Striae gravidarum – colloquially called stretch marks – are skin stretch marks (striae distensae; ICD-10 L57.0: Striae distensae).
Stretch marks often form during gravidity (pregnancy), largely due to rapid weight gain on the breasts and abdomen.
Symptoms – Complaints
Stretch marks occur in two versions:
- Striae rubra (= erythematous, i.e. reddish stripes).
- Striae alba (= hypopigmented and thus whitish lesions).
Endspring striae are initially bluish-reddish in color, but later fade and remain as whitish-yellowish sunken striae on the skin.
Localization: preferred abdomen, hips, gluteal region (buttock region) and breast.
Pathogenesis (disease development) – etiology (causes)
The cause of striations is damage to the elastic fibers in the skin, caused on the one hand by the rapid growth of the unborn child and the breast, respectively. Therefore, these stripes are sometimes called stretch or growth stripes.
Furthermore, glucocorticoids, which belong to the group of hormones, play an essential role in the development of stretch marks. These hormones are produced in the adrenal cortex and are present in increased amounts during pregnancy.
Therapy
Depending on the age and appearance of the stretch marks, three goals are pursued: Collagen formation, fading and repigmentation.
Collagen formation
- Collagen production can be improved using hyaluronic acid supplements, if necessary. Other options to stimulate collagen synthesis include chemical peeling and microdermabrasion (controlled, mechanical removal of the upper layers of the skin with small crystals).
- Another option for collagen activation is treatment using fractional lasers. Non-ablative lasers (minimally invasive lasers; fractional erbium glass laser) are said to provide the best results.
Fading
- Pulsed dye lasers (PDL), known as vascular lasers, are used for redness. These can reduce the redness in fresher stretch marks, i.e. contribute to the fading of the same.
Repigmentation
- For repigmentation of striae albae (“white stripes”), melanin synthesis can be stimulated with UV light for a short period of time. Another option for this is the XeCl eximer laser.
Further notes
- Microneedling (see dermaroller below): the procedure caused more pain than laser therapy (neodymium:yttrium albumin perovskite 1340nm fractional nonablative laser, NAFL); erythema (skin redness) and pruritus (itching) occurred with microneedling in 68.3% and 13.5% of women, respectively (laser therapy: erythema: 66.3%; itching: 12.5%). With laser therapy, there was additional crusting (1.9%), hyperpigmentation (1%) and pain that occurred only after treatment (1.9%); in addition, the side effect lasted longer in the group of laser patients (4 versus 3 days)
- As far as relatively fresh striae are concerned, a therapy trial with topical tretinoin (topical therapy) – also called vitamin A acid (short: VAS or all-trans-retinoic acid) – can be performed.
