:Stretch marks

{{Redirect|Stria|inner ear structure|Stria vascularis of cochlear duct|brain structure|Stria terminalis}}

{{Infobox medical condition (new)

| name = Stretch marks

| image = Belly Strech Marks.jpg

| caption = multiple recent (reddish) and a few older (white) stretch marks

| pronounce =

| field = Dermatology

| synonyms = stria, striae distensae

| symptoms =

| complications =

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| duration =

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Stretch marks, also known as striae ({{IPAc-en|ˈ|s|t|r|aɪ|iː}}){{Citation needed|date=July 2024}} or striae distensae,{{cite book| vauthors = Zink C |title=Dictionary of Obstetrics and Gynecology|date=15 June 2011|publisher=Walter de Gruyter|isbn=978-3-11-085727-6|pages=230}} are a form of scarring on the skin with an off-color hue. Over time, they may diminish, but will not disappear completely. Striae are caused by tearing of the dermis during periods of rapid growth of the body, such as during puberty or pregnancy, in which they usually form during the last trimester. Usually on the belly, these striae also commonly occur on the breasts, thighs, hips, lower back, and buttocks. Pregnancy-related striae are known as striae gravidarum.{{cite web |date=January 2008 |title=Are Pregnancy Stretch Marks Different? |url=http://americanpregnancy.org/your-pregnancy/are-pregnancy-stretchmarks-different/ |url-status=dead |archive-url=https://web.archive.org/web/20130119091203/http://americanpregnancy.org/commondiscomforts/PE-pregnancy-stretchmarks-different.html |archive-date=19 January 2013 |publisher=American Pregnancy Association |df=dmy-all}} Striae may also be influenced by the hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy. There is no evidence that creams used during pregnancy prevent stretch marks. Once they have formed, there is no clearly effective treatment, though various methods have been attempted and studied.

Signs and symptoms

Striae, or "stretch marks", begin as reddish or purple lesions which can appear anywhere on the body, but are most likely to appear in places where larger amounts of fat are stored- as such, they can be experienced by all genders. The most common places are the abdomen (especially near the navel), breasts, upper arms, underarms, back, thighs (both inner and outer), hips, and buttocks. Over time, they tend to atrophy and lose pigmentation. The affected areas appear empty, and are soft to the touch.{{cite encyclopedia|url=http://www.britannica.com/EBchecked/topic/568975/stretch-mark|title=Stretch Mark|access-date=1 November 2009|encyclopedia=Encyclopædia Britannica|archive-date=25 June 2010|archive-url=https://web.archive.org/web/20100625032029/http://www.britannica.com/EBchecked/topic/568975/stretch-mark|url-status=live}}

Stretch marks occur in the dermis, the resilient middle tissue layer that helps the skin retain its shape. No stretch marks will form as long as there is support within the dermis; stretching plays a role in where the marks occur and in what direction they run.

They can (but do not always) cause a burning and itching sensation, as well as emotional distress. They pose no inherent health risk on their own, and do not compromise the body's ability to function normally and repair itself. However, some people dislike the way stretch marks look.{{cite web |date=2023-01-12 |title=Stretch Marks - Symptoms & Causes |url=https://www.mayoclinic.org/diseases-conditions/stretch-marks/symptoms-causes/syc-20351139 |url-status=live |archive-url=http://web.archive.org/web/20240713164100/https://www.mayoclinic.org/diseases-conditions/stretch-marks/symptoms-causes/syc-20351139 |archive-date=2024-07-13 |access-date=2011-11-10 |website=Mayo Clinic}} Young women are generally affected the most and often seek treatment for them from a dermatologist{{cite journal | vauthors = Chang AL, Agredano YZ, Kimball AB | title = Risk factors associated with striae gravidarum | journal = Journal of the American Academy of Dermatology | volume = 51 | issue = 6 | pages = 881–885 | date = December 2004 | pmid = 15583577 | doi = 10.1016/j.jaad.2004.05.030 }} and following pregnancy.{{cite book |title=Andrews' Diseases of the Skin: Clinical Dermatology |vauthors=James WD, Berger TG, Elston DM |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6}}

Causes

Stretch marks appear to be caused by stretching of the skin. This is especially true when there is an increase in cortisone{{cite web|url=http://www.mayoclinic.org/diseases-conditions/stretch-marks/basics/causes/con-20032624|title=Stretch marks - Symptoms and causes|website=mayoclinic.org|access-date=4 April 2018|archive-date=9 December 2015|archive-url=https://web.archive.org/web/20151209032515/http://www.mayoclinic.org/diseases-conditions/stretch-marks/basics/causes/con-20032624|url-status=live}}{{snd}} an increase in cortisone levels can increase the probability or severity of stretch marks by reducing the skin's pliability. More specifically, it affects the dermis by preventing the fibroblasts from forming collagen and elastin fibers necessary to keep rapidly growing skin taut; this can create a lack of supportive material as the skin is stretched, and lead to dermal and epidermal tearing, which in turn can produce scarring in the form of stretch marks. This is particularly the case when there is new tissue growth, which can interfere with the underlying physical support of the dermis or epidermis by displacing the supportive tissue.{{cn|date=September 2021}}

Examples of cases where stretch marks are common include weight gain (in the form of fat and/or muscle), pregnancy, and adolescent growth spurts, though it is also noted that some medications, as well as other medical conditions and diseases, may increase the likelihood of stretch marks appearing. Common medications that can contribute to stretch marks include "corticosteroid creams, lotions and pills and chronic use of oral or systemic steroids". Medical conditions that can contribute to stretch marks include Ehlers–Danlos syndrome, Cushing's syndrome, Marfan syndrome, and adrenal gland diseases.{{cite web |vauthors=Burrows N |title=Skin |url=https://www.ehlers-danlos.org/what-is-eds/information-on-eds/skin/ |website=Ehlers-Danlos Support UK |access-date=14 June 2023 |archive-date=14 June 2023 |archive-url=https://web.archive.org/web/20230614095545/https://www.ehlers-danlos.org/what-is-eds/information-on-eds/skin/ |url-status=live }}{{cite web |title=Cushing Disease |url=https://medlineplus.gov/genetics/condition/cushing-disease/ |website=Medline Plus |access-date=14 June 2023 |archive-date=14 June 2023 |archive-url=https://web.archive.org/web/20230614100749/https://medlineplus.gov/genetics/condition/cushing-disease/ |url-status=live }}{{cite web |title=Symptoms - Marfan syndrome |url=https://www.nhs.uk/conditions/marfan-syndrome/symptoms/ |website=National Health Service |date=3 October 2018 |access-date=14 June 2023 |archive-date=14 June 2023 |archive-url=https://web.archive.org/web/20230614100748/https://www.nhs.uk/conditions/marfan-syndrome/symptoms/ |url-status=live }}

Asians are more prone to stretch marks.{{cite web|url=https://www.newsobserver.com/living/article10345682.html|title=}}

=Pregnancy=

File:Squircle belly (19004951).jpg

Pregnancy stretch marks, also known as striae gravidarum, are a specific form of scarring of the skin of the abdominal area due to rapid expansion of the uterus as well as sudden weight gain during pregnancy. About 90% of pregnant women are affected.{{cite journal | vauthors = Korgavkar K, Wang F | title = Stretch marks during pregnancy: a review of topical prevention | journal = The British Journal of Dermatology | volume = 172 | issue = 3 | pages = 606–615 | date = March 2015 | pmid = 25255817 | doi = 10.1111/bjd.13426 | hdl-access = free | s2cid = 23269984 | hdl = 2027.42/110856 }}

A number of additional factors appear to promote the appearance of stretch marks: one study of 324 women, done just after they had given birth, demonstrated that low maternal age, high body mass index, weight gain over 15 kg (33 pounds) and higher neonatal birth weight were independently correlated with the occurrence of striae. Teenagers were found to be at the highest risk of developing severe striae.{{cite journal | vauthors = Atwal GS, Manku LK, Griffiths CE, Polson DW | title = Striae gravidarum in primiparae | journal = The British Journal of Dermatology | volume = 155 | issue = 5 | pages = 965–969 | date = November 2006 | pmid = 17034526 | doi = 10.1111/j.1365-2133.2006.07427.x | s2cid = 42623629 | author-link3 = Chris Griffiths (dermatologist) }}

These skin marks are symptoms of pregnancy caused by the tearing of the dermis, resulting in atrophy and loss of rete ridges.{{cite journal | vauthors = Kroumpouzos G, Cohen LM | title = Specific dermatoses of pregnancy: an evidence-based systematic review | journal = American Journal of Obstetrics and Gynecology | volume = 188 | issue = 4 | pages = 1083–1092 | date = April 2003 | pmid = 12712115 | doi = 10.1067/mob.2003.129 | doi-access = free }} These scars often appear as reddish or bluish streaks on the abdomen, and can also appear on the breasts and thighs. Some of these striae disappear with time, while others remain as permanent discolorations of the body.{{Citation needed|date=July 2024}}

Mechanical distension and rapidly developing areas of the body during pregnancy (such as the abdomen, breasts, and thighs) are most commonly associated with striae formation. Some have suggested that relaxin and estrogen combined with higher levels of cortisol during pregnancy can cause an accumulation of mucopolysaccharides, which increases water absorption of connective tissue, making it prime for tearing under mechanical stress. There also seems to be an association between higher body mass indices and in women with bigger babies and the incidence and severity of striae. Also, younger women seem to be at higher risk of developing striae during pregnancy.{{cite journal | vauthors = Thomas RG, Liston WA | title = Clinical associations of striae gravidarum | journal = Journal of Obstetrics and Gynaecology | volume = 24 | issue = 3 | pages = 270–271 | date = April 2004 | pmid = 15203623 | doi = 10.1080/014436104101001660779 | s2cid = 36643446 }}

The prevalence and severity of striae gravidarum varies among populations. The current literature suggest that in the general population of the United States, there is a 50% to 90% prevalence of striae associated with pregnancy, partly as a result of the normal hormonal changes associated with pregnancy and partly due to stretching of skin fibers.{{cite journal | vauthors = Brennan M, Young G, Devane D | title = Topical preparations for preventing stretch marks in pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 11 | pages = CD000066 | date = November 2012 | pmid = 23152199 | pmc = 10001689 | doi = 10.1002/14651858.CD000066.pub2 }}{{cite journal | vauthors = Tunzi M, Gray GR | title = Common skin conditions during pregnancy | journal = American Family Physician | volume = 75 | issue = 2 | pages = 211–218 | date = January 2007 | pmid = 17263216 }} Many women experience striae gravidarum during their first pregnancy. Nearly 45% percent of women develop striae gravidarum before 24 weeks of gestation.{{Citation needed|date=July 2024}} Many women who develop lesions during the first pregnancy do not develop them during later pregnancies. Genetic factors such as genealogy and race also seem to be predictive in the appearance of striae.

Prevention

Collagen and elastin are proteins in the skin that contribute to the skin's strength, resilience, flexibility, and help skin that has been stretched to recover its original state. Boosting the production of collagen and elastin helps prevent stretch marks from occurring.{{Cite web|title=Skin: Layers, Structure and Function|url=https://my.clevelandclinic.org/health/articles/10978-skin|access-date=2022-02-17|website=Cleveland Clinic|archive-date=4 March 2022|archive-url=https://web.archive.org/web/20220304023159/https://my.clevelandclinic.org/health/articles/10978-skin|url-status=live}} Stretch marks can also derive from nutritional deficiencies. Consuming foods that contribute to the skin's health, such as zinc-rich foods, protein-rich foods, and foods high in vitamin A, C, and D, can help suppress stretch marks.{{Cite web|title=Stretch Marks|url=https://my.clevelandclinic.org/health/articles/10785-stretch-marks|access-date=2022-02-17|website=Cleveland Clinic|archive-date=17 February 2022|archive-url=https://web.archive.org/web/20220217202207/https://my.clevelandclinic.org/health/articles/10785-stretch-marks|url-status=live}} A systematic review has not found evidence that creams and oils are useful for preventing or reducing stretch marks in pregnancy. The safety in pregnancy of one ingredient, Centella asiatica, has been questioned. Evidence on treatments for reducing the appearance of the scars after pregnancy is limited.

Treatment

There are no clearly useful treatments for stretch marks, although there are many different suggestions on how to remove them or lessen their appearance.{{cite journal | vauthors = Liu L, Ma H, Li Y | title = Interventions for the treatment of stretch marks: a systematic review | journal = Cutis | volume = 94 | issue = 2 | pages = 66–72 | date = August 2014 | pmid = 25184641 }}

Various efforts that have been tried including laser treatments, glycolic acid, and microdermabrasion.{{cite journal | vauthors = Al-Himdani S, Ud-Din S, Gilmore S, Bayat A | title = Striae distensae: a comprehensive review and evidence-based evaluation of prophylaxis and treatment | journal = The British Journal of Dermatology | volume = 170 | issue = 3 | pages = 527–547 | date = March 2014 | pmid = 24125059 | doi = 10.1111/bjd.12681 | s2cid = 13416547 }} Tretinoin (0.1% w/w), which is a retinoid, has found to be effective on early stretch marks in several studies. Hyaluronic acid also improves the appearance of stretch marks.{{cite journal | vauthors = Lokhande AJ, Mysore V | title = Striae Distensae Treatment Review and Update | journal = Indian Dermatology Online Journal | volume = 10 | issue = 4 | pages = 380–395 | year = 2019 | pmid = 31334056 | pmc = 6615396 | doi = 10.4103/idoj.IDOJ_336_18 | doi-access = free }}{{cite web | title=Stretch marks: Why they appear and how to get rid of them | website=American Academy of Dermatology | date=2019-11-11 | url=https://www.aad.org/public/cosmetic/scars-stretch-marks/stretch-marks-why-appear | access-date=2020-06-16 | archive-date=10 March 2021 | archive-url=https://web.archive.org/web/20210310113347/https://www.aad.org/public/cosmetic/scars-stretch-marks/stretch-marks-why-appear | url-status=live }} Topical tretinoin is categorized by the United States Food and Drug Administration (FDA) as a known teratogen (causing malformations in fetuses) in animals, without adequate human studies on safety in pregnancy.{{cite web|title=Renova (tretinoin) cream|url=http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ad4cd608-ee26-4467-9957-a95b33101f9a|work=DailyMed|publisher=FDA and National Library of Medicine|access-date=14 July 2013|archive-date=29 October 2013|archive-url=https://web.archive.org/web/20131029193656/http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ad4cd608-ee26-4467-9957-a95b33101f9a|url-status=live}}

Carboxytherapy is a known procedure; however, there is a lack of evidence to support how effective it is.{{cite press release | year=2009 | title=Carboxytherapy And Mesotherapy Unproven | url=http://www.medicalnewstoday.com/releases/159481.php | access-date=21 May 2016 | archive-date=13 May 2019 | archive-url=https://web.archive.org/web/20190513183046/https://www.medicalnewstoday.com/releases/159481.php | url-status=live }}

Research into a new skin grafting technique called "microcolumn grafting / micrografting", which uses needles to take autologous full-thickness skin biopsies, is also being investigated as a potential treatment for stretch marks.{{cite journal | vauthors = Horie Y, Notoya S, Matsuda M, Trovato L | title = Use of autologous micrografting in the treatment of stretch marks | journal = Dermatologic Therapy | volume = 33 | issue = 2 | pages = e13217 | date = March 2020 | doi = 10.1111/dth.13217 | pmid = 31899571 | s2cid = 209671919 | url = https://www.researchgate.net/publication/338376116 | doi-access = free }}{{cite journal | vauthors = Tam J, Wang Y, Vuong LN, Fisher JM, Farinelli WA, Anderson RR | title = Reconstitution of full-thickness skin by microcolumn grafting | journal = Journal of Tissue Engineering and Regenerative Medicine | volume = 11 | issue = 10 | pages = 2796–2805 | date = October 2017 | pmid = 27296503 | pmc = 5697650 | doi = 10.1002/term.2174 }}{{cite journal | vauthors = Girão L, Pinto P | title = Efficacy and Safety of an Autologous Micrografting Procedure for Management of Striae Distensae in Women | journal = Dermatology and Therapy | volume = 14 | issue = 2 | pages = 469–488 | date = February 2024 | pmid = 38321354 | pmc = 10891005 | doi = 10.1007/s13555-023-01096-7 }}

V-EMF therapy{{Cite journal |last1=Veronese |first1=Sheila |last2=Bacci |first2=Pier Antonio |last3=Garcia-Gimenez |first3=Victor |last4=Canel Micheloud |first4=Casiana Cecilia |last5=Haro García |first5=Norma Laura |last6=Sbarbati |first6=Andrea |date=2024 |title=V-EMF therapy: A new painless and completely non-invasive treatment for striae gravidarum |journal=Journal of Cosmetic Dermatology |language=en |volume=23 |issue=6 |pages=2007–2014 |doi=10.1111/jocd.16220 |pmid=38549181 |issn=1473-2165|doi-access=free }}{{Cite journal |last1=Scarano |first1=Antonio |last2=Sbarbati |first2=Andrea |last3=Amore |first3=Roberto |last4=Iorio |first4=Eugenio L. |last5=Ferraro |first5=Giuseppe |last6=Lorusso |first6=Felice |last7=Amuso |first7=Domenico |date=2021 |title=A New Treatment for Stretch Marks and Skin Ptosis with Electromagnetic Fields and Negative Pressure: A Clinical and Histological Study |journal=Journal of Cutaneous and Aesthetic Surgery |volume=14 |issue=2 |pages=222–228 |doi=10.4103/JCAS.JCAS_122_20 |doi-access=free |issn=0974-2077 |pmc=8423202 |pmid=34566367}} / Biodermogenesi® treatment (Bi-one® LifeTouchTherapy){{Cite web |title=Rigenerazione smagliature - Trattamento antismagliature |url=https://www.bi-one.it/en/bi-one/ |access-date=2025-04-12 |website=Bi-One® |language=en-GB}} uses a device that generates an electromagnetic field & a negative vacuum (suction) to treat striae, scars & cellulite. Research & marketing claims that the stretch marks - even ones over twenty years old - are able to tan closer to normal skin post-treatment, which should indicate a restructuring of the skin layers that enables melanocytes to function more normally.{{Cite web |date=2022-10-26 |title=The synergy between vacuum and electromagnetic fields in the treatment of striae distensae: retrospective study on 917 patients with clinical and histological case records |url=https://www.bi-one.it/en/the-synergy-between-vacuum-and-electromagnetic-fields-in-the-treatment-of-striae-distensae-retrospective-study-on-917-patients-with-clinical-and-histological-case-records/ |access-date=2025-04-12 |website=Bi-One® |language=en-GB}}{{Cite web |date=2022-09-27 |title=TREATMENT OF STRETCH MARKS AGED MORE THAN TWENTY YEARS WITH THE SINERGY OF ELECTROMAGNETICAL FIELD AND VACUUM. CLINICAL CASE STUDIES AND SUBSEQUENT FOLLOW-UP |url=https://www.bi-one.it/treatment-of-stretch-marks-aged-more-than-twenty-years-with-the-sinergy-of-electromagnetical-field-and-vacuum-clinical-case-studies-and-subsequent-follow-up/ |access-date=2025-04-12 |website=Rigenerazione cutanea |language=it-IT}}

History

Since ancient times, people have sought remedies to prevent stretch marks during pregnancy. Both ancient Greeks and Romans used olive oil, while Ethiopians and Somalis used frankincense.{{cite web |last=Grieve |first=M. |title=Botany |url=http://www.botanical.com/botanical/mgmh/f/franki31.html |url-status=live |archive-url=https://web.archive.org/web/20210421094324/http://botanical.com/botanical/mgmh/f/franki31.html |archive-date=21 April 2021 |access-date=2009-11-10 |website=Botanical.com}}

Striae were first recognized by Roederer in 1773, and were later histologically described by Troisier and Ménétrier in 1889.{{cite book |title=Clinical Approaches and Procedures in Cosmetic Dermatology |vauthors=Almeida G, Marques E, Golovaty R |publisher=Springer International Publishing |year=2017 |isbn=978-3-319-20250-1 |location=Cham |pages=1–10 |chapter=CO2 Laser for Stretch Marks |doi=10.1007/978-3-319-20251-8_12-1 |issn=2511-820X}} In 1936, Nardelli made the first morphologically correct descriptions.{{cite journal | vauthors = Elsaie ML, Baumann LS, Elsaaiee LT | title = Striae distensae (stretch marks) and different modalities of therapy: an update | journal = Dermatologic Surgery | volume = 35 | issue = 4 | pages = 563–573 | date = April 2009 | pmid = 19400881 | doi = 10.1111/j.1524-4725.2009.01094.x | publisher = Ovid Technologies (Wolters Kluwer Health) | s2cid = 7887237 }}

Terminology

Medical terminology for these kinds of markings includes: striae atrophicae, vergetures, stria distensae, striae cutis distensae, lineae atrophicae, linea albicante, or simply striae.{{cn|date=September 2021}}