Medical Edge Newspaper Column

Stretch Marks: Treatable But Not Removable

Feb. 12, 2007
Dear Mayo Clinic:
Are there any effective nonsurgical treatments for stretch marks? -- Chicago

Answer:
With many medical problems, doctors counsel a wait-and-see attitude in order to avoid interventions that may be painful, inconvenient and possibly unnecessary. The problem just might go away by itself.

This is not the case with stretch marks, for which time is of the essence. They are most responsive to treatment before they are six weeks old. Even then, therapy might best be described as "mildly effective." Not every patient responds, and improvement, if it occurs, is often marginal.

Stretch marks develop in a variety of circumstances. Some involve a physical stretching of the skin (such as seen in weight lifters), substantial weight gain or adolescent growth spurts; areas of skin get stretched to the point that collagen and elastin fibers break down. Other cases involve hormonal effects, such as from chronic steroid use or Cushing's syndrome. Sometimes, as in pregnancy, there is both the physical component (stretching of the skin) as well as hormonal change.

Either way, a stretch mark is skin that has lost its elasticity -- it cannot bounce back to its original form -- and the resulting scar-like tissue is shiny, depressed, flaccid, and thin compared to surrounding normal tissue. At first, the stretch mark may be pink, red, or purple; later, it will fade to a color closer to the individual's natural skin tone, though it will plainly be lighter. Its texture, however, will be unchanged.

One way to reduce the likelihood of a stretch mark's occurrence is to maintain a normal weight, which of course has numerous other benefits. And even though it is inevitable that a pregnant woman will put on some weight over a relatively brief period of time, she can work with her obstetrician to minimize that gain by maintaining a proper diet and pursuing a suitable exercise program.

Research has shown that tretinoin cream (Retin-A, Renova) may improve the appearance of recent stretch marks -- those that are less than six weeks old -- though it should never be used during pregnancy, as it might adversely affect the fetus. Tretinoin, when it works, helps to rebuild collagen, rendering the stretch mark more similar in appearance to one's normal skin. Once the mark is fairly well established -- that is, it's no longer reddish but light -- it tends not to respond to this treatment.

Another option, which also is best used when the stretch mark is new but still has some effectiveness when it's older, is pulsed dye laser therapy. Used at wavelengths of light that are non-ablative (will not remove any skin), the treatment remodels the dermis (the layer of skin just beneath the surface layer, the epidermis) by stimulating the growth of fibroblasts, cells that help produce the elastic tissues collagen and elastin.

Two leading options for older stretch marks are microdermabrasion and excimer laser therapy. Microdermabrasion uses mineral crystals blown onto the target tissue. This "polishing" gently removes the skin's topmost layer, which, when effective, results in new growth that is more elastic.

The excimer laser, an altogether different system from the pulsed dye laser, does nothing for collagen or elastin growth. Instead, its aim is repigmentation by stimulating melanin production. If it works, the old and lighter scar is rendered similar in color to the surrounding skin, and therefore less visible.

Some individuals with stretch marks are content to live with them, and therefore seek no treatment. But for people who find them unsightly and unacceptable, help is available. They should work with a dermatologist or plastic surgeon to choose the most appropriate treatment. Factors to consider include age of the stretch mark, convenience of treatment (therapies differ in length and frequency of sessions), and cost (being cosmetic, these options are usually not covered by health plans). Patients also need to be advised that treatment will, at best, be only partially effective. But for lots of people, that may be enough.

-- P. Kim Phillips, M.D., Dermatology, Mayo Clinic, Rochester, Minn.