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Stretch marks are narrow, off-colored streaks that appear on the skin when it expands or contracts too quickly.
Although commonly associated with pregnancy, these band-like striations can form due to regular body growth as well.
People often develop stretch marks during puberty as their body undergoes a rapid spurt of growth. Similarly, sudden weight gain or weight loss can also lead to this form of harmless skin scarring.
Stretch marks are typically considered a female concern largely because they are often associated with pregnancy. However, these marks are not restricted to any one gender.
Men are prone to abrupt body changes as well and can get stretch marks just as easily. This is particularly true of bodybuilders who develop these marks in areas where they form muscle.
Stretch marks are known as striae in medical terminology. The specific names for different types are as follows:
- Striae rubrae: red-colored marks
- Striae albae: silvery-white
- Striae atrophicans: These are caused by skin thinning or atrophy
- Striae gravidarum: pregnancy-related
- Striae distensae: caused by the rapid expansion of the skin
- Striae nigrae: deep-colored marks that appear almost black
- Striae caerulea: dark-blue
What Areas Are Affected by Stretch Marks?
Stretch marks can appear anywhere on the body, but they are more common in areas with high subcutaneous fat.
Moreover, the skin over certain body parts is more prone to stretching, often due to weight gain.
These areas include the abdominal wall, breasts, thighs, upper arms, buttocks, and lower back.
How Do Stretch Marks Form?
There are three main skin layers:
- Epidermis: forms the outermost surface of the skin
- Dermis: lies below the epidermis and is referred to as the middle layer
- Subcutaneous tissue or hypodermis: the deepest layer
Collagen and elastin are proteins that serve as building blocks of your skin.
These structural components are located in the dermis, or middle layer of the skin, and are responsible for its elasticity and resilience.
When the body grows at a faster rate than the skin does, the collagen and elastin are unable to keep up.
In other words, the skin may not be elastic enough to adapt to the rapid physical changes.
When your skin overstretches, the connective fibers may extend beyond their elastic capacity and snap under pressure.
As the skin tries to repair itself and recoil to its original shape, stretch marks form in the middle layers of the skin.
They become visible as patches of parallel stripes or lightning bolts on the surface.
When the skin is not flexible enough to stretch beyond a point, it tears and exposes the deeper layers. These layers appear as reddish stretch marks on the outer surface.
Stretch marks are more likely to form if the skin loses its elasticity, often due to a rise in certain hormones released by the adrenal glands.
What Do They Look Like?
The internal tearing of the skin tissue exposes the blood vessels underneath, making the stretch marks appear pink, reddish brown, or purplish when they first develop.
The stretched-out skin often becomes unusually pink, papery, and itchy even before the striations appear.
Once formed, they emerge as fine, shriveled streaks that are raised above the surrounding skin. The deep color of the newly formed scars eventually fades into a lighter silvery hue.
The wrinkled lines flatten over time and become consistent with the rest of the skin.
While the scarring usually becomes less conspicuous eventually, the stretch marks may never disappear completely.
What Causes Stretch Marks?
1. Sudden weight gain
Obese and overweight people usually have stretch marks on different parts of their body where the skin is stretched beyond its elastic bandwidth such that it tears.
This kind of skin tearing occurs in the dermis, or middle layers, when the skin is unable to expand fast enough to accommodate the growing size of the body.
The scarring is more intense and prevalent in people who gain a significant amount of weight in a relatively brief duration, as opposed to people who increase their weight gradually.
The flexibility of your skin depends upon the collagen and elastin in it. When your body grows, these structural proteins make your skin grow accordingly but at their own measured pace.
If the body expands too much too quickly, the collagen and elastin will not be able to make your skin grow at the same rate.
As a result, your skin will be pulled apart and the connective fibers in the dermis will rupture. These effects lead to the formation of stretch marks.
2. Weight loss
Conversely, sudden weight loss can also cause stretch marks.
When your weight reduces drastically in a short period, your skin fails to shrink at the same pace as the body, leaving you with excess skin.
As there isn’t enough surface area to accommodate the extra skin, it can fold and compress other areas of the skin.
The surplus skin can cause stretching and tearing.
Bodybuilding exercises are designed to increase your muscle mass. People who regularly engage in such strenuous workouts often undergo a rapid physical transformation as their muscle size increases.
As the muscle grows, the skin over it may become overstretched and tear. Hence, stretch marks tend to appear in areas with increased muscle formation.
4. Overuse of cortisone skin creams
Steroid-containing creams can compromise the structural integrity of your skin when used for an extensive period of time without a break.
Skin atrophy, or thinning of the skin, is one of the most common and well-established side effects of topical corticosteroids.
The higher the potency of the cream, the more severe the skin damage.
Thinning of the skin makes it more vulnerable to tearing and scarring. If you discontinue using the topical corticosteroid during the early stage of skin atrophy, the damage can be reversed.
However, prolonged and uninterrupted application of topical corticosteroids can damage your skin beyond repair and can lead to the development of permanent stretch marks.
This kind of skin damage can also result if you take high doses of oral corticosteroids for several months or longer.
Stretch marks are a common occurrence during pregnancy, when a woman’s body transforms in a matter of months.
The abdomen expands rapidly and drastically and the rest of the body can also experience significant weight gain.
The weight gain can be more prominent in some parts than the others. For instance, childbearing women are more likely to accumulate weight in the thighs and legs.
As the skin is pulled in different directions, stretch marks may develop on the expanding body parts.
The first sign of scarring usually appears when the woman enters her final trimester. Women who were on the heavier side even before the pregnancy started are more susceptible to stretch marks.
In addition to the pregnancy-induced weight gain, expecting women also experience certain hormonal fluctuations that contribute to the development of stretch marks.
Women who are pregnant with multiple babies will inadvertently have a larger abdominal circumference than those who are carrying only one baby. Therefore, they have a higher tendency to develop stretch marks.
Moreover, women who conceive at a young age are more likely to get stretch marks than older mothers.
Up to 90% of all pregnant women develop stretch marks. The marks usually appear over the abdomen, on the thighs (inner and upper), and behind the knees.
6. Hormonal changes
The human body goes through a phase of transition during puberty, which is marked by rapid hormonal changes.
The same is true of pregnancy. These hormonal fluctuations render your skin more prone to tearing when stretched.
During puberty and pregnancy, the production of cortisone hormone in your body increases. The elevated cortisone makes your skin retain more water and become less elastic.
Moreover, the bonds between the collagen fibers weaken. So, when the skin is stretched too much, the collagen fibers break more easily and stretch marks emerge thereafter.
People who have a family history of stretch marks are likely to get them as well. This genetic predisposition applies predominantly to pregnancy-related stretch marks.
If other women in your family have experienced a similar condition, when pregnant, you have a high risk of developing them.
Your genes may suppress the expression of the collagen and fibronectin genes. As a result, your skin is less elastic and more prone to tearing, resulting in the formation of stretch marks. (1)
The exact genetic mechanism that makes one prone to this condition needs further investigation to be established clearly.
8. Other Conditions
Cushing syndrome is characterized by a heightened activity of the adrenal cortex, which leads to excessive production of cortisol hormone in the body.
The surge in the cortisol levels is associated with reduced skin elasticity. Increased amounts of cortisol can weaken the collagen fibers, thereby increasing the risk of skin tearing.
Ehlers-Danlos syndrome is yet another disorder that can make your skin unusually stretchy and prone to bruising.
Patients with Marfan syndrome usually develop stretch marks on their shoulders, flank, and buttocks. This is due to the reduced collagen formation and weakened skin tissue brought about by this condition.
Certain medications that suppress collagen synthesis can make your skin less elastic and prone to tearing.
How Are Stretch Marks Diagnosed?
Your doctor will recommend the appropriate treatment for stretch marks once the cause behind the scarring is identified.
To get a clearer understanding of your skin condition, the doctor will:
- Inquire about your symptoms.
- Take into account your medical history.
- Physically examine the affected skin.
If this preliminary assessment fails to provide any definitive answers or insights, your doctor may order additional tests to reach the root of the problem.
Treatment for Stretch Marks
Stretch marks do not pose any danger to your health, but having them can make you self-conscious. For some people, they can be a source of anxiety and decreased confidence.
In most cases, stretch marks become less visible over time without any medical intervention.
However, if the scarring is extensive and appears on the commonly exposed areas of the skin, you may consider some treatment methods that can help diminish the appearance of stretch marks.
It is unlikely that the scar will go away completely, but the objective of treatment is to:
- Increase the production of collagen and elastin fibers.
- Alleviate the redness, swelling, and itchiness, especially in the case of striae rubrae.
- Curb the inflammatory response in the case of white stretch marks.
- Moisturize the dry, overstretched skin.
While there are several treatments available for treating stretch marks, none of them guarantees complete removal of the scar. The most you can expect is for the scar to become less noticeable.
Also, just because a particular therapy was a success for someone does not mean it will work for you too.
You may have to try several alternative treatments before you find the one that gives you the best results.
If you are pregnant, you should be especially careful when deciding about a preventative treatment during pregnancy. Consult your ob-gyn before using any cream or ointment to avoid the occurrence of stretch marks.
a. Topical Treatments
A number of the commonly used topical treatments for stretch marks were found to be ineffective in preventing pregnancy-related stretch marks.
However, some individual studies highlighted the promising potential of specific treatment strategies, such as a cream with Punica granatum and Croton lechleri resin extract. (2)
According to several published comprehensive reviews, topical management is commonly recommended to prevent and treat striae.
The scarring may be minimized if you treat your skin as soon as the marks begin to show.
Some of the standard topical treatments that can help reduce the degree of atrophic scarring in stretch marks include:
- Cosmeceuticals, emollients, and silicone gels that may be available without a prescription.
- Tretinoin cream, which is a type of retinoid or vitamin A derivative. This cream can make your skin increasingly irritated, red, and prone to peeling.
It should not be used during pregnancy. Tretinoin cream may require a prescription.
Before starting with these treatments, bear the following in mind:
- Topical treatment may be more effective in reducing the appearance of stretch marks when used in the early stages. So, start applying the product as soon as you notice the scar forming.
- Apply the product to the affected area, and massage it gently so that it seeps into the skin. Gentle circular motions help stimulate blood flow in the area, allowing better product absorption.
- Consistency is key if you want the topical therapy to bear fruit. You must apply the product every day for several weeks at a stretch to get the desired results.
b. Dermatological Procedures
The following cosmetic procedures can be performed by a dermatologist to make stretch marks less visible. However, none of these methods can permanently remove them.
- Chemical peel: Chemical peels have an acidic composition and are best used under the guidance of a skin specialist to avoid any skin reactions.
This skin therapy involves applying a chemical solution to the affected skin to stimulate cell turnover in the area. This kind of topical treatment helps exfoliate the scarred skin.
As the old layers of skin peel and are replaced by fresh new ones, the appearance of the scar diminishes. (6)
- Laser therapy: Laser treatment is a relatively expensive clinical procedure that requires the trained expertise of a dermatologist or cosmetic surgeon.
In this treatment, the stretch marks are exposed to a focused laser beam. This process speeds up the removal of dead and damaged skin tissue.
Laser therapy also facilitates speedy skin regeneration, which can help lighten the skin scars to a great extent over multiple sessions.
- Microdermabrasion: Microdermabrasion is a clinical procedure aimed at promoting new skin growth but without the use of chemical agents or invasive tools.
This treatment uses a concentrated spray of crystals to exfoliate the surface layer of the scarred skin. The light abrasive action of the crystals helps remove the dead skin cells and improve the overall appearance of the skin.
- Radiofrequency: Radiofrequency devices may be used for tightening lax skin and increasing collagen production.
Both actions may help diminish the appearance of stretch marks. (6)
- Microfocused ultrasound with visualization: This procedure is regarded as a safe and effective treatment option for the improvement of skin elasticity, particularly in the face and neck.
This procedure, when performed on stretch mark-ridden skin, may yield positive outcomes for scar reduction. (7)
- Microneedling: Microneedling is another form of professional skin exfoliation that uses tiny needles to remove dead epidermal layers and stimulate the skin renewal process.
Treating the skin with microneedles helps trigger collagen synthesis, which leads to the formation of fresh layers of skin. Speedy skin regeneration is the only way to reduce the visibility of scars, including stretch marks.
Your skin specialist will determine the best treatment technique for your case, after taking into account all the relevant factors, which include:
- Your overall health
- Your age
- The length of time you have had the stretch marks
In many cases, dermatologists recommend a combination of therapies instead of just one.
Combination treatment gives you the best of what every technique has to offer, which usually leads to fast and enhanced skin healing.
However, before you proceed with any of the above-listed skin treatments, you must educate yourself about potential risks and side effects.
You may experience minor skin irritation after undergoing most of these skin procedures. However, it will last only for a brief period and resolve on its own.
For instance, a lot of people report having some degree of redness and swelling in the skin, which usually subsides within a few hours or days.
Speak with your doctor at length to know just what to expect from each of these treatment options.
Your skin is delicate and needs to be handled gently and carefully. Make sure to get treatment only from trained skin professionals, such as board-certified dermatologists, to minimize the possibility of adverse reactions.
Do Home Treatments Work?
Stretch marks are such a common occurrence across generations and genders that people try different home treatments in the hopes of reducing their appearance.
Certain topical remedies that address stretch marks have become quite popular among general users. These include cocoa butter, olive oil, shea butter, aloe vera, coconut oil, and vitamin E.
These alternative therapies gain legitimacy from anecdotal merit but carry little to no scientific support.
However, one small-sized study found bitter almond oil to be helpful in making the stretch marks slightly less conspicuous when massaged into the affected skin. (10)
Stretch marks are more prominent in naturally tanned skin. A self-tanner may be useful in hiding both early and mature marks. Bear in mind, however, that this technique does not offer removal of the scar.
Can Stretch Marks Be Prevented?
There are no sure-fire ways to prevent stretch marks from occurring.
The commonly used preventative tools, measures, and therapies may or may not give the desired outcome, but you can try various approaches to minimize the risk.
Although topical emollients, lotions, and creams are largely ineffective in removing stretch marks, they may help alleviate the itchiness associated with these scars by keeping your skin moisturized.
A comparative study suggested that oral supplements that contain a herb called centella or hyaluronic acid may be effective in preventing stretch marks. (11)
However, this claim has to be substantiated by further large-scale studies.
Here are some of the things you can do to prevent getting stretch marks.
1. Stay hydrated
Drink plenty of fluids throughout the day to keep your body sufficiently hydrated.
Maintaining optimal fluid intake ensures that your skin is well hydrated. Well-hydrated skin is likely to become supple and elastic, making it less susceptible to tearing when pulled apart by rapid weight gain.
On the other hand, dry skin has a greater tendency to tear and form stretch marks than well-hydrated skin. Hence, it is imperative to meet your fluid needs daily.
It is best to spread out your fluid intake over the entire day, so that your skin remains sufficiently hydrated at all times.
You can break down your daily water intake by drinking one or two glasses of water at regular intervals throughout your waking hours.
It is advised that you drink at least 8-10 glasses of water daily. (12)
2. Maintain a healthy weight
Weight stability is fundamental to the avoidance of stretch marks. Any sudden changes in your body size can pave the way for these marks, which applies to both weight gain and weight loss.
Remember that even healthy weight gain due to muscle buildup can trigger the formation of these scars.
Thus, if you wish to keep your skin free of stretch marks, strive for progressive muscle formation and design your exercise routine accordingly.
Weight management is especially recommended for pregnant women. They are already undergoing a significant body transformation and any extra weight gain may increase their chances of getting stretch marks.
Thus, you should ask your ob-gyn to specify the appropriate weight gain for a healthy pregnancy. Do your best to keep your weight within the healthy range.
3. Avoid tanning and direct sunlight
People who have a tendency to develop stretch marks should not go out in the sun without proper skin protection. Sunlight contains UV rays that can damage the collagen fibers in your skin.
To prevent this UV-induced skin damage, apply a premium-quality sunscreen on your exposed skin whenever you step out. It may also help to wear sun-protective clothing to cover bare skin.
Avoid tanning beds if you are prone to stretch marks, which expose your skin to UV radiation and make it increasingly brittle.
There are safer ways to give your skin a tanned hue without inviting stretch marks, such as:
- Using a sunless tanner
- Applying a bronzer
- Going for a spray tan
Who Are at Risk?
Stretch marks figure as one of the most common cosmetic concerns that afflict people across all ages and genders.
This form of scarring usually occurs during puberty, which is a rapid phase of growth. Nearly 70% of girls and 40% of boys develop stretch marks during their teenage years.
The stretch marks commonly appear in areas where the skin is subjected to prolonged and extensive stretching. The more they grow, the greater the stretching.
Stretch marks usually occur on the following sites:
- Childbearing women usually develop them on their abdomen and breasts.
- Adolescents tend to get them on their thighs, breasts, and buttocks.
- Bodybuilders or weight lifters usually build muscle mass on their shoulders, where the stretch marks may occur.
What to Do with Itchy Stretch Marks?
Stretch marks usually form when the skin is pulled apart so much that it ruptures. This kind of dermal tearing is more common in dry skin, which is characteristically itchy.
When the skin fiber breaks, the nerves in the area trigger an itchy response, which further aggravates your skin discomfort.
The itchiness associated with stretch marks can also be brought on by the healing process of the damaged skin. As the body tries to undo the skin tearing, the affected area may turn unusually itchy.
You must resist the urge to scratch that itch to avoid further skin damage. Your skin is already in a brittle state, and rubbing or scratching can lead to further tearing.
Instead, apply a good-quality moisturizer on the affected skin to keep the itchiness under control.
Drink plenty of water to hydrate your skin from within. You can also use some home ingredients to soothe the itch, such as coconut oil, vitamin E oil, and cocoa butter.
Taking hot showers can further dry out your skin and worsen the itch. So, it is best to bathe in room-temperature water.
Do not to spend too much time in the shower or bath. Prolonged exposure to water can strip the moisture off your skin and cause microscopic tears in the dermal barrier.
Myths and Facts
1. Thin people do not get stretch marks.
It is generally assumed that thin people do not get stretch marks, but this is entirely untrue. Anyone can develop these marks, regardless of their body weight or physique.
These harmless scars are part and parcel of growing up, and they often occur during adolescence, which is a period of rapid physical growth.
Besides, thin people are not immune to certain hormonal imbalances, which make one prone to stretch marks.
To think that they are only induced by weight gain and therefore cannot affect thin people is a gross misjudgment.
2. Stretch marks are caused only by stretching of the skin.
If you think that stretch marks can only appear when your skin is overstretched, think again.
It is true that your skin fibers usually rupture when they are extended beyond their elastic capacity. However, other factors can also make your skin tear without any physical strain.
An excess of glucocorticoids and certain other hormones in your body can diminish the elasticity of your skin.
As a result, the collagen fibers may break at the slightest bit of exertion. This kind of skin atrophy can make you more susceptible to stretch marks.
3. Weight loss can help you get rid of stretch marks.
Because stretch marks are typically associated with drastic weight gain, it is often wrongly assumed that losing the extra weight will make the scars disappear or become less noticeable.
Healthy weight management can yield a number of health benefits, but it does little to improve the appearance of stretch marks once they have already formed.
When to See a Doctor
Consult with your doctor if the stretch marks:
- Cover an extensive part of the body.
- Develop quickly or without any discernible cause.
- Cause itchiness.
What your dermatologist may ask you:
- Have you had stretch marks before?
- When did these marks first appear?
- Are you currently on any skincare medication or otherwise?
- Have you used a cortisone cream on your skin?
- What other symptoms do you have?
- Is the affected site itchy?
What you may want to ask your dermatologist:
- Is it possible to remove the stretch marks completely and for good?
- Can these marks indicate or lead to any serious health risk?
- How common are these?
- Is there any way to fade these scars and make them less noticeable?
- How can I prevent stretch marks during pregnancy?
Expert Answers (Q&A)
Answered by Dr. Dina Keen, MD (Dermatology)
Yes. A stretch mark is a type of scar caused by ruptured collagen and elastin in the dermis. Vitamin A is important for the development of collagen, which plays a crucial role in keeping our skin strong and elastic.
Also, local treatments with retinoids (derivative of vitamin A) such as tretinoin cream can help restore damaged collagen.
Yes. Sometimes when the cause of stretch marks is no longer present, the stretch marks can disappear on their own. However, in most cases, they just become less visible and fade over time.
Bitter almond oil as a base mixed with bitter orange oil, patchouli oil, neroli oil, pomegranate oil, or lemon oil may help reduce stretch marks.
Yes. Genetic skin disorders such as Ehlers-Danlos syndrome and medical conditions such as Marfan syndrome and Cushing’s syndrome can lead to stretch marks.
Some skin conditions requiring long-term use of steroid and corticosteroid creams can also result in stretch marks.
Yes, especially during pregnancy or puberty. Sometimes a rapid increase in cortisone level makes the skin lose its elasticity.
• Control your weight.
• Stay hydrated; drink at least 1 to 1.5 liters of water per day.
• Limit your caffeine intake.
• Moisturize your skin regularly.
• Use a good natural brush to dry brush your skin before a shower to increase blood circulation.
• Make sure to take more vitamins C, A, D, E and zinc.
About Dr. Dina Keen, MD: Dr. Keen is a dermatologist with extensive experience in working with various ages, ethnicities, and cultures. She is skilled in acne treatment, laser rejuvenation, body contouring, rosacea treatment, and intense pulsed light (IPL) treatments.
Dr. Keen currently practices at a private clinic in Nottingham, Nottinghamshire, United Kingdom.
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