Definition

Stretch marks, also known as striae distensiae or striae atrophicus is a skin condition characterized by irregular indented lines on the skin. Stretch marks can appear on the skin of the abdomen, hips, buttocks, breasts, thighs, or elsewhere. They are common in overweight people and pregnant women, especially in the last trimester. The condition is painless and harmless but usually causes discomfort due to its uneven appearance.

Causes

The cause of stretch marks is the rapid stretching of the skin. It is said that the stretching of the skin's connective tissue causes damage that results in the thinning of the skin tissue as well as the overlying skin layers. The severity is influenced by several factors, such as genetics and the degree of stress on the skin. In addition, the body's cortisol hormone levels can also have an effect. Cortisol is a hormone produced by the adrenal glands and has the effect of weakening the skin's elastic fibers.

Risk factor

Everyone can get stretch marks, but some factors increase one's risk of getting them, namely:

• Female gender
• Having a personal or family history of stretch marks
• Being pregnant, especially in young women
• Rapid growth during puberty
• Rapid weight gain or loss
• Excessive use of cortisone creams. Creams with this content can cause thinning of the skin resulting in stretch marks
• History of breast augmentation surgery
• Exercise and use of anabolic steroid drugs
• Has a genetic disease such as:
• Cushing's syndrome: a disease in which the body has high levels of the hormone cortisol
• Ehlers-Danlos syndrome: a disease characterized by skin that stretches and bruises easily
• Marfan syndrome

Symptoms

Not all stretch marks have similar appearances. They can vary in appearance depending on the length of time they have been present, the cause, the location on the body, and each person's skin type. Common variations include:

• Parallel indented lines on the abdomen, chest, waist, hips, buttocks, or other parts of the body
• Pink, reddish, blackish, bluish, or purplish-colored stripes
• Bright or shiny stripes that may fade to just a light color on the skin
• Stripes that cover a large part of the body

Diagnosis

Stretch marks rarely require a specific diagnosis. The doctor will usually examine the skin and ask about your medical history. If the doctor suspects an increase in the hormone cortisol, you will be advised to undergo certain examinations.

Management

Stretch marks do not require any specific treatment. They usually fade over time, with or without treatment. However, they may not disappear completely, even with treatment.

Treatment for stretch marks is difficult because many options provide minimal improvement. Several treatment options to improve the appearance and texture of stretch marks are widely used, but there is no evidence that one treatment is better than another.

Stretch marks treatment options that have been proven effective are:

• Retinoid creams. Retinoids are derivatives of vitamin A, such as tretinoin. This cream can be applied to the skin to improve stretch marks that have only been present for a few months. Tretinoin helps to carry a protein in the skin called collagen, so stretch marks will look more similar to normal skin. However, tretinoin can irritate the skin. If you are pregnant or breastfeeding, consult with your doctor for other treatment options as retinoid creams have side effects that may affect the baby or fetus
• A combination of vitamin C, alpha hydroxy acids, and a group of natural acids includes glycolic, lactic, and citric acids. These ingredients are said to increase collagen production
• Light and laser therapy. Many variations of light and laser therapy are available for stretch marks. These therapies work by stimulating collagen growth or by increasing skin elasticity
• Microneedling. This therapy is performed using a hand-held device equipped with tiny needles. It is used to stimulate collagen growth. This technique has a lower risk of skin pigmentation (skin discoloration) when compared to laser therapy

To choose the most appropriate combination of therapies for you, you should discuss it with your doctor first. Factors that will be considered in the selection of therapy are:

• How long the stretch marks have been present
• Skin type
• Some treatments require multiple visits to achieve optimal results.
• Therapies that aim to improve appearance or cosmetics are usually not covered by public or private insurance
• Your expectations

Complications

Stretch marks will fade over time, but they will rarely disappear entirely. Stretch marks do not cause any health issues.

Prevention

There is a belief that stretch marks can be prevented or treated with scrubs, oils, or certain lotions. However, this is not supported by definitive research evidence. Many products claim to prevent stretch marks but serve the same purpose of keeping the skin moisturized. In the end, it is genetic factors that play an important role.

Prevention of stretch marks is as follows:

• Moisturize the skin
• Using skin medications appropriately
• Avoiding excessive weight gain, although rapid growth during puberty and pregnancy, cannot be avoided

Pregnant women are advised to use moisturizers to prevent the formation of stretch marks. Although this method has not been proven effective, applying extra moisture and massaging the skin can help stretch the skin and widen the surface of the abdominal skin, reducing the formation of stretch marks. If you are pregnant, you should consult your doctor before using any alternative products that claim to treat or prevent stretch marks.

When to see a doctor?

You should consider talk with your doctor if you feel concerned or uncomfortable about your appearance due to stretch marks, especially if they cover a significant portion of your body. Additionally, consulting a doctor is advisable if stretch marks appear without an obvious cause, such as pregnancy or rapid weight gain. Your doctor can assist in identifying the underlying cause of the stretch marks and offer appropriate treatment options.

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