related striae are known asstriae gravidarum.[2]Striae may also be influenced by thehormonalchanges associated with puberty, pregnancy,bodybuilding,orhormone replacement therapy.There is no evidence that creams used during pregnancy prevent stretch marks.[3]Once they have formed, there is no clearly effective treatment, though various methods have been attempted and studied.[4]

Signs and symptoms

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Striae, or "stretch marks", begin as reddish or purplelesionswhich can appear anywhere on the body, but are most likely to appear in places where larger amounts of fat are stored. The most common places are theabdomen(especially near thenavel), breasts, upper arms, underarms, back, thighs (both inner and outer), hips, and buttocks. Over time, they tend toatrophyand losepigmentation.The affected areas appear empty, and are soft to the touch.[5]

Stretch marks occur in thedermis,the resilient middle tissue layer that helps theskinretain its shape. No stretch marks will form as long as there is support within the dermis; stretching plays a role in where the marks occur and in what direction they run.

They can (but do not always) cause a burning and itching sensation, as well as emotional distress. They pose no inherent health risk on their own, and do not compromise the body's ability to function normally and repair itself. However, some people dislike the way stretch marks look.[6]Young women are generally affected the most and often seek treatment for them from adermatologist[7]and followingpregnancy.[8]

Causes

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Stretch marks appear to be caused by stretching of the skin. This is especially true when there is an increase incortisone[9]– an increase in cortisone levels can increase the probability or severity of stretch marks by reducing the skin's pliability. More specifically, it affects thedermisby preventing thefibroblastsfrom formingcollagenandelastinfibers necessary to keep rapidly growing skin taut; this can create a lack of supportive material as the skin is stretched, and lead to dermal andepidermaltearing, which in turn can produce scarring in the form of stretch marks. This is particularly the case when there is new tissue growth, which can interfere with the underlying physical support of the dermis or epidermis by displacing the supportive tissue.[citation needed]

Examples of cases where stretch marks are common include weight gain (in the form offatand/ormuscle),pregnancy,and adolescentgrowth spurts,though it is also noted that some medications, as well as other medical conditions and diseases, may increase the likelihood of stretch marks appearing. Common medications that can contribute to stretch marks include "corticosteroidcreams, lotions and pills and chronic use of oral or systemicsteroids".[9]Medical conditions that can contribute to stretch marks includeEhlers-Danlos syndrome,Cushing's syndrome,Marfan syndrome,andadrenal gland diseases.[10][11][12]

Pregnancy

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Striae gravidarum in a pregnant woman at 38 weeks

Pregnancy stretch marks, also known asstriae gravidarum,are a specific form ofscarringof the skin of the abdominal area due to rapid expansion of theuterusas well as sudden weight gain during pregnancy. About 90% of pregnant women are affected.[13]

A number of additional factors appear to promote the appearance of stretch marks: one study of 324 women, done just after they had given birth, demonstrated that low maternal age, highbody mass index,weight gain over 15 kg (33 pounds) and higher neonatal birth weight were independently correlated with the occurrence of striae. Teenagers were found to be at the highest risk of developing severe striae.[14]

These skin marks aresymptoms of pregnancycaused by the tearing of thedermis,resulting inatrophyand loss ofrete ridges.[15]These scars often appear as reddish or bluish streaks on the abdomen, and can also appear on the breasts and thighs. Some of these striae disappear with time, while others remain as permanent discolorations of the body.[citation needed]

Mechanical distension and rapidly developing areas of the body during pregnancy (such as the abdomen, breasts, and thighs) are most commonly associated with striae formation. Some have suggested thatrelaxinandestrogencombined with higher levels ofcortisolduring pregnancy can cause an accumulation ofmucopolysaccharides,which increases water absorption ofconnective tissue,making it prime for tearing under mechanicalstress.[7][14]There also seems to be an association between higher body mass indices and in women with bigger babies and the incidence and severity of striae. Also, younger women seem to be at higher risk of developing striae during pregnancy.[7][16]

The prevalence and severity of striae gravidarum varies among populations. The current literature suggest that in the general population of the United States, there is a 50% to 90% prevalence of striae associated with pregnancy,[16]partly as a result of the normal hormonal changes associated with pregnancy and partly due to stretching of skin fibers.[3][17]Many women experience striae gravidarum during their first pregnancy. Nearly 45% percent of women develop striae gravidarum before 24 weeks of gestation.[citation needed]Many women who develop lesions during the first pregnancy do not develop them during later pregnancies. Genetic factors such asgenealogyand race also seem to be predictive in the appearance of striae.[17]

Prevention

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Collagen and elastin are proteins in the skin that contribute to the skin's strength, resilience, flexibility, and help skin that has been stretched to recover its original state. Boosting the production of collagen and elastin helps prevent stretch marks from occurring.[18]Stretch marks can also derive fromnutritional deficiencies.Consuming foods that contribute to the skin's health, such aszinc-rich foods, protein-rich foods, and foods high in vitamin A, C, and D, can help suppress stretch marks.[19]A systematic review has not found evidence that creams and oils are useful for preventing or reducing stretch marks in pregnancy.[3]The safety in pregnancy of one ingredient,Centella asiatica,has been questioned.[17]Evidence on treatments for reducing the appearance of the scars after pregnancy is limited.[17]

Treatment

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There are no clearly useful treatments for stretch marks, although there are many different suggestions on how to remove them or lessen their appearance.[4]

Various efforts that have been tried includinglaser treatments,glycolic acid,andmicrodermabrasion.[20]Tretinoin(0.1% w/w), which is aretinoid,has found to be effective on early stretch marks in several studies.Hyaluronic acidalso improves the appearance of stretch marks.[21][22]Topical tretinoin is categorized by theUnited States Food and Drug Administration(FDA) as a knownteratogen(causing malformations in fetuses) in animals, without adequate human studies on safety in pregnancy.[23]

Carboxytherapyis a known procedure; however, there is a lack of evidence to support how effective it is.[24]

Research into a newskin graftingtechnique called "microcolumn grafting / micrografting", which uses needles to take autologous full-thicknessskin biopsies,is also being investigated as a potential treatment for stretch marks.[25][26][27]

History

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Since ancient times, people have sought remedies to prevent stretch marks during pregnancy. Both ancientGreeksandRomansusedolive oil,whileEthiopiansandSomalisusedfrankincense.[28]

Striae were first recognized byRoedererin 1773, and were later histologically described byTroisierandMénétrierin 1889.[29]In 1936, Nardelli made the first morphologically correct descriptions.[30]

Terminology

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Medical terminologyfor these kinds of markings includes: striae atrophicae, vergetures, stria distensae, striae cutis distensae, lineae atrophicae, linea albicante, or simply striae.[citation needed]

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References

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  1. ^Zink C (15 June 2011).Dictionary of Obstetrics and Gynecology.Walter de Gruyter. p. 230.ISBN978-3-11-085727-6.
  2. ^"Are Pregnancy Stretch Marks Different?".American Pregnancy Association. January 2008. Archived fromthe originalon 19 January 2013.
  3. ^abcBrennan M, Young G, Devane D (November 2012)."Topical preparations for preventing stretch marks in pregnancy".The Cochrane Database of Systematic Reviews.2012(11): CD000066.doi:10.1002/14651858.CD000066.pub2.PMC10001689.PMID23152199.
  4. ^abLiu L, Ma H, Li Y (August 2014). "Interventions for the treatment of stretch marks: a systematic review".Cutis.94(2): 66–72.PMID25184641.
  5. ^"Stretch Mark".Encyclopædia Britannica.Archivedfrom the original on 25 June 2010.Retrieved1 November2009.
  6. ^"Stretch Marks - Symptoms & Causes".Mayo Clinic.12 January 2023.Archivedfrom the original on 13 July 2024.Retrieved10 November2011.
  7. ^abcChang AL, Agredano YZ, Kimball AB (December 2004). "Risk factors associated with striae gravidarum".Journal of the American Academy of Dermatology.51(6): 881–885.doi:10.1016/j.jaad.2004.05.030.PMID15583577.
  8. ^James WD, Berger TG, Elston DM (2006).Andrews' Diseases of the Skin: Clinical Dermatology.Saunders Elsevier.ISBN978-0-7216-2921-6.
  9. ^ab"Stretch marks - Symptoms and causes".mayoclinic.org.Archivedfrom the original on 9 December 2015.Retrieved4 April2018.
  10. ^Burrows N."Skin".Ehlers-Danlos Support UK.Archivedfrom the original on 14 June 2023.Retrieved14 June2023.
  11. ^"Cushing Disease".Medline Plus.Archivedfrom the original on 14 June 2023.Retrieved14 June2023.
  12. ^"Symptoms - Marfan syndrome".National Health Service.3 October 2018.Archivedfrom the original on 14 June 2023.Retrieved14 June2023.
  13. ^Korgavkar K, Wang F (March 2015). "Stretch marks during pregnancy: a review of topical prevention".The British Journal of Dermatology.172(3): 606–615.doi:10.1111/bjd.13426.hdl:2027.42/110856.PMID25255817.S2CID23269984.
  14. ^abAtwal GS, Manku LK,Griffiths CE,Polson DW (November 2006). "Striae gravidarum in primiparae".The British Journal of Dermatology.155(5): 965–969.doi:10.1111/j.1365-2133.2006.07427.x.PMID17034526.S2CID42623629.
  15. ^Kroumpouzos G, Cohen LM (April 2003)."Specific dermatoses of pregnancy: an evidence-based systematic review".American Journal of Obstetrics and Gynecology.188(4): 1083–1092.doi:10.1067/mob.2003.129.PMID12712115.
  16. ^abThomas RG, Liston WA (April 2004). "Clinical associations of striae gravidarum".Journal of Obstetrics and Gynaecology.24(3): 270–271.doi:10.1080/014436104101001660779.PMID15203623.S2CID36643446.
  17. ^abcdTunzi M, Gray GR (January 2007). "Common skin conditions during pregnancy".American Family Physician.75(2): 211–218.PMID17263216.
  18. ^"Skin: Layers, Structure and Function".Cleveland Clinic.Archivedfrom the original on 4 March 2022.Retrieved17 February2022.
  19. ^"Stretch Marks".Cleveland Clinic.Archivedfrom the original on 17 February 2022.Retrieved17 February2022.
  20. ^Al-Himdani S, Ud-Din S, Gilmore S, Bayat A (March 2014). "Striae distensae: a comprehensive review and evidence-based evaluation of prophylaxis and treatment".The British Journal of Dermatology.170(3): 527–547.doi:10.1111/bjd.12681.PMID24125059.S2CID13416547.
  21. ^Lokhande AJ, Mysore V (2019)."Striae Distensae Treatment Review and Update".Indian Dermatology Online Journal.10(4): 380–395.doi:10.4103/idoj.IDOJ_336_18.PMC6615396.PMID31334056.
  22. ^"Stretch marks: Why they appear and how to get rid of them".American Academy of Dermatology.11 November 2019.Archivedfrom the original on 10 March 2021.Retrieved16 June2020.
  23. ^"Renova (tretinoin) cream".DailyMed.FDA and National Library of Medicine.Archivedfrom the original on 29 October 2013.Retrieved14 July2013.
  24. ^"Carboxytherapy And Mesotherapy Unproven"(Press release). 2009.Archivedfrom the original on 13 May 2019.Retrieved21 May2016.
  25. ^Horie Y, Notoya S, Matsuda M, Trovato L (March 2020)."Use of autologous micrografting in the treatment of stretch marks".Dermatologic Therapy.33(2): e13217.doi:10.1111/dth.13217.PMID31899571.S2CID209671919.
  26. ^Tam J, Wang Y, Vuong LN, Fisher JM, Farinelli WA, Anderson RR (October 2017)."Reconstitution of full-thickness skin by microcolumn grafting".Journal of Tissue Engineering and Regenerative Medicine.11(10): 2796–2805.doi:10.1002/term.2174.PMC5697650.PMID27296503.
  27. ^Girão L, Pinto P (February 2024)."Efficacy and Safety of an Autologous Micrografting Procedure for Management of Striae Distensae in Women".Dermatology and Therapy.14(2): 469–488.doi:10.1007/s13555-023-01096-7.PMC10891005.PMID38321354.
  28. ^Grieve M."Botany".Botanical.com.Archivedfrom the original on 21 April 2021.Retrieved10 November2009.
  29. ^Almeida G, Marques E, Golovaty R (2017). "CO2 Laser for Stretch Marks".Clinical Approaches and Procedures in Cosmetic Dermatology.Cham: Springer International Publishing. pp. 1–10.doi:10.1007/978-3-319-20251-8_12-1.ISBN978-3-319-20250-1.ISSN2511-820X.
  30. ^Elsaie ML, Baumann LS, Elsaaiee LT (April 2009). "Striae distensae (stretch marks) and different modalities of therapy: an update".Dermatologic Surgery.35(4). Ovid Technologies (Wolters Kluwer Health): 563–573.doi:10.1111/j.1524-4725.2009.01094.x.PMID19400881.S2CID7887237.
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