Yes, the good news is that something can be done, but you won’t find it online or in U.S. health food or department stores. A friend of mine is 7 months pregnant and is horrified by the stretch marks on her abdomen. She read on the internet that rubbing Vics VapoRub on the stretch marks several times daily will get rid of them. She also read that she could open a Vitamin E capsule and rub the contents onto the marks, so she’s been doing that. too. So far, she has noticed no change. No surprise there! The medical term for stretch marks is striae distensae. These occur when the skin is abnormally stretched in a rapid amount of time (ie, pregnancy, significant weight gain, rapid growth during puberty). As a result, the skin’s support structure of collagen and elastin breaks down and ruptures. One way to explain this to patients is to say that stretch marks are actually a scar that has formed from the inside out, rather than a scar that happens when the skin is externally wounded. Discoloration from these marks tends to fade over time, but the tread-mark appearance of the skin rarely returns to its original smooth state. Not everyone gets striae though. There appears to be a genetic tendency toward them, but the exact link is not clear. There does not seem to be an ethnic tendency toward stretch marks, as all races can be affected. The type of discoloration may vary, however, in different skin tones, as those with fair to light skin typically have pink-tinged stretch marks while darker skin tones tend to be more heavily pigmented. Conventional Treatments Currently, there are a variety of treatments that dermatologists may prescribe including topical tretinoin, chemical peels, microdermabrasion and non-ablative laser treatments. Brief descriptions of these conventional treatments follow. Tretinoin: Tretinoin (Retin-A, Renova, or in generic form) can have a modest positive effect.1-4 A 0.1% concentration of tretinoin has been the most studied, and the best results are seen when it is used at the first signs of stretch marks (stria rubra) but not when the stretch marks are mature (stria alba).Typical improvement in these trials is a 8% to 20% reduction in length and width. The dilemma for expectant mothers is that tretinoin cannot be used during pregnancy, and is also contraindicated if the mother-to-be intends to breastfeed her baby. Lasers/Light/Radiofrequency Devices: Intense pulsed light (IPL), pulsed dye lasers (PDL) emitting 585 nanometers (nm) of light, and the xenon-chloride laser (Excimer) emitting 308 nm treatments result in varying degrees of clinical improvement.5-10 Neodymium-doped YAG (Nd:YAG), diode and fractional photothermolysis (ie, Fraxel) are the newer applications of laser technology to venture into treatment of stretch marks, all showing encouraging preliminary results.11-17 Preliminary studies show radiofrequency devices (ie, Thermage) used in combination with PDL to be safe and effective.18 Acid Peels: Trichloroacetic acid (TCA) peels may be of some help for improving the appearance of stretch marks when used at the proper concentration (typically 15% to 20% TCA) and applied by a dermatologist or cosmetic surgeon skilled in the use of this type of peel.19 There is also one report using 20% glycolic acid (GA), an alpha-hydroxy acid, that found improvement of existing stretch marks.20 However, the GA was used in conjunction with either 0.05% tretinoin or 10% ascorbic acid, so it cannot be determined which of the compounds produced the clinical improvement. Microdermabrasion: There is insufficient literature about the efficacy of microdermabrasion for stretch mark improvement. A study from an Egyptian group showed promising results after five treatment sessions at weekly intervals to half of the body with the other half (control) receiving no treatment.21 While there were only 20 people studied, these preliminary results serve as a good starting point for larger studies to be conducted. Alternative Approaches Is there anything your patients can do to improve or eliminate the appearance of stretch marks that is natural? The simple answer is not really. There are a lot of creams, ointments, vitamin preparations and plant oils available that largely rely on anecdotal evidence only. Below are some common preparations that your patients may be seeing in health food or department stores or on the internet. Your patients may ask you about the following topicals, all of which provide hydration to the skin but are unproven regarding stretch mark improvement: • Hydrating creams: cocoa butter, shea butter • Vitamin capsules: vitamins E, A and C • Plant oils: rose hip, emu, jojoba, castor, sweet almond, avocado, wheat germ, eucalyptus There are also some preparations, tested in Germany and Spain — and not available in the United States — that are combination topicals that have shown some improvement: Combination Topicals: Trofolastin, Verum, Alphastria • Trofolastin cream contains Centella asiatica extract, vitamin E and collagen-elastin hydrolysates. • Verum ointment contains vitamin E, panthenol, hyaluronic acid, elastin and menthol. • Alphastria cream contains hyaluronic acid, allantoin, vitamin A, vitamin E and dexpanthenol. Two of these creams (Trofolastin and Alphastria) were tested against a placebo while the Verum cream was not. All of the studies for these topicals were tested in a small number of participants (n=50 to 80), and each study concluded some effect was had. The active compound(s) in these preparations have not been identified so these studies are really not that helpful. Additionally, there were too few people studied to draw any sort of definitive conclusion regarding efficacy.22-25 Other Topical Products: StriVectin-SD, Mederma, ScarSof Scar Softening Cream, Vita-K Solution, Magia Bella Ultra-Intensive Anti-Stretch Mark Concentrate, Maternity Solutions Stretch Mark Cream, Phytomer SeaTonic Stretch Mark Reducing Cream, Decleor Stretch Mark Restructuring Cream and Mustela Stretch Marks Double Action These products are all heavily marketed and available in department stores, drug stores and on the Internet, and in general contain moisturizing agents, emollients and various plant oils. None of them have substantiated evidence they can make a positive impact on the formation or prevention of stretch marks. And they are ridiculously expensive: a 6-oz tube of StriVectin-SD is $135! What to Tell Your Patients The lack of scientific data available makes it difficult to conclude that any of these topical preparations are effective. Obviously, larger studies that are well-designed are needed to determine the efficacy and safety of these products. Until then, discuss conventional therapeutic options with your patients (tretinoin, lasers, peels), and emphasize that so far, one hasn’t been proven more effective than the other, although laser technology applications seem the most promising. Advise your patients who want to improve their stretch marks to try one of the tested conventional modalities and not waste their money on creams, lotions or plant oils. For further reading and more detail, please refer to this excellent article: Elsaie ML, Baumann LS, Elsaaiee LT. Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update. Dermatolgic Surgery 2009;35(4):563-573. Dr. Taylor, a Fellow in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC, is board-certified in Family Medicine, which she practices in Winston-Salem, NC. Disclosure: Dr. Taylor has no conflict of interest with any subject matter in this article.
ALTERNATIVE APPROACHES TO STRETCH MARKS
Yes, the good news is that something can be done, but you won’t find it online or in U.S. health food or department stores. A friend of mine is 7 months pregnant and is horrified by the stretch marks on her abdomen. She read on the internet that rubbing Vics VapoRub on the stretch marks several times daily will get rid of them. She also read that she could open a Vitamin E capsule and rub the contents onto the marks, so she’s been doing that. too. So far, she has noticed no change. No surprise there! The medical term for stretch marks is striae distensae. These occur when the skin is abnormally stretched in a rapid amount of time (ie, pregnancy, significant weight gain, rapid growth during puberty). As a result, the skin’s support structure of collagen and elastin breaks down and ruptures. One way to explain this to patients is to say that stretch marks are actually a scar that has formed from the inside out, rather than a scar that happens when the skin is externally wounded. Discoloration from these marks tends to fade over time, but the tread-mark appearance of the skin rarely returns to its original smooth state. Not everyone gets striae though. There appears to be a genetic tendency toward them, but the exact link is not clear. There does not seem to be an ethnic tendency toward stretch marks, as all races can be affected. The type of discoloration may vary, however, in different skin tones, as those with fair to light skin typically have pink-tinged stretch marks while darker skin tones tend to be more heavily pigmented. Conventional Treatments Currently, there are a variety of treatments that dermatologists may prescribe including topical tretinoin, chemical peels, microdermabrasion and non-ablative laser treatments. Brief descriptions of these conventional treatments follow. Tretinoin: Tretinoin (Retin-A, Renova, or in generic form) can have a modest positive effect.1-4 A 0.1% concentration of tretinoin has been the most studied, and the best results are seen when it is used at the first signs of stretch marks (stria rubra) but not when the stretch marks are mature (stria alba).Typical improvement in these trials is a 8% to 20% reduction in length and width. The dilemma for expectant mothers is that tretinoin cannot be used during pregnancy, and is also contraindicated if the mother-to-be intends to breastfeed her baby. Lasers/Light/Radiofrequency Devices: Intense pulsed light (IPL), pulsed dye lasers (PDL) emitting 585 nanometers (nm) of light, and the xenon-chloride laser (Excimer) emitting 308 nm treatments result in varying degrees of clinical improvement.5-10 Neodymium-doped YAG (Nd:YAG), diode and fractional photothermolysis (ie, Fraxel) are the newer applications of laser technology to venture into treatment of stretch marks, all showing encouraging preliminary results.11-17 Preliminary studies show radiofrequency devices (ie, Thermage) used in combination with PDL to be safe and effective.18 Acid Peels: Trichloroacetic acid (TCA) peels may be of some help for improving the appearance of stretch marks when used at the proper concentration (typically 15% to 20% TCA) and applied by a dermatologist or cosmetic surgeon skilled in the use of this type of peel.19 There is also one report using 20% glycolic acid (GA), an alpha-hydroxy acid, that found improvement of existing stretch marks.20 However, the GA was used in conjunction with either 0.05% tretinoin or 10% ascorbic acid, so it cannot be determined which of the compounds produced the clinical improvement. Microdermabrasion: There is insufficient literature about the efficacy of microdermabrasion for stretch mark improvement. A study from an Egyptian group showed promising results after five treatment sessions at weekly intervals to half of the body with the other half (control) receiving no treatment.21 While there were only 20 people studied, these preliminary results serve as a good starting point for larger studies to be conducted. Alternative Approaches Is there anything your patients can do to improve or eliminate the appearance of stretch marks that is natural? The simple answer is not really. There are a lot of creams, ointments, vitamin preparations and plant oils available that largely rely on anecdotal evidence only. Below are some common preparations that your patients may be seeing in health food or department stores or on the internet. Your patients may ask you about the following topicals, all of which provide hydration to the skin but are unproven regarding stretch mark improvement: • Hydrating creams: cocoa butter, shea butter • Vitamin capsules: vitamins E, A and C • Plant oils: rose hip, emu, jojoba, castor, sweet almond, avocado, wheat germ, eucalyptus There are also some preparations, tested in Germany and Spain — and not available in the United States — that are combination topicals that have shown some improvement: Combination Topicals: Trofolastin, Verum, Alphastria • Trofolastin cream contains Centella asiatica extract, vitamin E and collagen-elastin hydrolysates. • Verum ointment contains vitamin E, panthenol, hyaluronic acid, elastin and menthol. • Alphastria cream contains hyaluronic acid, allantoin, vitamin A, vitamin E and dexpanthenol. Two of these creams (Trofolastin and Alphastria) were tested against a placebo while the Verum cream was not. All of the studies for these topicals were tested in a small number of participants (n=50 to 80), and each study concluded some effect was had. The active compound(s) in these preparations have not been identified so these studies are really not that helpful. Additionally, there were too few people studied to draw any sort of definitive conclusion regarding efficacy.22-25 Other Topical Products: StriVectin-SD, Mederma, ScarSof Scar Softening Cream, Vita-K Solution, Magia Bella Ultra-Intensive Anti-Stretch Mark Concentrate, Maternity Solutions Stretch Mark Cream, Phytomer SeaTonic Stretch Mark Reducing Cream, Decleor Stretch Mark Restructuring Cream and Mustela Stretch Marks Double Action These products are all heavily marketed and available in department stores, drug stores and on the Internet, and in general contain moisturizing agents, emollients and various plant oils. None of them have substantiated evidence they can make a positive impact on the formation or prevention of stretch marks. And they are ridiculously expensive: a 6-oz tube of StriVectin-SD is $135! What to Tell Your Patients The lack of scientific data available makes it difficult to conclude that any of these topical preparations are effective. Obviously, larger studies that are well-designed are needed to determine the efficacy and safety of these products. Until then, discuss conventional therapeutic options with your patients (tretinoin, lasers, peels), and emphasize that so far, one hasn’t been proven more effective than the other, although laser technology applications seem the most promising. Advise your patients who want to improve their stretch marks to try one of the tested conventional modalities and not waste their money on creams, lotions or plant oils. For further reading and more detail, please refer to this excellent article: Elsaie ML, Baumann LS, Elsaaiee LT. Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update. Dermatolgic Surgery 2009;35(4):563-573. Dr. Taylor, a Fellow in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC, is board-certified in Family Medicine, which she practices in Winston-Salem, NC. Disclosure: Dr. Taylor has no conflict of interest with any subject matter in this article.
Yes, the good news is that something can be done, but you won’t find it online or in U.S. health food or department stores. A friend of mine is 7 months pregnant and is horrified by the stretch marks on her abdomen. She read on the internet that rubbing Vics VapoRub on the stretch marks several times daily will get rid of them. She also read that she could open a Vitamin E capsule and rub the contents onto the marks, so she’s been doing that. too. So far, she has noticed no change. No surprise there! The medical term for stretch marks is striae distensae. These occur when the skin is abnormally stretched in a rapid amount of time (ie, pregnancy, significant weight gain, rapid growth during puberty). As a result, the skin’s support structure of collagen and elastin breaks down and ruptures. One way to explain this to patients is to say that stretch marks are actually a scar that has formed from the inside out, rather than a scar that happens when the skin is externally wounded. Discoloration from these marks tends to fade over time, but the tread-mark appearance of the skin rarely returns to its original smooth state. Not everyone gets striae though. There appears to be a genetic tendency toward them, but the exact link is not clear. There does not seem to be an ethnic tendency toward stretch marks, as all races can be affected. The type of discoloration may vary, however, in different skin tones, as those with fair to light skin typically have pink-tinged stretch marks while darker skin tones tend to be more heavily pigmented. Conventional Treatments Currently, there are a variety of treatments that dermatologists may prescribe including topical tretinoin, chemical peels, microdermabrasion and non-ablative laser treatments. Brief descriptions of these conventional treatments follow. Tretinoin: Tretinoin (Retin-A, Renova, or in generic form) can have a modest positive effect.1-4 A 0.1% concentration of tretinoin has been the most studied, and the best results are seen when it is used at the first signs of stretch marks (stria rubra) but not when the stretch marks are mature (stria alba).Typical improvement in these trials is a 8% to 20% reduction in length and width. The dilemma for expectant mothers is that tretinoin cannot be used during pregnancy, and is also contraindicated if the mother-to-be intends to breastfeed her baby. Lasers/Light/Radiofrequency Devices: Intense pulsed light (IPL), pulsed dye lasers (PDL) emitting 585 nanometers (nm) of light, and the xenon-chloride laser (Excimer) emitting 308 nm treatments result in varying degrees of clinical improvement.5-10 Neodymium-doped YAG (Nd:YAG), diode and fractional photothermolysis (ie, Fraxel) are the newer applications of laser technology to venture into treatment of stretch marks, all showing encouraging preliminary results.11-17 Preliminary studies show radiofrequency devices (ie, Thermage) used in combination with PDL to be safe and effective.18 Acid Peels: Trichloroacetic acid (TCA) peels may be of some help for improving the appearance of stretch marks when used at the proper concentration (typically 15% to 20% TCA) and applied by a dermatologist or cosmetic surgeon skilled in the use of this type of peel.19 There is also one report using 20% glycolic acid (GA), an alpha-hydroxy acid, that found improvement of existing stretch marks.20 However, the GA was used in conjunction with either 0.05% tretinoin or 10% ascorbic acid, so it cannot be determined which of the compounds produced the clinical improvement. Microdermabrasion: There is insufficient literature about the efficacy of microdermabrasion for stretch mark improvement. A study from an Egyptian group showed promising results after five treatment sessions at weekly intervals to half of the body with the other half (control) receiving no treatment.21 While there were only 20 people studied, these preliminary results serve as a good starting point for larger studies to be conducted. Alternative Approaches Is there anything your patients can do to improve or eliminate the appearance of stretch marks that is natural? The simple answer is not really. There are a lot of creams, ointments, vitamin preparations and plant oils available that largely rely on anecdotal evidence only. Below are some common preparations that your patients may be seeing in health food or department stores or on the internet. Your patients may ask you about the following topicals, all of which provide hydration to the skin but are unproven regarding stretch mark improvement: • Hydrating creams: cocoa butter, shea butter • Vitamin capsules: vitamins E, A and C • Plant oils: rose hip, emu, jojoba, castor, sweet almond, avocado, wheat germ, eucalyptus There are also some preparations, tested in Germany and Spain — and not available in the United States — that are combination topicals that have shown some improvement: Combination Topicals: Trofolastin, Verum, Alphastria • Trofolastin cream contains Centella asiatica extract, vitamin E and collagen-elastin hydrolysates. • Verum ointment contains vitamin E, panthenol, hyaluronic acid, elastin and menthol. • Alphastria cream contains hyaluronic acid, allantoin, vitamin A, vitamin E and dexpanthenol. Two of these creams (Trofolastin and Alphastria) were tested against a placebo while the Verum cream was not. All of the studies for these topicals were tested in a small number of participants (n=50 to 80), and each study concluded some effect was had. The active compound(s) in these preparations have not been identified so these studies are really not that helpful. Additionally, there were too few people studied to draw any sort of definitive conclusion regarding efficacy.22-25 Other Topical Products: StriVectin-SD, Mederma, ScarSof Scar Softening Cream, Vita-K Solution, Magia Bella Ultra-Intensive Anti-Stretch Mark Concentrate, Maternity Solutions Stretch Mark Cream, Phytomer SeaTonic Stretch Mark Reducing Cream, Decleor Stretch Mark Restructuring Cream and Mustela Stretch Marks Double Action These products are all heavily marketed and available in department stores, drug stores and on the Internet, and in general contain moisturizing agents, emollients and various plant oils. None of them have substantiated evidence they can make a positive impact on the formation or prevention of stretch marks. And they are ridiculously expensive: a 6-oz tube of StriVectin-SD is $135! What to Tell Your Patients The lack of scientific data available makes it difficult to conclude that any of these topical preparations are effective. Obviously, larger studies that are well-designed are needed to determine the efficacy and safety of these products. Until then, discuss conventional therapeutic options with your patients (tretinoin, lasers, peels), and emphasize that so far, one hasn’t been proven more effective than the other, although laser technology applications seem the most promising. Advise your patients who want to improve their stretch marks to try one of the tested conventional modalities and not waste their money on creams, lotions or plant oils. For further reading and more detail, please refer to this excellent article: Elsaie ML, Baumann LS, Elsaaiee LT. Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update. Dermatolgic Surgery 2009;35(4):563-573. Dr. Taylor, a Fellow in the Department of Dermatology at Wake Forest University Baptist Medical Center in Winston-Salem, NC, is board-certified in Family Medicine, which she practices in Winston-Salem, NC. Disclosure: Dr. Taylor has no conflict of interest with any subject matter in this article.
