Stretch Marks: The Causes and Solutions

Pregnancy is (in most cases) greeted with a great deal of excitement. There is just so much to take in. Then, inevitably, worries start creeping in. One of those could be the subject of stretch marks. It would be churlish for anybody to consider this a vanity trip. It is a legitimate concern. So what are the facts about why these dreaded skin changes?

Skin has got underlying connective tissue in the form of collagen. This is responsible for the ‘tone’ of the skin in the sense that its quantity and integrity determines how firm or loose the skin is. When there is rapid distension of the skin, the integrity of this underlying connective tissue could be breached. This can happen in any part of the body. It is often seen in a non-pregnant state and even in men when there is marked weight gain, especially when this happens over a relatively short time. It means, the fibres do not get enough time to stretch and they end up breaking. This is particularly common in areas where the skin is meant to be tight such as the back of the thighs, lower back and the hip area. Stretch marks are also seen in some disease condition where the underlying problem is overproduction of steroids with resultant thinning of skin and rapid weight gain. Cushing’s syndrome is one such condition.

With pregnancy, the abdomen naturally distends. It is designed to do so and therefore can cope with the process comfortably over the 40 weeks or so for a human pregnancy.  However, whilst the abdominal wall can cope with this, the overlying skin may not ‘give’ so easily. As a result of that, the elastic tissue within the inner (dermis) layer of the skin continually stretches and in some cases this gets beyond the breaking point and it starts to give way. The result is those lines (striae gravidarum) or, as we all call them; stretch marks. Stretch marks are therefore the visible evidence of broken skin supporting fibres. The process tends to start in late pregnancy. The stretch marks, when raw or newly broken tend to appear pink or dark red. They then heal with fibrous tissue (scar tissue) forming and the colour changes to off-white or silvery. These, like all forms of scars, are more or less permanent.

Now for that all important question: Is it possible to prevent stretch marks from developing? Before answering this question, it is important to be aware that the make-up of every person’s skin is unique and different from the next person. So, if your hair or your nails are markedly different even from your own sibling, the skin may be just as different despite the outwardly similarity before it is challenged. It is therefore unrealistic to expect the skin to behave the same even under similar conditions. It is equally naïve to expect that a uniform recipe will work for everybody.

The Cochrane Database of Systematic Reviews, arguably the ultimate authority in global scientific studies, back in 1996 cited a study which showed benefit for some women who used Trofolastin cream for prevention of stretch marks in pregnancy. This study showed that those who used the cream massaged into the abdominal skin fared better than those who used placebo. That was an exciting finding. The cream, a plant extract, contains Centella asiatica extract, alpha tocopherol (Vitamin E) and the enzyme collagen-elastin hydrolysate. More than a decade and a half later, there is a serious problem with this study. One of the hallmarks of a quality scientific study is that the results have to be reproducible. In other words, if the same study is repeated by a different set of researchers, similar results will be obtained. The Cochrane database review in 2011 does not show any similar study or results. It is impossible to imagine that this is because of lack of trying on such a subject of enormous interest and which is potentially very lucrative. Make of that what you will.

Apart from the promise held by the study quoted above, there is no single product with a scientifically proven ability to prevent development of stretch marks.

There is some evidence that regular massage using any type of hydrating cream could help reduce the development of stretch marks or their intensity. The hypothesis is that massage, which is known to optimise blood supply to the treated area, keeps the skin supple and maximises its elasticity and its ability to distend. It is practically impossible to confirm this benefit beyond doubt in a proper scientific setting but it is worth trying in the absence of anything else.

Once stretch marks have developed, many affected women are often on the lookout for a way of eliminating them. You may have read a sales pitch which wishes you to believe otherwise or seen those ubiquitous ‘Before’ and ‘After’ images which promise a lot. The bottom line is that there is no skin preparation that can entirely remove stretch marks. It is important to be aware that healed stretch marks, after the causative distension has gone, are essentially scars. Like all scars, these are permanent. Again, like all scars, they gradually fade and, if not particularly severe to begin with, could effectively disappear with time.

Laser therapy has a role in helping reduce visibility of stretch marks. It is important to be aware that there are several types of laser therapy. For red stretch marks, pulsed-dye laser is arguably the best type. The results can be quite impressive as the marks fade sufficiently to blend into the background. The white or silvery stretch marks are more of a challenge. A 50% fade of the intensity is realistically the best you can expect from laser therapy for these. Anything better should be regarded as a bonus. Fractional laser resurfacing is the best option for these. In most cases, several treatment sessions will be required. What’s more, this treatment may be unsuitable for dark-skinned individuals. Overall, laser treatment is expensive and is out of reach for many people.

Masking

There are many skin preparations that are meant to mask the appearance of the stretch marks. They obviously don’t remove the stretch marks but are largely affordable and are often effective enough to allow those otherwise dreaded scenarios: Cue two piece bikini on a crowded beach.

Stretch marks result from the breaking or tearing of elastic fibres within the inner dermis layer of the skin with the surface remaining intact

The skin damage resulting in stretch marks is permanent

There is flimsy evidence of effectiveness of any skin preparation for preventing stretch marks

Observational evidence suggest regular massage during pregnancy may help moderate the stretch marks

There is no treatment available that can completely eliminate stretch marks

Laser therapy is probably the most effective form of treatment for stretch marks. Whilst it is unlikely to completely eliminate them, it can make them fade significantly. This does not work for everybody and is, in general, expensive.