They are long, thin and mostly parallel to one another. They start off as red or purple and gradually fade to a silvery white. Doctors often refer to them as stria, striae or, during pregnancy, striae gravidarum. And the rest of us just call them ‘stretch marks’.

Stretch marks are common and rarely a sign of a medical condition, although they do cause distress of a cosmetic nature. Generally induced by excessive stretching of the skin, they affect both genders, although in different ways.

Among women, they usually appear in areas of the body that store fat – such as the abdomen, breasts, upper arms, buttocks and thighs.

They also appear on the backs of teenage boys and shoulders of body builders.

They get etched as skin gets stretched.

Often associated with pregnancy, stretch marks are generally formed during periods of rapid weight gain or weight loss – typically during puberty or when on corticosteroid medication. And chances are that if one of the parents have stretch marks, the child is predisposed to developing them as well.

Sometimes, however, an underlying health condition or syndrome such as Cushing’s Syndrome or Marfan Syndrome can also set off the development of stretch marks.

Let’s take a look at what goes on beneath the surface. Normally, skin is elastic enough to bear the stretching that occurs in the normal course of growth. The middle layer of skin – the dermis – contains strong, fibres, namely collagen and elastin, that assist the skin to stretch with growth.

But during periods of rapid change in body size, when the stretching is too sudden, the skin finds it tougher to adjust, and gets stretched too thin. Something has to give way; and indeed the elastic fibres in the middle layer of skin – the dermis-weaken and tear, making the blood vessels apparent. Initially, the freshly irritated blood vessels make the thinned-out and glossy streak of skin above look red or purple. But eventually, the blood vessels contract and the pale coloured fat cells show through – giving the stretch marks their characteristic silvery-white colour.

Keeping clear of stretch marks

The best way to avert stretch marks is to avoid any sudden weight gain or weight loss. Although this may be hard to manage during pregnancy, the doctor may be able to guide you on the quantum of weight gain that is best for both mother well as the baby.

Exercising regularly and eating right through pregnancy, puberty and periods of intense bodybuilding help to avoid sudden spurts in weight gain or weight loss, and hence the rupturing of the collagen and elastin tissues.

Since no amount of lotions, ointments and creams can influence the development of stretch marks, a dermatologist’s expertise is vital.

Erasing them

According to dermatologists, topical applications such as creams, gels and lotions are of limited use. However they could help keep the skin moisturised when the stretch marks are fresh, red or purple. They can be especially helpful with the itchiness in that phase.

Stretch marks can also be treated with tretinoin cream which works by restoring collagen – the fibrous protein that makes the skin elastic. But these measures need to be supplemented by focused treatments.

For a more successful and aggressive approach to the problem of stretch marks, dermatologists employ one or more of these therapies from their toolkit. Each of these has its specific benefits.

  1. Carboxytherapy significantly contributes to the increase of collagen and elastin in the skin. It reduces the diameter of the torn fibres in the whitish lines of the stretch marks.The therapy consists of injecting medical carbon dioxide in the skin and the body responds by rushing oxygen to that area. This oxygen enables the formation of new blood vessels and tissue regeneration. When the stretch marks are fresh, an improvement of up to 70% are visible after the first treatment itself. But it is necessary to do a series of 8 treatments for the skin to form adequate circulation and new cells on the areas.
  2. Mesotherapy stimulates cells to make elastin and collagen for connective tissue.Numerous amino acids and vitamins are included in the mesotherapy injections and are delivered into the scar tissue as well as below it to stimulate cells into making elastin and collagen for connective tissue.Mesotherapy is usually combined with microneedling or carboxytherapy for better results.
  3. Pulsed dye laser therapy stimulates the growth of collagen and elastin. It works best on newer stretch marks. However, it is used with discretion as darker-skinned individuals may experience skin discoloration.The PDL uses a concentrated beam of light, which is converted into heat, that targets the problem area exclusively.
  4. Fractional photothermolysis like (CO2 or Erbium Laser) also uses a laser. It heats the deeper layers of skin to encourage collagen production.This technique can remove the damaged skin, layer by layer, with precision, until softer, smoother and fresher skin below the surface gets exposed. It works by targeting smaller areas of the skin and causes minimal skin damage.
  5. Fractional RF microneedle treatment helps form new healthy tissue and collagen to repair the damaged areas.This treatment warms up the collagen fibres in a precise and controlled manner, resulting in the production of collagen and elastin getting activated, and stimulating the regeneration processes in the skin.
  6. Microneedle therapy with manual dermal rolling devices (Dermaroller) or electrically driven microneedling devices (Dermapen). These procedures help to resurface the skin.Collagen can be induced to generate by deploying the process of micro-needling. Skin needling or micro-needling also creates a channel for nutrients applied to the skin to be better absorbed by the epidermis.
  7. Cosmetic surgery may be an option. If there are significant stretch marks on the abdomen, and if there is a large amount of loose skin, an abdominoplasty (tummy tuck) may be recommended. This removes excess fat and skin from the abdomen, and gets rid of stretch marks below the belly button.
  8. Platelet-Rich Plasma (PRP) Therapy can make a significant difference with its ability to stimulate collagen regeneration and resurface the skin. PRP is a skin rejuvenation therapy which uses the innate healing and regenerative powers of your own blood. Your blood platelets, rich in growth factors, are injected into targeted areas of your skin to stimulate and accelerate cell regeneration.

In essence, all of these treatments attempt to reverse damage, restore structure and revive production of the collagen and elastin – the underlying support structure. Once the rejuvenation process is underway, the skin can regain its healthy, firm, supple texture and the stretch marks can be dwarfed into insignificance.

Written by: Dr. Amani Said

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