Stretch Marks — Causes, Treatment and Prevention.
Do creams really work for stretch marks? What causes stretch marks? Why do they occur in areas like the legs and the arms? Is there any way to prevent stretch marks in pregnancy? What are the current treatment options for stretch marks?
Stretch marks are a very common problem, for both men and women. While stretch marks are very usual in relation to pregnancy, also called striae gravidarum, it is not unusual to see these stretch marks in almost every man and woman.
So why do stretch marks happen?
The very name ‘stretch mark’ is self-explanatory. When the skin is unable to keep up with the growth/ expansion or stretch of the underlying tissues, its connective tissue support becomes disrupted. The second layer of the skin, called the dermis and the subdermal tissue are rich in support fibres like collagen and elastin. When the stretch of underlying structures, (eg, a growing uterus in pregnancy, or rapid increase in height), is too much to keep up with, this connective tissue layer becomes stretched and eventually torn or disrupted. Stretch marks tend to have lesser elasticity and more roughness and / or dryness than normal skin.
Why are some stretch marks, red in colour?
Stretch marks can be either red, pink or dark coloured, or they can be pale or white in colour. Accordingly, they are called striae rubra (red stretch marks) or striae alba (white stretch marks).
These are nothing but phases in the development of a stretch mark. The initial stretching phase, where there is active disruption of the collagen and the elastin fibres shows up as the red or dark coloured stretch mark. Over time, there is no active disruption, but the changes have come to be more permanent — and the colour of the stretch marks is now white.
These colours do have some implications in treatment. While the early stretch marks may still benefit from topical agents like vitamin A creams, the more older, white stretch marks may need treatments like laser or microneedling. During pregnancy, the stretch marks tend to be much darker under the influence of the pregnancy hormones. They gradually lighten up after delivery, and may transition into white stretch marks.
Do creams and topical agents really work for stretch marks?
Yes and no! The retinoid creams, which are basically vitamin A derivatives, are the only truly effective agents for treating stretch marks. However, the response rate is variable, and these creams cannot completely reverse the process of stretching, or erase the stretch marks totally. But, considering the lack of other effective options, these are the primary treatments chosen by most dermatologists. They work best in early stretch marks, and the effectiveness is doubtful for older striae. Retinoids are not recommended in pregnancy, and hence are usually not suggested for prevention of striae gravidarum (stretch marks related to pregnancy). Other agents like Centella extracts and bitter almond oil may have marginal efficacy, while hyaluronic acid seems to fare better.
Why do stretch marks occur in unusual areas, like the arms and the legs?
Even in skinny individuals, the rapid process of the adolescent growth spurt causes the skin to be stretched beyond capacity leading to stretch marks. A similar process occurs during the development of secondary sexual characteristics, with stretch marks occurring over the breasts. In most cases, the stretch mark is simply a response to mechanical stretch. However, the use of certain agents — like oral and topical steroid medications, can weaken the connective tissue and predispose to stretch marks.
What are the treatment options for stretch marks?
As mentioned above, the early lesions do benefit from some topical agents containing vitamin A. The established stretch marks benefit very well from energy based devices like lasers, ultrasound and radiofrequency devices. Often, a combination and sequential treatment works best to address all the dimensions of a stretch mark. These treatments should be well understood — they only provide the initial stimulus for collagen production and repair. The production process itself takes 6 to 8 weeks, and even up to 12 weeks. So treatments are best spaced out at 2–3 month intervals. Also, the collagen production happens in small instalments, so it is realistic to expect that several sessions may be needed for noticeable results.
Also, the timing of the procedure must be well thought out. It doesn't make sense to treat the pregnancy related stretch marks of a young mom, who is planning a second pregnancy in a few months time. In someone who is unable to control the obesity related stretch, treatment should ideally be planned only after a result oriented exercise/ diet regimen is in place. It is important to plan well, for good, stable results!
