Predominantly a skin problem that women and adolescents face, stretch mark or striae as it is medically known, is a type of scar that develops when the middle layer of the skin (dermis) stretches or shrinks too quickly. When the body expands, the connecting fibers in the dermis slowly stretch to accommodate slow growth. With rapid growth, there is sudden stretching and this causes the dermis to tear, allowing deeper layers of skin to show through. The abrupt change causes the collagen and elastin, which support the skin, to rupture. As the skin heals, stretch marks may appear as long, narrow streaks, bands, or lines that can occur on various body parts.
But they eventually fade to a silvery, white, or glossy appearance, due to the pale fat beneath the skin becoming visible instead of the usual blood vessels.
Stretch marks are common, affecting 70% of adolescent girls and can occur in females between the ages of 5 and 50 years. They usually appear in areas where skin is subjected to continuous and progressive stretching; such as abdomen and breast in pregnant women, thighs, buttocks and breasts in adolescents undergoing growth spurts, as well as thighs, hips, upper arms and even lower back for those who are obese or overweight. Genetics and fluctuating hormone levels may also be factors.
Early stretch mark may feel slightly raised and can be itchy but later becomes flattened, thin and turn pink or reddish in colour. Over time, these pink or red marks will fade to a silvery white and less prominent. Stretch marks are usually several centimetres long and 1 to 10 mm wide. Those caused by corticosteroid use or Cushing Syndrome are often larger and wider and may involve other regions, including the face.
Although some stretch marks gradually become less noticeable over time, this can take years.
Types of Stretch Marks
Signs of inflammation due to overstretching are most apparent at this stage and the affected skin turns pink / red or violaceous in colour. These marks are characterized by thickened collagen fibres that become more densely packed, arranging themselves in a perpendicular or parallel pattern. The number of elastic fibres also decreases. Markings may appear flat but can sometimes be slightly raised too. Formations gradually increase in both length and width. At this stage, stretch marks can also become itchy.
Classified as a more chronic or mature stage of stretch mark formation, these appear more irregularly shaped, hypo-pigmented and turning more whitish in color. Some may even develop a slightly wrinkly texture. The progression from striae rubrae to striae albae is gradual and can take several months to years, and which may become prominent with aging as skin loses elasticity.
Stretch marks which develop as a result of pregnancy, appearing mostly on the abdomen, breast and thigh areas, typically occurring around the sixth or seventh month of gestation. These stretch mark may also occur around the lower back area, upper arms, hips and buttocks. This is due largely to a reduction in or weakening of elastin fibres and fibrillin microfibrils (a glycoprotein) in the dermis, mostly attributed to the physical and hormonal changes experienced during pregnancy. Although stretch marks acquired during pregnancy do tend to fade, they do not disappear completely.
Dark grey or black stretch marks that usually develop on darker complexion skin types.
Dark blue / purplish stretch marks that also usually develop on those with darker complexions.
Thinned skin that is associated with stretch marks that may develop in those with Cushing’s syndrome, due to the prolonged use of corticosteroids or after a surgical procedure.
Do's and Don't's
Do give yourself a massage
Massaging the skin in a circular motion with a hydrating oil, may be helpful in keeping the areas moisturized and stretching the skin’s collagen and elastin, making skin more pliant.
Don’t go for drastic weight loss program
Rapid changes in body size should be avoided if possible. Since stretch marks represent small scars, rapid growth of the body can result in tearing of the skin and more stretch marks. Slower changes in body size may allow the skin to adjust more gradually. People with better skin elasticity and less rigid collagen are less likely to develop stretch marks, but it is not possible to modify these skin characteristics at present.
Do more exercises
By exercising, it not only aids in blood circulation, it also promotes anti-oxidants which are really important for stimulating collagen production. With exercise, any bodily repair works much better.
Don’t expose your marks to UV
Avoid getting a suntan especially while on a holiday. It is important to put on sunscreen or sunblock with high SPF (depending on your activity), especially when you have new stretch marks as you don’t want the marks to worsen or darken.
There are many creams, gels and oils that claim to treat stretch marks. They may work for some and not others. If you want to try these topical solutions, ensure that you use the product on early stretch marks. Take time to massage the product into your stretch marks to increase efficacy. Apply the product diligently every day for weeks until you see results.
Emollients and moisturizers are products used to add moisture, relieve dryness and appearance of scales. Emollients and moisturisers are most effective when applied immediately after bathing but can also be applied at other times.
Topical isotretinoin, tretinoin and retinol (another type of retinoid) derived from vitamin A, also known to lighten marks and melasma, may also be used to help reduce severity of scarring and fade early stretch marks.
Medical professionals and doctors may use various procedures ranging from chemical peel, laser therapy, microneedling, to radio frequency and IPL to reduce the appearance of stretch marks. For optimum results, your medical doctor may use more than one procedure.
Light Based Treatments:
Intense Pulsed Light (IPL)
In Singapore, IPL is a popular and well-established means of treating various skin concerns. It is a procedure that uses a flash lamp to improve skin appearance. In IPL, light energy of a precise wavelength is absorbed by the skin, raising its temperature, and cells then respond by stimulating the production of collagen. With more collagen produced, any residual stretch marks that aren’t improved and where redness remains, will help improve its appearance.
Improvement in stretch marks using laser therapy (ablative or non-ablative) usually entails wounding the scarred skin and hoping that the newly healed skin with new collagen will have an improved textural change and more cosmetically acceptable appearance. However, lasers work better with fresh red stretch marks and not so much with the silvery white ones due to their loss of pigment.
Ablative laser treatments use intense wavelengths of light energy to remove the surface layers of skin but they will not remove stretch marks completely, only in reducing their appearance. Ablative treatments may cause redness and irritation after the procedure.
Non-ablative lasers are less aggressive compared to the former. It works by encouraging collagen growth deep within the skin, without affecting the topmost layer of skin. These treatments have few associated side effects, and provide effective results by fading stretch marks. Much like ablative laser treatments, they are unable to completely remove these marks.
Non Light-Based Treatments:
This treatment uses the application of one or combination of acids such as glycolic and salicylic acid to deeply exfoliate the skin to 'burn off’ damaged cells that are several layers deep (depending on the grade of peel). Consider this a more “organic” way of resurfacing the skin. This procedure forces the skin to produce new collagen, improving skin texture as a result. Although chemical peels have been shown to reduce the appearance of stretch marks, they do involve a longer healing process due to the powerful ingredients used.
When used in conjunction with laser therapy or radio frequency, microneedling (short-needled derma roller) which create micro injuries to the layers of skin, through the healing and renewal process, can help to tighten up the laxity in the skin and the surrounding area to improve the texture and tone.
Fractional Radiofrequency Microneedling
When fractional radiofrequency (RF) combines with microneedling, the RF heat penetrates much deeper, leaving the upper skin layer cool. RF technology causes old collagen and elastin fibres to break down in a controlled manner, while microneedling is a procedure using tiny needles to create punctures in the top layer of skin to stimulate healing and cell regeneration.
Within a few hours any redness will generally have subsided. Sun exposure should be avoided for at least one week. Noticeable results are usually visible after two weeks, with improved results over the following three months.
Radiofrequency delivers heat into the skin but at a more superficial lever to trigger collagen production. Heat generated by RF waves works by shrinking the bundles of collagen under the skin. As the collagen becomes shorter, the skin tightens as a result. In response, as the skin heals and renew itself, older damaged tissues are swept away while fresh, new collagen and elastic is being produced. The new collagen can leave the stretch mark smoother in texture and improve the color and overall appearance.
While microdermabrasion will not completely remove stretch marks, studies have shown that this treatment can effectively reduce the appearance of mild to moderate ones.
Microdermabrasion works by buffing the epidermis with a spray head, blasting (or exfoliating) the skin with micro crystals to sand away dead skin cells. This type of exfoliation aids in stimulating the growth of new, healthy cells. You shouldn’t feel any pain or much discomfort while the treatment is being performed. It is a relatively quick procedure (often as part of a facial), with each treatment taking 20 to 30 minutes to complete.
The results of a smoother skin texture is only temporary as it cannot remove the stretch mark completely. Multiple sessions may be required depending on the severity of the stretch marks.