Collagen

Related Terms

AHA, alpha hydroxya acid, cocoa butter, collagen, dermabrasion, dermis, epidermis, intense pulsed light therapy, IPL, pulse dye laser therapy, Retin-A, striae alba, striae atrophicans, striae distensae, striae rubra, subcutaneous stratumn, topical retinoid therapy

Background

Stretch marks are a form of scarring caused by the overstretching of skin. This stretching disrupts the normal production of collagen and a scar results. Stretch marks are not a disease, but rather a term to refer to the physical appearance of these scars.
The term "stretch marks" is a nonprofessional term. Dermatologists (skin doctors) refer to stretch marks by their scientific names, such as striae distensae, striae atrophicans, striae rubra (red stretch marks) and striae alba (white stretch marks). Though stretch marks first appear as reddish or purple lines, they usually fade very gradually to a lighter color.
Stretch marks may appear anywhere on the body. They are most likely to appear in places where fat is stored, or that have a tendency to stretch. Most common places are the abdomen (especially near the belly button), breasts, upper arms, underarms, thighs (both inner and outer), and buttocks. They pose no health risk in and of themselves, and do not compromise the body's ability to function healthily.
Stretch marks may occur with pregnancy, obesity, bodybuilding and, occasionally, puberty. Women with darker skin are less likely to get stretch marks. Though stretch marks are relatively common, especially among athletes and women who have given birth, many individuals feel self-conscious about their scars.
There are several popular treatments for the prevention and minimization of appearance of stretch marks. Diet, hydration and physical exercise are among the therapies thought to prevent stretch marks. Over-the-counter creams, lotions, and oils are also available, although there is mixed evidence about the safety and efficacy of some of these products. Prescription medications are available. Some people have also used chemical peels or laser/light therapy to minimize the appearance of stretch marks.

Theory / Evidence

There are three layers of skin: the epidermis (outer layer), the dermis (middle layer), and the subcutaneous stratum (innermost layer). Stretch marks occur in the dermis, the resilient middle layer that helps the skin retain its shape. When the dermis is constantly stretched over time, the skin becomes less elastic and the small connective fibers within it break. The result is what we know as stretch marks. When the skin is stretched excessively over a short length of time dermal tearing occurs which creates scars in the dermis (middle layer of the skin), which we refer to as stretch marks. The epidermis (outer layer of skin) is also affected; the cells become thin and flattened which makes the defect in the dermis more visible.
Stretch marks occur in certain areas of the body where skin is subjected to continuous and progressive stretching. These areas include the abdomen and breasts in pregnant women; adolescents undergoing growth spurts (thighs, buttocks, and breasts); shoulders in body-builders; in numerous areas in obese or overweight people.
The first sign of stretch marks are lines of pink, sometimes itchy, skin. These lines soon take on reddish or purplish lines, called striae rubra. Over time, these lighten to become whitish or flesh-colored and much less conspicuous.
Stretch marks may also occur from prolonged use of oral, topical, or injectable corticosteroids. Rapid growth of underlying muscle tissue causes skin to stretch in order to accommodate the increased surface area underneath.
Stretch marks are often a symptom of Cushing's syndrome, a hormonal disorder. Excessive circulating cortisol in the bloodstream quickly results in upper body obesity, a rounded face, and increased fat around the neck. Individuals often develop stretch marks on their thighs, abdomen, arms, buttocks, and breasts. The skin of individuals with Cushing's syndrome heals poorly, and their likelihood of developing stretch marks is therefore increased.
Stretch marks are usually several centimeters long and 1-10 mm wide. Those caused by corticosteroid use or Cushing's syndrome are often larger and wider and may involve other regions, including the face.
Stretch marks are also quite common in pregnancy. Between 50 and 90% of women may get stretch marks on their abdomen, breasts, thighs, or buttocks during pregnancy. Some of the risk factors related to pregnancy stretch marks are family history, ethnicity, sudden weight gain and weight loss. Individuals whose mothers who developed stretch marks during pregnancy are more likely to develop stretch marks in the course of their own pregnancy.
Over the years, a number of treatments have come into popularity to supposedly treat stretch marks.
Over the counter creams, lotions, and oils: Many of these products contain alpha hydoxy acid (AHA), which removes the skin cells on top thus allowing healthier skin cells to grow. Formulations with vitamin A, C and E also help in diminishing the appearance of stretch marks. Vitamin E oil and cocoa butter are commonly used to treat stretch marks.
Topical retinoid therapy: Retin-A cream is commonly used to reduce the redness in new stretch marks and may help prevent prominent scarring. These may be very successful on mild stretch marks and may improve the appearance of deeper stretch marks as well.
Chemical peels (dermabrasion): Microdermabrasion involves the use of fine sand that is blown across the skin. The low-grade mechanical irritation of repeat treatments may induce new collagen formation in stretch marks.
Pulse dye laser therapy: Laser treatment removes, vaporizes, and breaks down the skin's tissues. Although laser surgery is generally the most effective treatment for stretch marks, this method still may be ineffective as well as cost prohibitive for some people. Unlike other methods, pulse dye laser may be effective in minimizing deeper and older stretch marks.
Intense pulsed light (IPL) therapy: Targeted flashes of light eliminate dilated and broken blood vessels without injuring the surrounding healthy skin.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Hernandez-Perez E, Colombo-Charrier E, Valencia-Ibiett E. Intense pulsed light in the treatment of striae distensae. Dermatol Surg. 2002 Dec;28(12):1124-30.
Kang S, Kim KJ, Griffiths CE, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dematol 1996 May; 132(5):519-26.
McDaniel DH, Ash K, Zukowski M. Treatment of stretch marks with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg. 1996 Apr;22(4):332-7.
Moreno-Arias GA, Castelo-Branco C, Ferrando J. Side-effects after IPL photodepilation. Dermatol Surg. 2002 Dec;28(12):1131-4.
Rangel O, Arias I, Garcia E, et al. Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study. Adv. Ther 2001 Jul-Aug; 18(4):181-9.

Technique

Some individuals may choose to change their lifestyle in order to minimize the appearance of new stretch marks.
Appropriate diet: Eating a well-balanced, healthy diet rich in nutrients such as phytochemicals, vitamins, and minerals is thought to help maintain healthy skin, and may help prevent stretch marks. Vitamins A, E, and C may reduce stretching of skin that results in stretch marks. Foods that are high in zinc and silica (beets, brown rice, bell peppers, soybeans, leafy green vegetables, and whole grains) may assist in the formation of collagen, therefore supporting the fibers of the skin. Foods that contain essential fatty acids may also help to contain cell walls when stretching occurs.
Appropriate hydration: Most experts believe that 6 - 8 glasses of water daily keeps skin soft and supple. It is believed that in doing so, the skin will not stretch as much. At the same time, a reduction in the intake of tea, coffee and carbonated drinks will also help to keep the body hydrated. Moisturizing the surface of the skin with lotion or baby oil provides additional hydration to localized areas of skin
Though none of the methods is entirely accepted by the medical community, treatments to supposedly reduce the appearance of stretch marks are numerous. These treatments include over the counter creams, lotions and oils, topical retinoid therapy, chemical peels (dermabrasion), pulse dye laser therapy, and intense pulse light (IPL) therapy. Many of these treatments are too expensive for most people to afford. Medical insurance does not usually cover cosmetic treatments for stretch marks.
Chemical peels (dermabrasion): Multiple treatments are generally required, and may be painful.
Intense pulsed light (IPL) therapy: On average, a series of four to six treatments is typically recommended by advocates, scheduled at three-week intervals. Each session usually lasts about 20 minutes, with patients returning to normal activity immediately.
Over the counter creams, lotions, and oils: These products can be massaged into the skin twice a day or more. Proponents of these products claim that best results occur if regular use of these products begins as soon as stretch marks appear.
Pulse dye laser therapy: Successful laser surgery depends on the result of a series of treatments over several weeks. Usually between six and eight treatments are needed to see results.
Topical retinoid therapy: Retinoid creams are only available by prescription. Retin-A may only be used on newer stretch marks that are still red or pink, typically less than one year old.