Stretch marks are common and can affect both men and women, however they are more frequent among women and usually occur at one’s thighs, buttock, lower back, chest, upper arm and knee. Although they rarely cause medical problems, stretch marks are considered a major aesthetic concern and may be distressing to some individuals. In this article, we will discuss the causes of stretch marks, how they form, and the treatment options available.
What exactly is a stretch mark?
A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin that supports our skin, to rupture. As the skin heals, stretch marks may appear. When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on one’s skin colour. Early stretch marks may feel slightly raised and can be itchy while over time, the colour fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you can feel a slight depression.
Causes of stretch marks
Stretch marks occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include hormonal imbalance, 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 marks.
Stretch marks can form via three main mechanisms:
No specific gene has been identified as the cause of marks developing on the skin. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions, suggesting genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.
A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown, hence less collagen and elastin fibres are produced and the skin is less flexible and resilient to withstand stretching, causing marks to form. This effect is similar to that caused by corticosteroids, which explains why chronic use of the drug is more prone to developing stretch marks.
Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in the middle skin layer stretch to accommodate when growth is slow. However, with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming marks.
Who is more prone to stretch marks?
One who is undergoing puberty and has growth spurts, pregnant women, one who undergoes rapid weight loss or gain or is weight training and experiencing rapid muscle growth. Those who apply a corticosteroid to their skin for a long time can also cause stretch marks. Individuals who have Cushing’s disease or Marfan syndrome may also see stretch marks.
It is important to have your stretch marks reviewed by your dermatologist, as there are a few medical conditions which may mimic these marks. Like any scar, stretch marks are permanent, but treatment helps to make them less noticeable. Consulting an accredited dermatologist would help you in seeking an effective treatment. In addition, there are also specific treatments which should only be performed by a qualified dermatologist to reduce the appearance of these marks.
How to treat stretch marks
Topical treatments only have mild effects in reducing the appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach. It is recommended to use products on early stretch marks as in general, early stretch marks respond better to treatment than the older lesions.
Tretinoin is a retinoid, helping to boost fibroblast production, which are molecules responsible for the structural support in our cells and synthesize collagen, hence helping to make early stretch marks less noticeable. In one study, people who applied this prescription cream every night for 24 weeks had less noticeable stretch marks while those who didn’t apply the cream saw their early stretch marks grow. It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Researchers have found that products containing centella may help prevent stretch marks. 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.
The Elixir-V™ Total Recovery Serum contains intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.
A randomized, double-blind, placebo-controlled study in pregnant women showed that the severity of stretch marks can be reduced by topical application of moisturisers. Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide, helps stimulate collagen synthesis, tighten and lift stretch marks. The Radiance Emulsion formula is recommended for use with Qraser Custom Cut Mask, uniquely engineered with several properties which are beneficial for creating a healthy skin microenvironment, and helping the balance of growth factors that stimulate collagen production.
The Radiance Fluide™ Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. Specially formulated for a light-weight feel to impart a radiant glow without make-up.
Procedures that dermatologists perform:
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.
In this process, 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. In a study conducted, microdermabrasion was found to be as effective as the daily application of topical 0.05% tretinoin cream in the reduction in the severity of early stretch marks.
Learn more about microdermabrasion in our podcast, Dermatologist Talks: Science of Beauty Ep 43, where accredited dermatologist Dr. Teo Wan Lin discusses the benefits of microdermabrasion, as well as how it works.
Different types of light treatment are also available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.
Such lasers are effective in reducing scars as they create a deliberate wound to induce healing of the skin. The treatment of stretch marks using the laser showed clinical improvement, with the laser inducing the formation of collagen. There are rarely complications, and the cooling of the stretch marks before and immediately after the use of the laser further helps to protect the skin.
Wollina U, Goldman A. Management of stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg. 2017;10(3):124-129. doi:10.4103/JCAS.JCAS_118_17
A keloid is a smooth, raised scar that is generally larger than the original injury and darker than the surrounding skin. An estimated 10% of people will experience keloid scarring. Due to their raised appearance, they are some of the most conspicuous types of scars, which might pose a challenge to minimize. In this article, we will discuss keloid treatment options, what they usually look like, as well as their causes.
What is a keloid?
Keloids form when there is an overgrowth of fibrous tissue (scar tissue) on the skin, presenting itself as a raised scar. When the skin tissue is damaged, scar tissue will develop above the wound to repair the injury.
What do keloids look like? How do I know if I have a keloid?
Credit: American Academy of Dermatology Association
Keloids may vary in shapes and sizes. If it’s on the earlobe, it mostly presents itself as a round, solid mass. When it develops on the shoulders or chest area, the keloid is likely to be spread out across the skin. To identify a keloid, they usually feel painful or itchy and begin as a pink, red or purple scar raised above your skin. In some cases, if this scar covers a large area on the body, it may decrease an individual’s mobility at that certain body part.
Once you see a keloid, it tends to grow slowly. Most continue to spread for weeks and months. They can become increasingly irritated, itchy or painful when rubbed against your clothes. Additionally, keloids may become darker with time – the border is usually darker than the center.
How do people get keloids?
Keloids are classified as a type of tumor, but not malignant. Surprisingly, they can develop from the most common types of skin injuries such as acne scars, burns, chicken pox scars, piercings, vaccinations as well as surgical incision areas. Keloid scarring can also stem from genetic factors, which means a child has a higher risk of getting it if either parents have them. They are also more likely to develop on people of darker skin colours as compared to those with lighter skin tones. Therefore, researchers believe that this scarring may be linked to a gene related to dark skin pigment.
Keloids on a man’s chest. These keloids appeared slowly after severe acne cleared.
Credit: American Academy of Dermatology Association
Keloids vs Hypertrophic scars
It is not uncommon that some people confuse keloids with hypertrophic scars. Unlike keloids, hypertrophic scars are smaller and flatter, and the colours can range from pink to brown. They can also fade or go away over time, but keloids are not able to. Causes of hypertrophic scars are similar to keloids, such as piercings. Initially, they can be itchy and painful but symptoms will alleviate as the skin heals.
Do keloids go away? What are the keloid treatment options available?
Unfortunately, keloids are considered quite difficult to get rid of and even if they are treated, there are chances of them resurfacing again. However, the success of keloid treatment can vary, and it is advisable to seek a dermatologist to help develop a treatment plan to best suit the removal of keloid scarring.
Steroid Injection or Cream
These are also known as intralesional injections, which involves injecting steroids directly into the scar tissue in order to reduce its size. This keloid treatment method is one of the more common approaches, however, it is important to note that 50-80% of keloids reform after this treatment. Steroid creams are also an alternative. According to studies, there is a 9-50% chance of the scar resurfacing.
Cryotherapy, also known as cryoablation, refers to the use of extreme cold to freeze and remove abnormal tissues. This treatment method involves freezing off a keloid scar, and is generally more successful for smaller scars.
Surgery and Radiotherapy
Surgery is usually the last resort for keloids treatment, mainly because it may cause a larger scar to develop. Radiotherapy can aid in decreasing the size of the scar and also produces much better results if it occurs after surgery.
This keloid treatment is non-abrasive and is a type of superficial radiation therapy and is significantly effective in getting rid of keloid scarring, with a success rate over 90%. Performing surgery will still lead to keloids growing back eventually but with the SRT-100TM, there is a less than 10% chance of the regrowth. The mechanism behind this is that keloid cells are destroyed, which allows low chances of resurfacing. Due to its high success rate, it has been described as The Keloid Cure and is also approved by the FDA.
Prevention of Keloids
Prevention methods include avoiding piercings, cosmetic surgeries and tattoos and adopting proper wound care habits. Practice proper wound care by washing the injured skin area immediately using soap and clean water, followed by using a sterile gauze to cover up and bandage the affected area. Do visit an accredited dermatologist, for advice on your keloid scarring.
Have a keloid concern? Book a TeleConsultation, with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.
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The two most common skin cysts are epidermoid cysts and sebaceous cysts. Typically harmless, cysts are bumps that show up under the skin. In this article, we will go through what exactly are epidermoid and sebaceous cysts, what are the causes, and treatment options for cyst removal by a dermatologist.
What are epidermoid cysts?
A cyst is a benign (non cancerous), round, dome-shaped bump that contains fluid or other material. They can appear anywhere on the skin, but are most common on the face, neck, and trunk (e.g chest and shoulders). They are also common on the scrotum and vulva.
Credit: DermNet NZ
What are sebaceous cysts?
Unlike epidermoid cysts which originate from the skin, true sebaceous cysts are rare and originate form the sebaceous glands.
Sebaceous cysts can be found over you entire body, except for the palms of your hands and the soles of your feet. When squeezed, a small dome shaped projection called a punctum will appear. Through that opening, the sebum may be squeezed out.
Signs of an epidermoid cysts include:
- A small blackhead on the opening of the cyst
- A thick, smelly yellow material that may drain from the cyst
- Often has a diameter of 1-3cm
Credit: DermNet NZ
Rupture of the contents of the cyst can lead to swelling, redness, and tenderness. This can occur from bacterial infection such as Staph.A, E.Coli, or from trauma.
Credit: DermNet NZ
Other names for epidermoid cysts:
- Epidermal cysts
- Keratin cysts
- Sebaceous cysts (commonly mistakenly identified as these cysts do not involve sebaceous glands)
What causes an epidermoid cyst?
The epidermis – top layer of your skin – is made up of a thin, protective layer of cells that your body sheds continuously. Most epidermoid cysts form when these cells move into the deeper layers of your skin and multiply rather than shed. This causes a buildup of keratin in the skin, developing into cysts.
Sometimes, the epidermoid cysts can form due to irritation or trauma to the skin, or a portion of the hair follicle. The epidermal cells are the walls of the cysts which secrete the protein keratin into the interior. The keratin is the thick, yellowish substance that sometimes drains from the cyst.
What causes a sebaceous cyst?
Sebaceous cysts come from your sebaceous glands. Cysts can develop if the gland gets damaged, or the passage through which sebum leaves the skin is blocked. This usually occurs because of some sort of trauma in the area such as a scratch, surgical wound, or skin condition like acne.
Who gets epidermoid cysts?
Epidermoid cysts occur most commonly in adults, especially when young to middle aged. Additionally, they also occur twice as more frequently in men. Injuring the skin can also lead to development of epidermoid cysts.
Having certain rare genetic disorders may also increase the risk of developing epidermoid cysts:
- Gardner syndrome
- Basal cell naevus syndrome
- Pachyonychia congenita type 2
Epidermoid cysts vs sebaceous cysts
Many refer to epidermoid cysts as sebaceous cysts, but they are different. True sebaceous cysts are much less common. Sebaceous cysts start in the sebaceous gland. This is an oil gland in the skin that secretes oil, or sebum that lubricates the skin and hair.
What are the options for cyst removal?
Most epidermal cysts are slow growing and painless, so they don’t usually need treatment. However, if the cyst grows rapidly, ruptures or becomes painful, bothers you for cosmetic reasons, or occurs in a spot that causes irritation, you can see a skin specialist to have perform an epidermoid cyst removal.
Talk to your dermatologist about these options:
- Injection: this involves injecting the cyst with a steroid that reduces inflammation and swelling.
- Incision and drainage: Your dermatologist will make a small cut in the cyst, and gently squeeze out the contents. While this method is fairly quick and easy, cysts tend to recur after this treatment.
- Complete surgical excision: The most effective treatment for is a a complete epidermal cyst removal. Your doctor will remove the entire cyst with an intact cyst capsule. This is done through minor surgery in which you need to return to have stitches removed.
Looking for cyst removal procedures in Singapore? Book a TeleConsultation with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.