Stretch marks are extremely common. Yet, those squiggly lines on your skin are never welcomed. While such forms of dermal scarring are not medically dangerous, it can be aesthetically unpleasant to patients, causing distress.

Common occurrence of stretch marks includes the thigh, buttock, lower back, chest, upper arm and knee. Striae rubrae and striae albae are the two recognizable forms of stretch marks. Striae rubrae are flesh-toned scars, often accompanied by redness and ruptured capillaries that cause a subtle violet appearance. They then progress to striae albae – silvery, wrinkled scars that are hypopigmented (lighter than your usual skin colour).  

What causes stretch marks

Stretch marks, or striae distensae, occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include endocrine imbalance (a type of hormone), extended periods of mechanical stretch or any structural changes to the skin can lead to stretch marks. Chronic use of oral or topical corticosteroids can also contribute to the development of stretch marks.

Stretch marks are formed via three main mechanisms:

1. Genetic predisposition
2. Hormonal disorders
3. Mechanical disorders/stretching of the skin

Genetic predisposition

No specific gene has been isolated as the cause of stretch marks developing. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions. This suggests genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.

Hormones

A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown. In turn, this leads to less collagen and elastin fibres being produced. With less collagen and elastin, the skin is less flexible and resilient to withstand stretching, causing stretch marks.

This effect is similar to that caused by corticosteroids, which explains why patients on long-term use of the drug are more prone to developing stretch marks.

Mechanical stretch

Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in the middle skin layer (dermis) stretch to accommodate when growth is slow. But with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming stretch marks.

In pregnancy, stretch marks frequently appear in the third trimester.

How to treat stretch marks

Topicals:               

Topical treatments only have mild effects in reducing appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach.

• Tretinoin: Boost fibroblast production. Fibroblasts are molecules responsible for the structural support in our cells and synthesize collagen. Best for striae rubrae (for newly developed stretch marks), poor for striae albae (stretch marks that have been around for some time).
• It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
• Phytochemicals: Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Resveratrol, naturally occurring in grapes and berries, can also boost skin elasticity. Elixir-V™ Total Recovery Serum contains a potent combination of phytochemicals, including resveratrol, to help fight ageing effects
• Moisturizers: They can be applied as an adjuvant to treat stretch marks. Look out for moisturizers with active ingredients such as niacinamide. Apart from its brightening abilities, niacinamide stimulates collagen synthesis. You may consider Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide.

While ingredients such as cocoa butter or olive oil are commonly marketed as effective in reducing stretch marks, it has not been scientifically proven to show results.

Chemical peels: They help to induce the production of collagen and improve the appearance of stretch marks. Salicylic acid, lactic acid and glycolic acid are most commonly used.

Microdermabrasion: In this process, physical agents such as aluminium oxide is used for skin resurfacing. A targeted injury is caused to trigger collagen production and to deposit elastin. Topical therapies are also more effective after microdermabrasion, as your active ingredients can better penetrate the dermis layer.

Light therapy: Different types of light treatment are available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.

Ablative lasers: Such lasers are effective in reducing scars as they create a deliberate wound to induce healing of the skin.

Stretch marks are not medically dangerous, but if you are seeking for an effective treatment, it is best to consult an accredited dermatologist for best results.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.