Therapeutics in Dermatology
A reference textbook in dermatology

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10 September 2014, by BACHOT N. & WETTERWALD E.

Striae or stretch marks are indented lines with an atrophic appearance that develop on the surface of the skin. The surface of stretch marks may be smooth or wrinkled and they are soft to the touch. Initially, stretch marks are red in colour, changing to a silvery-white colour at a later stage when they form scars. It is important to distinguish between the two forms because treatments are more effective on red stretch marks. Stretch marks are most common on the abdomen, breasts, thighs and buttocks and affected areas often present with numerous lines oriented parallel to the tension lines of the skin.

Stretch marks are particularly common during pregnancy. They also occur during puberty or may be associated with endocrine diseases such as Cushing’s syndrome, or with systemic or topical use of steroids, or with sudden weight loss or gain.

Histologically, the epidermis becomes thinner there is a marked decrease in elastic fibres in the dermis. The collagen fibres are narrow, less dense and oriented parallel to the epidermis. At the scar stage, the elastin and collagen fibres are regenerated and aligned with the tension lines of the skin.

As white stretch marks are permanent, they may have a non-negligible psychological impact on the quality of life of some patients.

Some studies assessing topical treatments and pulsed light and laser therapy have proved that the appearance of stretch marks may be improved [1]. However, few controlled randomised studies are available on stretch marks. No molecule has been granted a MA for the indication. Preventive treatment is based on providing patients with advice on healthy eating to avoid undue weight variations, particularly during pregnancy or puberty. Topical treatments have not been found to be effective for the prevention of stretch marks. Furthermore, the benefit/risk ratio of dermocorticosteroids should be carefully assessed, particularly for the treatment of pruritus associated with pregnancy.

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