A Consultant Physician and Dermatologist at Edo State University, Uzairue and Edo Specialty Hospital, Benin City, Dr. Aisha Sokunbi says ALEXANDRE OKERE the causes, prevention and management of stretch marks
How would you define stretch marks?
Stretch marks, medically known as striae distensae, refer to the appearance of thin, linear scar lines that often appear red, brown, or whitish, and in some cases purplish, usually in areas of marked skin that stretch on the body. These lines come from damage in the dermis, the middle part of the skin, resulting in scarring of the dermis.
What are the causes ?
There are several types of stretch marks, often related to the underlying cause. Overall, stretch marks occur due to rapid stretching of the skin which damages the supporting structure and tissues of the skin in the dermal layer, such as elastin and collagen. The most common type, which is striae distensae, is seen at puberty due to the rapid growth that occurs in this phase of life with associated fat deposition in different parts of the body. In women this is common around the chest, hip and buttocks, while in men it can be seen around the pelvic area and on the shoulder in bodybuilders. There are striae gravidarum, which are due to rapid stretching of the skin of the abdomen and breast during pregnancy.
Stretch marks are also commonly seen in overweight or obese people and in people who abuse steroids – whether orally or in creams – most commonly in skin lightening (bleaching) creams. Stretch marks can be caused by medications that cause water retention, weight gain and stretching of the skin, including steroid medications – whether oral, injectable or topical. Hormonal birth control pills and injections can also cause stretch marks.
Prolonged use of steroids can lead to a condition known as Cushing’s syndrome, which also leads to increased levels of the hormone cortisol, often associated with stretch marks. In this type, these stretch marks appear as large purplish bands or lines in areas of rapid stretching, although they can occur all over the body, even on the face. This type can rarely be associated with tearing and bleeding from the affected sites due to marked skin lesions. Some studies have linked stretch marks to an underlying genetic predisposition.
How common are stretch marks in Nigeria?
Stretch marks are common all over the world, including in Nigeria. This is because it follows the normal physiological changes seen in the body during puberty and also during pregnancy. However, with the recent obsession with the use of skin lightening products, an increase in the prevalence of stretch marks, which is a notable complication of bleaching creams, is expected. There are no studies yet found on the prevalence of stretch marks in the Nigerian population. However, the prevalence of skin bleaching, which has become a silent epidemic in Nigeria over the years, was estimated at 40.9% in a study by Egbi et al. in May 2021. From this, one can extrapolate that these numbers can lead to complications such as stretch marks from using these skin lightening products.
What is collagen and what role does it play in stretch marks?
Collagen is a protein found in abundance in the dermis of the skin that serves to provide structural support to the skin framework. It forms a network of cells called a fibroblast which is responsible for regenerating new cells in the skin and regrowing cells, replacing damaged skin cells. Stretch marks come from the damage of these collagen fibers in the skin as a result of the rapid stretching of the skin over a short period of time.
What are the other risk factors?
Other risk factors for stretch marks also include the use of anabolic steroids by athletes, the female sex due to their body constitution, which causes rapid fat deposition in certain parts of the body during puberty; and pregnancy. Due to the paid stretching of the skin of the abdomen and breasts as the baby grows inside, the mammary ducts widen in preparation for breastfeeding. Others include a family history of stretch marks, rapid growth during puberty, rapid weight gain and loss, which causes excessive stretching and breakdown of the skin’s collagen support network; obesity, which leads to rapid and excessive storage of fat under the skin, leading to rapid stretching of the skin; surgical procedures such as breast and buttock enlargements that cause localized stretching of the skin in the affected areas, genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome.
How does pregnancy cause stretch marks?
During pregnancy, due to the rapid stretching of the skin as the fetus grows and the rapid weight gain experienced by mothers, there is a breakdown of collagen fibers in the skin, resulting in the appearance of stretch marks. Also, pregnancy hormones can cause fluid to be drawn into the skin, which causes the bond between collagen fibers to relax and loosen, resulting in stretch marks.
How to identify stretch marks?
Stretch marks are easily identified by their common clinical manifestation on the skin. It usually appears as thin linear lines or bands on the skin. They are reddish, brown or white in areas of rapid skin growth such as the trunk, lower back, hips, breasts, thighs and shoulders and are often not aesthetically appealing. Those that result from the use of steroids and skin bleaching agents are usually larger, purple in color and can appear anywhere on the body. The skin of the affected areas is often thin and weakened.
Other conditions, such as linear elastosis, can show similar appearances on the body; however, they appear yellowish and the affected skin looks tight rather than thin.
What are the social and psychological challenges that come with stretch marks?
Stretch marks often pose no medical problem, but they are often of concern due to the unsightly nature of lines on the skin and lack of aesthetic appeal. Another problem is that they are difficult to treat.
This can lead to self-esteem issues, especially in teenagers; and psychologically, it can be damaging, especially in the body-shaming of this fashion-savvy generation. Many people with stretch marks, especially women who are more aware of their appearance, often have self-esteem issues.
Do stretch marks require a diagnosis?
Diagnosis is largely clinical; that is, it is diagnosed from its typical appearance on the skin and also taking into account the areas of the body affected.
Are there other forms of diagnosis?
Sometimes investigations such as skin biopsy, scanning electron microscopy, and transmission electron microscopy may be performed (mainly for academic purposes).
What forms of medical treatment can someone with stretch marks undergo?
Medical treatments include the use of topical and oral retinoids which should be done under the supervision of a doctor due to the risk of teratogenicity in women as well as liver damage and increased blood cholesterol and lipids. Other methods include skin micro-needling, use of glycolic acids, laser therapy, and skin dermabrasion.
Are there home remedies for the treatment of stretch marks?
You should know that stretch marks often disappear on their own without treatment, especially at first. There are methods that have been tried in the treatment of stretch marks. Although the best results are achieved when stretch marks are treated in their early stages, when the lines still appear red or brownish. Results are often not satisfactory when treated in the advanced stages, especially when the color begins to tend towards white (striae alba). Few of the home remedies available include the use of retinol-containing creams, pharmaceuticals, vitamin C, and fruit acids, and a diet high in protein, vitamins A, C, E, and D.
Are there other forms of treatment available for people with stretch marks?
Other forms of treatment that should be done under the supervision of a dermatologist are the application of tretinoin products to the skin. The use of retinoids, such as adapalene, should be strictly prescribed by a physician and monitored due to its unwanted side effects. There are no well-known effective therapies for stretch marks. By themselves, they may gradually fade over time.
Based on the causes you described, are stretch marks preventable?
Although they are not completely preventable as they can result from normal physiological changes in the body, they can be avoided in some cases. They can be avoided by avoiding the use of steroids, whether oral medications, injectables or overuse of bleaching creams which often contain very strong steroids. Also, weight gain and weight loss should be approached gradually to allow enough time for the skin and its supporting structures to adapt to the ongoing changes in the body and the skin in particular. It is advisable to avoid aesthetic enhancement procedures, especially for people who already have background risks such as a familiar predisposition.
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