Stretch Marks (Striae)

Striae, more commonly known as “stretch marks” are a relatively common condition seen in both men and women. They can affect individuals of all ages, and have been reported in adolescence. Although fluctuations in weight as seen in obesity and pregnancy are perhaps the most common causes of striae, there is some evidence to suggest that heredity may play a role in their development. Striae may also be a sign of an underlying endocrine disorder, including Cushing’s syndrome, in which there is an excess production of cortisol in the blood.

Presentation:
Striae can be best separated into active and residual components, based on their appearance and time elapsed from first development. Early striae are typically pink to slightly red, raised lines most commonly seen on the abdomen. They occasionally erupt on the arms, legs and back as well. In darker skinned individuals, early lesions may appear darker than the surrounding skin. Older lesions appear “thinned out”, irregularly shaped lines in a similar body distribution. Rarely, individuals may complain that these areas are itchy, but as a general rule, they have no symptoms.

Treatment:
Striae are best thought of as “scars” on the skin and therefore, pose no significant medical harm to the patient. However, many individuals view these marks as sources of great cosmetic concern and desire treatment. In addition to a complete history and physical examination by your physician, blood work may be needed to evaluate for the presence of an underlying cause for the striae. Given their typical appearance, skin biopsy is generally unnecessary. Unfortunately, treatment options currently available have only been shown to decrease the appearance of these lesions. There is no cure for striae.

Topical use of tretinoin, which is a prescription vitamin A preparation, has been shown to improve the appearance of striae. The use of lasers has also been attempted, namely the pulsed dye, intense pulsed light, and CO2 models. Although improvementis predicated upon the patient and the severity of striae, caution of their use in darker skinned individuals should be observed, as they may increase the darkness and color of the lesions.

References:
Kang S. Topical tretinoin for the management of early straie. J Am Acad Dermatol 1998;38:S90-92.
McDaniel DH, Ask K, Zukowski M. Treatment of stretch marks with the 585-nm
flashlamp-pumped pulsed dye laser. Dermatol Surg 1996;22:332-337.

Brian Walther, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.

Stephen M. Purcell, D.O., F.A.O.C.D.

Professor and Chairman of the Department of Dermatology
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvannia
www.adaltd.com