Questions from practice — Stretch marks
Is there anything you can recommend to get rid of these stretch marks? I hate them
Stretch marks (striae distensae, striae atrophicae, striae vergetures) werefirst described in medical literature in 1889. They affect as many as 90 percent of pregnant women (striae gravidarum), 70 per cent of adolescent womenand 40 per cent of adolescent men.1
Stretch marks are not a medical problembut can be associated with significant psychological stress and have spawneda plethora of purported effective therapies from the cosmetic industry.
The appearance of stretch marks evolve from an initial red colour (striae rubra) to a white lesion (striae alba). Histologically, striae rubra are characterised by the presence of inflammatory cells and the breakdown of the collagen fibres, while striae alba show atrophy of the epidermis.
The cause of stretch marks is poorly understood, probably because they occur in a number of situations. Stretch marks correlate closely with obesity,2 but they also occur in adolescents who are not obese, in pregnancy and in young male weightlifters. In addition, there may be a genetic component because stretch marks are present in Marfan’s syndrome (a hereditary connective tissue disorder).
Beneath the epidermis lies the dermis, which consists predominantly ofconnective tissue that provides the basic structural support to the skin.This tissue contains two major proteins, collagen and elastin, which areembedded in a mucopolysaccharide matrix, and all three components areproduced by fibroblast cells in the dermis.
One possible cause of stretchmarks is a reduction in fibroblast activity and there is some evidence thatshows that collagen and elastin are reduced compared with normal skin.3
It is also known that high levels of steroid hormones can decrease theactivity of fibroblasts and reduce the deposition of collagen in the dermis4and this is likely to be an important factor in the formation of stretchmarks that are a feature of Cushing’s disease and those that can develop inpatients using oral and topical corticosteroids.5
A large number of creams are advertised for stretch marks but there arecurrently no truly effective therapies available either over the counter oron prescription and little scientific evidence available to support claims.
One study suggested that topical retinoids, such as tretinoin 0.1 per cent,have some success in treating striae rubrae (ie, early lesions) with lesssuccess with striae alba (ie, existing stretch marks).6
Another study foundtretinoin to be ineffective, although the dose was lower.7
The mechanism ofaction of retinoids is unclear but some evidence suggests that the drug canincrease fibroblast activity.
Other topical agents include moisturising creams but a study with cocoabutter lotion did not find any effect on the prevention of striaegravidarum.8
An agent that has some evidence of efficacy is a cream that containsCentella asiatica. In a study of 80 women, 56 per cent of the placebo groupcompared with 34 per cent of the treatment group developed striaegravidarum.9
It was later shown that the mechanism of action related tostimulation of fibroblasts and inhibition of the effects of glucocorticoids.
Another agent that has shown some efficacy is menthol. One study using amenthol-containing cream found that in the treatment group, fewer patientsdeveloped stretch marks. However, the study did not include a placebo groupso the effects of the cream base could not measured.
A cream containing hyaluronic acid has been shown to reduce the developmentof striae gravidarum. It is believed that the main constituent, hyaluronicacid, is able to stimulate fibroblast activity and collagen formation.10
A product promoted for stretch marks in recent years is Bio-Oil. Thiscontains a vitamin A derivative, vitamin E and several plant oils. Althoughpopular, I have found no studies in peer-reviewed journals to support itsefficacy.
Other treatments used for stretch marks include laser devices, which havebeen shown to be effective only for stria rubrae, and microdermabrasion butthere are few good quality trials to support these. Radiofrequency devicesthat stimulate collagen formation have shown some promise.
Rod Tucker is a community pharmacist, East Yorkshire
1. Alaiti S. Striae Distensae [accessed27/06/2009]
2. Singh G, Kumar L. Striae distensae Indian J Dermatol Venereol Leprol2005;71(5):370-372)
3. Viennet C, Bride J, Armbruster V, Aubin F, Gabiot AC, Gharbi T,Humbert P. Contractile forces generated by striae distensae fibroblastsembedded in collagen lattices Arch Dermatol Res. 2005;297:10-17.
4. Elsaie M, Bauman LS, Elsaaiee LT. Striae Distensae (stretch marks) and different modalities of therapy: An Update Dermatol Surg 2009;35(4):536-573.
5. (Rogalski C, Haustein UF, Glander HJ, Paasch U. Extensive striaedistenase as a result of topical corticosteroid therapy in psoriasisvulgaris. [letter] Acta Derm Venereol 2002;83:54-55.
6. Kang S, Kim KJ, Griffiths CEM, Wong TY Talwar HS, Fisher GJ et alTopical tretinoin (retinoic acid) improves early stretch marks. ArchDermatol 1996;132:519-526.
7. Pribanich S, Simpson FG, Hled B, Yarbrough CL, White SW. Low-dosetretinoin does not improve striae distensae: a double-blind, placebocontrolled study. Cutis 1994;54:121-124.
8. Osman H, Usta IM, Rubeiz N, Abu-Rustum R, Charara I, Nassar AH. Cocca butter lotion for prevention of stria gravidarum: a double-blind, randomised and placebo-controlled trial. BJOG 2008;115(9):1138-42.
9. Mallol J, Belda MA, Costa D et al. Prophylaxis of striae gravidarumwith a topical formulation. A double-blind trial. In J Cosmet Sci1991:13:51-57.
10 de Buman M, Walther M, de Weck R. [Effectiveness of Alphastria cream in the prevention of pregnancy stretch marks (striae distensae). Results of a double-blind study] Gynakol Rundsch. 1987;27(2):79-84.
Citation: The Pharmaceutical Journal URI: 10997321
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