How to treat stretch marks
The dreaded stretch marks… What causes them and how do you treat them? The Tot expert, Dr. Clare Thompson, discusses.
Stretch marks are a skin condition that I hear women complain about time and again in my clinic. The unwelcome appearance of these pesky red marks cropping up over the body serve as a stark reminder of a pregnancy or else a significant amount of weight gained at some point in time.
Although the end result of having a healthy baby is undoubtedly worth a few blemishes, it is certainly nice to know that there are ways that they can be minimized and treated. While stretch marks are mostly genetic, there are things that you can do to prepare your skin for pregnancy and reduce the chances of the long-term scar formation associated.
In this article, I will go over:
- What stretch marks are
- What causes stretch marks
- How to treat stretch marks
- Tips for managing stretch marks during pregnancy
What are stretch marks?
Stretch marks (Striae Distensae) are a type of ‘scarring’ that happens when the skin is stretched beyond the limits of its elasticity due to rapid expansion or contraction of the skin.
They often appear as red or purplish raised marks because of the blood vessels showing through, but may slowly fade and flatten to a silvery-white pattern over time. Before stretch marks begin to emerge, the skin can appear thin and pink and may be irritated or itchy.
What causes stretch marks?
The skin structure of stretch marked skin shows slower growth of fibroblasts and less production of elastin, collagen and fibronectin.
The skin consists of 3 key layers: Epidermis (outer layer), Dermis (middle layer) and Hypodermis (deepest layer.) When connective tissue is abruptly stretched, it causes tearing which allows deeper skin layers to show through, forming stretch marks.
Studies show that people with stretch marks have a different phenotype (genetic makeup) in the fibroblasts compared with healthy skin. This is consistent with the hypothesis that there is a genetic tendency for people to develop stretch marks.
Cortisol is the stress hormone which is produced by the adrenal glands and is converted to cortisone, which weakens the elastic fibers in the skin. Stretch marks are more likely to develop when there are high levels of circulating cortisol or where topical cortisone (steroid cream) is used for prolonged periods of time.
Fibroblasts are the ‘construction workers’ in the dermis of the skin, which are responsible for collagen production. Collagen is a fibrous protein found in the skin and other connective tissues of the body. Collagen is important to the way the skin looks and feels because it is the main structural component providing firmness and shape.
Regardless of the cause, all stretch marks display the same changes in the dermis which are similar to those seen at a cellular level in scar formation.
Risk factors for stretch marks
Almost 50% of pregnant women will develop some stretch marks to varying degrees, usually appearing after 25 weeks gestation when there is sudden weight gain and stretching of the dermis.
A lot of this will have a genetic undertone, but the hormonal changes in the body and the stretching of the skin to the abdomen, hips and breasts also plays a role. High circulating levels of hormones produced in pregnancy act to soften the pelvic ligaments and increase their flexibility but also soften skin fibers giving an increased risk of stretch marks.
Interesting fact: Higher maternal age at delivery is associated with a LOWER risk of stretch marking, possibly due to different circulating levels of estrogen and its effects on collagen production.
High Body Mass Index
People with a higher BMI will be at greater risk of stretch marks due to the greater stretch applied to the skin in obesity.
Teenagers and young women
Teenagers and younger women are more prone to stretch marking than any other group due to the changes in skin collagen and connective tissue. Areas of skin that undergo greater mechanical stretching may respond differently to hormonal signals from estrogens and natural steroids. The skin cells in younger patients appear to express greater hormonal receptor activity and studies have suggested that there may be up to twice as many estrogen receptors in the skin of patients who are prone to stretch marks. In young males stretch marks tend to arise at the shoulders and back, whereas young females often develop marks to the thigh, hip and breast areas.
‘23 and Me’, the leading personal genetics company, has conducted the first study of stretch marks and researchers have identified 4 possible genes responsible for predisposing to susceptibility to stretch marks. Loose skin is thought to be caused by a deletion or mutation in the elastin proteins found in the skin cells, while variations of elastin and collagen gene expression in the dermis of the skin contributes to the reorganization and overall loss of elastic fibers resulting in stretch mark patterns.
Prolonged or inappropriate use of topical steroids can cause stretch marks by inhibiting fibroblast activity and decreasing collagen production, thus ‘thinning the skin’. This is often why your doctor will only suggest using steroid creams for short periods of time (eg/ in eczema).
Cushing’s disease is a condition in which there is an overproduction of the stress hormone cortisol. This leads to rapid weight gain, especially in the trunk, in addition to the skin becoming more fragile and thin with propensity for easy bruising, scarring and infection. Ehlers-Danlos Syndrome is a rare inherited condition that disrupts the structure of proteins in the skin which can also cause stretch marks. Marfans Syndrome is another genetic condition that causes weakness and decreased elasticity in the body tissues.
How To Treat Stretch Marks
Pregnancy-approved stretch mark creams, balms and oils
Natural creams, balms and oils may help with the dryness and itchy symptoms associated and they may also help prepare the dermal layer of the skin for the degree of stretch applied during pregnancy.
Also available individually
Tretinoin Cream (retinoic acid)
Products containing retinoic acid are UNSAFE for use in pregnancy and breastfeeding, but studies suggest that topical application of retin-A after a woman has delivered and finished breastfeeding can improve the clinical appearance of stretch marks.
Application of silicone gels can help promote collagen production and reduce pigmentation of stretch marks when compared to placebo groups.
This is a popular technique that Dermatologists use to polish the top layer of the skin by blowing fine crystals across it and removing the superficial layer to stimulate new growth of skin. The procedure can be of benefit in early stretch marks but it is only really targeting the epidermal (top) layer of the skin.
For those older stretch marks which have already faded to white, silvery lines there seems to be more cosmetic success with laser therapy.
Laser therapy works to stimulate new collagen and elastin fiber synthesis in the dermis.
Pulsed dye laser techniques have been shown to be effective at improving the appearance of early stretch marks. Fractora is a technique which uses radiofrequency fractional ablation and causes a heat-injury in the skin up to 3mm by heating up the dermis and activating fibroblasts to produce collagen.
PRP (platelet rich plasma) is blood plasma that has been enriched with platelets and contains several different growth factors to stimulate the healing of soft tissues. This is a process by which a patient’s blood is drawn and then processed in a centrifuging machine to spin out the top layer of cells which are rich in platelets. These platelets are then reinjected into the skin and stimulate growth factors and fibroblasts to lay down new sheets of collagen. Many Dermatologists are now using this technique with good results.
There is also some evidence that Centella Asiatica (gotu kola), which is a small herbaceous perennial plant, can prevent stretch marks by promoting collagen synthesis and fibroblast proliferation and increase intracellular fibronectin content. This helps to improve the tensile strength of newly-formed skin while inhibiting inflammation that leads to the developing of hypertrophic scars and keloids. This would not be recommended in pregnancy as there is no safety data.
Tips for managing stretch marks
#1 Firstly, it is far more important that you relax and try to enjoy your pregnancy than worry about stretch marks
#2 Preparing the skin for a degree of stretch in pregnancy is certainly helpful in strengthening the skin and makes it less likely to be damaged. If you wish to use organic topical creams then best to start doing so at the beginning of the second trimester
#3 Maintaining your water intake is beneficial for keeping the skin hydrated and plump
#4 Organic creams and oils will help target the surface layer of the skin and prevent dryness and itching whilst improving the appearance of any scar tissue from the stretch marks
#5 For older stretch marks you will likely need to target the dermal layer of the skin (after the pregnancy) with laser therapy and new techniques such as PRP to get the best results
#6 By only gaining a sensible amount of weight during the pregnancy you are less likely to over-stretch the skin and thus less likely to tear the dermal layers
#7 Remember that even if you do develop stretch marks during the pregnancy, the appearance will improve over time and they will fade and flatten to a much lighter color
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