Stretch Marks, formally known as Striae Distensea is a well-recognized medical skin condition, which though is rarely an issue in terms of health, but is generally a major source of mental distress among the people who are affected.

A 2012 study in the journal Surgical and Cosmetic Dermatology, by a Brazilian research team led by Flavia Addor , suggested that, Stretch marks (distensae striae) are caused by the rupture of collagen and elastin fibres in the dermis, when subjected to fast and intense distension (enlargement or swelling).

They can occur in any individual during situations of cutaneous distension, such as weight gain, physical exercise with fast increase in muscle volume, corticosteroids use etc. However, they are especially common in pregnancy. Stretch marks occur in up to 90% of pregnancies, especially in the third quarter, being a multi-factorial phenomenon.

(When we talk about the layers of the skin, the upper most is the Epidermis, which provides a waterproof barrier and creates our skin tone.

The Dermis lies beneath the Epidermis, which contains the tough connective tissue, hair follicles, and sweat glands. It contains sense organs for touch, pressure, pain and temperature, as well as blood vessels, nerve fibres etc.

The Dermis supplies the Epidermis with nutrients. The Dermis is an app. 2mm thick layer of fibrous and elastic tissue (made from primarily collagen and a bit of elastin)

Acc. to A.M. Oakley & S.S. Bhimji, authors of ‘Stretch Marks (Striae)’, stretch marks occur in pregnancy (43% to 88%), puberty (6% to 86%) and obesity (43%). Striae is more common in females than in males and may be more common in certain races. They can appear more prominent in dark-skinned individuals. A positive family history is a risk factor for striae. During pregnancy, younger age has been associated with more striae than arising in older women.

Addor & team suggest that, there are several treatment modalities for attenuating striae distensae, however once they have occurred, their complete eradication from atrophic areas is still virtually impossible. The team tested certain topical creams for the treatment of stretch marks on pregnant women. They did see improvement in the amount of hydration, skin elasticity, and softness in the treated area. But they also stated that there is no evidence that preventing dryness helps to avoid the formation of striae distensae.

Acc. to Wikipedia research , 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.

Since ancient times, pregnant women have sought remedies to prevent stretch marks during pregnancy. Both ancient Greeks and Romans used olive oil, while Ethiopians and Somalis used frankincense.

Stretch marks appear to be caused by stretching of the skin. This is especially true when there is an increase in cortisone. In other words, 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 fibres, 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 (Click here to know more).

(Cortisone is a synthetic/man-made corticosteroid which is not released by the adrenal gland. It is similar to cortisol, the corticosteroid released by adrenal glands. A cortisone injection can be used to give short-term pain relief and reduce the swelling from inflammation of a joint, tendon or bursa . However, corticosteroid creams, lotions, and pills can cause stretch marks by decreasing the skin’s ability to stretch (Click here to know more)).

Acc. to a 2009 study in the journal of American Society of Dermatologic Surgery, a research team led by Dr. M.L. Elsaie , the first correct description of these lesions was done by L. Nardelli in 1936, calling them Striae Atrophicae. But even now the exact origin of stretch marks and the factors responsible for their development are unknown.

Acc. to Elsaie, there are a number of theories which have been proposed. For e.g. studies have hypothesized that mechanical stretching is the main cause, leading to the rupture of the connective tissue framework. But many authors have denounced this theory, not finding any relationship between growth in abdominal girth in pregnant women and formation of stretch marks. In fact, stretch marks are two and a half times as frequent in women and affect up to 90% of pregnant women. The commonest sites are the outer aspects of the thighs and the lumbosacral region in boys and the thighs, upper arms, buttocks, and breasts in girls.

Normal growth has been suggested as another cause, with these marks commonly developing during adolescence and associated with the rapid increase in size of particular regions of the body.

Another proposed theory, acc. to Elsaie, is the increase in steroid hormones in the body, this is because high steroid hormone levels have a catabolic effect on the activity of fibroblasts and decrease the deposition of collagen in the substance of the dermal matrix.

Obesity and rapid increase or decrease in weight have shown to result in stretch marks.

In certain cases, it can be a genetic issue also. For e.g. K.S. Lee & team, in the 1994 study in the journal Clinical and Experimental Dermatology, suggest that low expression of collagen and fibronectin genes in affected tissue.

Stretch marks development is also seen in cases of typhoid, tuberculosis and chronic liver disease, after intense slimming diets, and people suffering from psychological disorders like Anorexia Nervosa.

Development of stretch marks start with pink-red marks developing on the skin, which tend to increase in length with time and acquire a dark purple colour. Eventually, overtime they become white in colour. Formation of stretch marks has been linked to scar formation and wound healing.

Because stretch marks are more of a cosmetic issue, there are several modalities being suggested for its treatment. But there is no conclusive data on any of them. It’s been also proposed that stretch marks automatically heal with time, but this is a false fact.

Acc. to Elsaie , there have been some improvements in stretch marks with some medicated topical ointments and creams, but the effect was very small and that too during the active stage of stretch marks development. There was no effect of these creams during the mature stage of stretch marks. For e.g. Elsaie found that certain creams based on retinoic acid when tested on women post pregnancy, the lesions decreased in length by 20%, when used for three months.

A 1991 study, in the International Journal of Cosmetic Sciences, by J. Mallol & team , involved 80 women and investigated the effect of massage with a cream containing Centella asiatica extract, vitamin E, and collagen-elastin hydrolysates (Trofolastin, Novartis Barcelona, Spain) and its preventive effect on the development of stretch marks in pregnant women. Forty-one subjects used the cream, and 39 used a placebo. Results showed that 56% of the placebo group and 34% of the treated group developed stretch marks in pregnancy. This study demonstrated that the active component, Centella asiatica, induced significant prevention of stretch mark development. The exact mechanism of action was identified as the stimulation of fibroblastic activity.

Now, there are certain studies which prove the effectiveness of certain creams, but there are not more than a single study substantiating these claims. So, there is nothing conclusive as of now.

A 2012 study in the Journal of Family Practice, by Dr. Jeanne Moore & team, stated that, no topical agent has proven to reduce or prevent stretch marks. For e.g. they found that neither does cocoa butter works, nor does olive oil. A cream containing Gotu Kola extract, vitamin E, and collagen hydrolysates doesn’t prevent new stretch marks but might avoid additional stretch marks in women who had already developed them during puberty.

The American Congress of Obstetricians and Gynecologists Web site states that although many creams, lotions, and oils on the market claim to prevent stretch marks, no proof exists that these treatments work. Using a heavy moisturizer may help keep skin soft, but it won’t help get rid of stretch marks. The American Academy of Dermatology Web site also says that a moisturizer can improve the appearance of stretch marks and reduce itchiness; sunless tanning products can hide the marks .

In a 2003 study in the journal Medicine and Science in Sports and Exercise, by A.C. Schwingel & team , 80 women aged 24 to 53 participated in a 3-month weight-loss program; 29 were on a diet, 31 were on a diet plus aerobic exercise program, and 20 obese women were on a diet plus a resistance exercise program.

The data suggested that the degree of stretch marks does not change with weight loss, regardless of the type of weight loss program. Stretch marks were prevalent in 79% of the women. The central abdomen was the most common area where stretch marks were present. No significant correlation existed between stretch marks and the number of births, the age of the first birth, weight immediately before pregnancy, weight immediately after pregnancy, or weight at age 20.

45% of the participants responded that they did not have negative feelings about having stretch marks, and it appeared that stretch marks did not affect the women’s psychological mood. It was inferred that a weight loss program using diet alone or a combination of diet and exercise did not change the degree of stretch marks.

Another recommended therapy for treatment of stretch marks is oil massage. Various oils like olive, wheat germ, castor oil, mustard oil, avocado oil etc. have been used. But there is just anecdotal evidence to support these claims, and these local remedies remain largely unproven.

Similarly, there are hundreds of creams, gels and ointments which claim to reduce stretch marks, but none of them have been subjected to any clinical investigation or assessment. That’s where one needs to beware of various deceptive advertisements by companies selling you such useless products.

A 2012 study in the journal Complementary Therapies in Medicine, by an Iranian research team led by F. Soltanipoor , assessed fifty pregnant women, who were told to apply olive oil twice a day on the abdominal skin in a gentle manner without massaging it until the delivery. The researchers found that, olive oil does not reduce the incidence and the severity of stretch marks and it could not be recommended for stretch marks prevention.

A 2016 study in the Journal of the European Academy of Dermatology and Venereology, by a British research team led by, S. Ud-Din, reviewed 11 studies to assess the evidence for the use of topicals in stretch marks. The researchers found that, there is a distinct lack of evidence for each topical formulation. The majority of topicals failed to mention their effect on early vs. later stages of stretch marks and their role in both prevention and treatment. In conclusion, there is no topical formulation, which is shown to be most effective in eradicating or improving stretch marks.

Another 2016 study in the British Journal Medical Practitioners, by Indian Researcher Dr. M.A. Keen, found that, the treatment of this cosmetically distressing condition has been disappointing and there is no widely accepted surgical procedure for improving the appearance of stretch marks. Laser therapy may be advocated as a treatment for stretch marks.

In the 2013 study in the British Journal of General Practice, Dr. Brian R. McAvoy , stated that, there is no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received a placebo or no treatment.

An extensive 2014 study in the British Journal of Dermatology, by S. Al Himdani & team, reviewed various studies and articles in English, Spanish, Portuguese, Turkish and French, and found that, few high level evidence based medicine randomized controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae.

Acc. to the 2015 study in the British Journal of Dermatology, researcher F. Wang and team , found that, the elastic fibre network in the dermis gets disrupted in a stretch mark. After giving birth, this network remains disrupted. Elastic fibres give skin its elasticity, or the ability to “snap back,” after stretching. The skin tries to repair the disrupted elastic network but it does not appear to be effective, which in turn promotes the lax, loose skin seen in more mature stretch marks. Wang & team found that, present research of topical treatment options doesn’t find anything currently available to effectively repair those disrupted elastic fibres.

In a 2017 study in the Journal of Cutaneous and Aesthetic , researchers suggested that, “Topical treatments have only mild effects. It is questionable, if creams and ointments with “specific ingredients” exert a significant and better improvement than moisturizers. Topical treatment cannot prevent the occurrence of stretch marks under specific circumstances such as pregnancy “.

Researchers further suggested that, laser treatment can be an effective tool in the treatment of stretch marks, but only effective if the treatment starts in the early development of stretch marks.

A 2017 study in the Journal of American Academy of Dermatology, by British researchers Haque & Bavat , reviewed over seventy articles, and various methods of treating stretch marks that included laser therapy, topicals, UV rays etc. and found that, no treatment till date has proven to be completely effective.

One has to be very careful while using any cream or ointment for the process of reducing stretch marks during pregnancy, as the ingredients in the cream gets absorbed in the skin and may harm the baby. On the other hand, there is no cream or ointment which has any substantial evidence to prove its claims. There are many fly-by-night sellers of such oils and gels, but they are simply bluffing.

Various other therapies have shown positive results like laser therapy, but not in all studies. Also, such therapies are extremely complicated and costly.

Because stretch marks cure still remain largely a mystery, various new therapies are claiming their share of pie. However, the evidence is very weak and extremely small. In a 2014 study, researchers evaluated 8 randomized controlled trials (RCTs) to assess the efficacy and safety of currently available therapies for the treatment of stretch marks. Due to the limited number of patients and high or unclear risk of bias in the studies included in this assessment, the evidence from this review was found to be insufficient to provide clear guidelines for practice. 

However, many of these new therapies can be extremely harmful. For e.g. a 2009 report stated that:

“The Physicians Coalition for Injectable Safety issued a consumer warning about carboxytherapy and mesotherapy injections. These products, touting everything from cellulite treatment to weight loss are not FDA approved, and do not have clinical data that demonstrates results or safety.

Carboxytherapy uses carbon dioxide gas injected under the skin to reduce the look of cellulite, treatment of dark under-eye circles, and stretch marks and is also touted for fat sculpting on the face and the body. “Although many websites or providers claim carboxytherapy is safe and FDA approved, it has not been clinically tested or FDA approved for these purposes,” says Coalition leader Robert Weiss, MD of Baltimore, MD. “Carboxytherapy for use around the eyes is especially dangerous. It could potentially release gas bubbles into blood vessels causing blindness. In addition, the risks of putting carbon dioxide in your body are currently unknown.”

Mesotherapy, also known as injection lipolysis, is a mixture of vitamins, drugs and enzymes that are compounded (mixed together) to make the injected substance. “There is no conclusive, authoritative information that exists, such as unbiased, peer-reviewed clinical studies that meets the standards of an accepted medical journal, measuring both the efficacy and safety of mesotherapy,” says Coalition leader Mark Jewell, MD, Eugene, Oregon. “We don’t know the safety or efficacy of these compounds and, until there exists credible evidence, consumers are advised not to have these injections.”

The Coalition urges consumers to be very selective about cosmetic treatments, and the individuals who provide them.”

When it comes to sportsmen, specially bodybuilders, they employ a number of natural and synthetic ways to enhance their muscle volume. Anabolic steroids, growth hormones, insulin, IGF-1, even site injection oils like Synthol etc. are all being used in the unregulated sports of bodybuilding.

Writer Don Alessi, says that, “these practices force more nutrients and water into the muscle cells and stretch the crap out of the cells along with the connective tissues which enclose them. Cellular osmotic pressure produces muscle tissue when an individual muscle cell becomes excessively filled with water and nutrients. Concurrently, the cell wall swells and thins, becoming increasingly unstable. In protective response to this change, the stretched cell wall triggers an increase in protein synthesis and thickens for survival.”

IMPORTANT CONCLUSION

I really don’t understand, what’s the issue in accepting the truth. In the case of stretch marks, on the face blunt fact is that, there is nothing much you can do about them.

Some therapies may work, but there is no direct clear or long term evidence. You may waste your hard earned money and still feel disappointed, because you are aiming to achieve the impossible. Stretch marks may or may not fade away with time.

The market of stretch marks is rising and is quite prosperous to the ‘fly-by-night’ businesses. In a report , the reason was clearly stated, that “The stretch mark treatment market is dominated by topical treatment. This is majorly attributed to the high cost of other treatments such as laser and Microdermabrasion. Another factor propelling the growth of this segment is the availability and ease of use of these products. Most of the females take treatment for their stretch marks at home only for which they prefer creams, lotions, or oils. Also, the price of these products is comparatively less which makes it more affordable for low to middle-income people.

In developing countries like India and South Africa, people usually go with the products that are cost-effective and easily accessible which is resulting in the high sale of topical products for stretch marks in such countries. Added to that, topical products come with fewer side effects than that of lasers which makes it more trustworthy treatment.”

I tried to search for various local topical options advised and believe me, I couldn’t finish the list, as the recommendations were virtually endless. Coconut oil, castor oil, shea butter, cocoa butter, aloe vera, apple cider vinegar, olive oil, vitamin E, lemon juice, Vicks Vaporub, Vaseline, coffee scrub, baking soda, baby oil, breast milk, almond oil, sugar scrub, tea tree oil, argan oil, turmeric, jojoba oil, Rose hip oil, apricot oil, potato juice, aspirin, egg white… the list continues.

I mean the sheer number of therapies promising the treatment of stretch marks is mind boggling. In a 2019 study in the Indian Dermatology Online Journal, researchers extensively studied multiple processes being used for the treatment of stretch marks, which included, topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q‐switched Nd:YAG, pulse dye and excimer laser.

Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture were also studied. 

Acc. to the researchers, there are various therapeutic strategies available, but so far no single modality is found solely effective. Multiple sessions using different therapeutic modalities targeting skin at different levels are often needed. None of the treatments can provide complete clearance and multiple sessions are always needed.

Please understand that stretch marks do not define your beauty. Having stretch marks don’t make you any less beautiful. This is a simple sign which indicates that you are human.

Stop staring at your stretch marks every day in the mirror. There are some general advices on having a particular type of diet or a supplement, or having more water. But these advices are given for the heck of it. There is no diet, supplement, pill, gel, cream, oil, exercise, medicine etc. which works to reduce your stretch marks. 

If you think people will notice your less than perfect skin, and think something, then you are highly mistaken. People don’t have time and neither are they interested. No one is noticing you or paying any attention to your imperfections.

They are a part of your body. It’s your body’s natural response. They just show that you have grown as a human being. Everyone irrespective of gender, gets stretch marks at some point in their lives. You know why? Because that’s being human.

People call them ‘Tiger Stripes’ or ‘Battle Scars’. Because you have earned them. For e.g. going through the most beautiful experience of motherhood is your achievement and your stretch marks are your trophies. Cherish them, don’t hate them.

You are more beautiful than your stretch marks. If anyone doesn’t accept you the way you are, they don’t deserve you.