Stretch marks, or striae distensae, much like cellulite, are another common cosmetically-troubling problem for which ideal treatment is still unavailable. Like the American flag, stretch marks come in red, white and blue. Early on, they may be reddish and slightly elevated, later, dusky purple or bluish, and finally, ivory-colored or whitish flattened bands with a wrinkly, crinkly surface. Typically, they appear on the breasts, abdomen, thighs and arms and commonly appear after the skin is excessively stretched as a result of adolescent growth spurt, pregnancy, weight gain and weight lifting. They are estimated to affect seventy percent of adult women and forty percent of young men.
Although much remains to be learned about what causes them, current wisdom suggests that stretch marks result from an overproduction of adrenal glucocorticoid, which accompanies each of the above circumstances. They can also appear following prolonged use of high potency glucocorticoid creams and ointments. Whichever the case, the high level of steroids interferes with the production of collagen and elastin fibers, resulting in a loss of dermal support that leads to tearing when the skin is stretched.
The term stretch marks is actually a misnomer. Although stretching may determine where striae may appear and even in which the direction they run, it does not cause them. In fact, no matter how much you stretch or overstretch, they will not appear unless glucocorticoid steroid levels are increased.
To be effective, treatments must be geared to the particular phase of stretch mark development. Early on, during the reddish-purple phase, therapy must be directed to dealing with dilation of blood vessels and damage to collagen in the dermis. Later, during the white crinkly “mature stretch mark” phase, the approach must address thinning of the epidermis (the topmost layer of the skin) and the inflammation and remodeling of collagen theat leads to the loss of pigment cells or obscuring of normal skin pigmentation.
Unfortunately, we currently do not have any gold standard method for entirely eliminating stretch marks. We do, however, have a number of very effective techniques for improving them. In general, the earlier the mark is treated, the greater the anticipated improvement. Certain lasers and intensed pulsed light therapies (IPL) may be useful for diminishing the vascular dilation of the early phase and for promoting the production of healthy collagen. Light-emitting diodes (LEDs) in the ultraviolet range have stimulated pigment production. Each of these methods usually requires anywhere from six to ten or more treatments. Microdermabrasion, which is little more than epidermabrasion (the kind of skin polishing you might get with an ordinary Buf Puf, Loofah or even a wash cloth) is of little to no value in my experience.
I have found that all all stages, daily topical application of high potency retinoids (vitamin A derivatives), such as Avage, along with alpha hydroxy acids, such as Amlactin, has been helpful for promoting new collagen and elastic fiber production and stimulating the turnover of epidermal cells. Here, too, the earlier treatment is begun, the better.
I have also found that a series of fractional microneedle resurfacting treatments (aka medical microneedling, skin needling, dermal rolling, needle dermabrasion) can be helpful for smoothing the surface of stretch marks.Using a manual roller arrayed with needles or an automated, electric device (e.g. Dermapen), microscopic wounds are created within the stretch marks, which in turn promote new, native collagen and elastic fiber synthesis (neocollagenesis and neoelastogenesis), which can improve the surface tone and texture of the stretch marks. In selected cases, I add subcision for breaking up distorted collagen bands underneath and further stimulating new collagen production.