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Earn your stripes

stretchmarks2Earn your stripes

While stretch marks are—to some women—a badge of honour following pregnancy, many others seek ways to banish them for good. Anna Jean Lloyd reviews the available treatments and technologies

 

In the realm of skin concerns, stretch marks (stria distensae) are among the most prevalent and, maddeningly, elusive to treat. Often associated with emotions of distress, these red, white and purple scars bear a significance for many that is more than cosmetic. The result is a market place saturated with products claiming to remedy the appearance of stretch marks—and an increasingly confused consumer.

Characterised as atrophic linear scars, stretch marks are essentially micro-tears in the dermis, brought on by periods of skin strain, hormonal surges, systemic drug use—or a combination of all. Both women and men are susceptible to stretch marks and those with a personal or family history may be especially at risk.

Pregnancy and adolescence

Stretch marks are most popularly associated with pregnancy. Research by the American Pregnancy Association indicates that approximately 90% of new mothers report stretch marks of varying degrees. However, while some women accept their new skin as a mark of motherhood, the vast majority (89%) buy topical products in an effort to prevent them—an average of two products throughout the term of their pregnancy and spending around $85 in the same period of time.

The same research, in fact, shows that another 69% of new mums will seek therapy post-partum, including a segment of women who describe feelings of “desperation and helplessness” associated with their stretch marks.

These findings were reiterated by a recent study published in The Daily Mail in which 1,736 new mothers were surveyed on the topic of stretch marks. Nearly all of the study participants reported stretch marks due to their pregnancies, with 78% reporting marks on their abdomen and 50% across their breasts, hips and thighs.

Among the respondents, 11% reported being “covered in” stretch marks and one third stated that they were “so embarrassed” by their stretch marks that they did not want partner to see them naked.

While hormonal fluctuations, weight gain and skin stretching contribute to some of the most severe stretch marks being in pregnant women, mothers are not alone in being affected. As much as 70% of adolescent females report stretch marks resulting from puberty or weight gain and an unnumbered cohort of post-pubescent boys are also affected by the same.

In fact, feedback from the retail level indicates that the adolescent market—perhaps ultra-motivated by typical teen self-consciousness—is the major driver in over the counter purchases for stretch mark products.

Of course, no matter who the bearer, not all stretch marks are created equal.

Broadly speaking, stretch marks can be classified in three ways: stria gravidum, stretch marks as a result of pregnancy; stria rubra, fresh, red scarring; and stria alba, mature, white stretch marks. Although popularly lumped together, these classifications represent important physical differences relating to the nature of the scar and the way in which it should be addressed.

Treatment options

Despite their multitude, the array of over the counter products for stretch marks varies little in the way in which they address the problem. A ubiquitous offering on pharmacy shelves is cocoa butter. Used by grandmothers around the globe, cocoa butter’s properties have long been touted for the prevention of stretch marks.

However, while cocoa butter-based products provide hydrating properties that may minimise the risk of developing the problem, a 2009 study showed no significant advantage in using a cocoa butter cream versus a placebo in the prevention of stretch marks from pregnancy.

Nonetheless, sales of these products—such as Palmer’s Cocoa Butter—are growing in some markets and are driven, in part, by women opting for natural actives over efficacy during their pregnancies.

Reaching near cult status in the stretch mark sphere is Bio Oil. It contains a blend of ingredients including Vitamin A and E, lavender, chamomile and other botanical oils—the South African brand has come to dominate the product category in 17 international markets, including the UK, Canada and Australia.

Though the manufacturer does not provide any peer review evidence to support the product’s comparative advantage, many of its ingredients are accepted as having moisturising properties which—combined with daily massage—may reduce the chance of stretch marks.

Following Bio Oil’s lead, a suite of products based on plant derivatives including onion extract (Mederma), Lupin Seed Extract (Cussons) and sweet almond oil (Weleda) are being marketed as over the counter stretch mark remedies, largely on the basis of their moisturising abilities.

Rounding out mass-market options is a category of higher-priced products for stretch marks, led by StriVectinSD. Known for its anti-ageing claims, StriVectinSD generated interest in the stretch mark category on the basis of its proprietary NIA-114 peptide and “collagen boosting” properties. StrivectinSD commands a following of loyal users but, with a list of ingredients as long as your arm, it might not be a pregnant woman’s first choice for prevention.

As both demand and OTC product selection for stretch mark treatments grow, so too does interest in professionally-administered treatments. Laser therapy, including pulsed dye and fractional modalities, are among the conventional options offered by clinicians for the revision of stretch marks and stria rubra in particular.

Targeting the dilated blood vessels that mark the early stage of stretch mark formation, McDaniel et al specified an optimal treatment fluence using a pulsed dye of 3 J/cm2 using a 10-mm spot size. Though treatment is suggested to increase the collagen content of the extra-cellular matrix, it is also noted that PDL—and many light/laser options—may not be appropriate for Fitzpatrick skin types IV and higher.

Another study tackled stria alba, or mature stretch marks, and demonstrated 60%–70% amelioration in the hypopigmentation using a 308nm excimer laser. A total of nine treatments was typically needed with the excimer and maintenance therapies were required every 1–4 months to sustain results.

While laser and microdermabrasion regimens may be beyond a patient’s pocket book or effort threshold, topical prescription treatments like tretinoin may offer a more affordable, convenient option for physicians. Although not recommended for use during pregnancy, studies have shown between 8–20% improvement in active stria rubra and a variable effect on mature, whitish lesions, or stria alba.

Chemical peel regimens including trichloroacetic acid and glycolic acid have, anecdotally, yielded some results in the improvement of the appearance of stretch marks and may be combined with home care for optimal results.

Prevention

The literature as a whole does not indicate that any one approach to stretch marks is either more consistent or significantly advantageous than any other. What it does show, however, is the advantage of a proactive, preventative approach.

Prevention can take the form of prophylaxis—whether in the form of massage oils, cocoa butter or silicone gel use during pregnancy or a period of growth. The benefits of massage and hydration in preventing stretch marks are generally accepted.

Lifestyle choices may also reduce the likelihood or severity of stretch marks. Avoiding periods of excessive weight gain unrelated to pregnancy is crucial. Steroid use similarly predisposes an individual to stretch marks and, while there is not a lot of data to support the effects of diet and exercise on the development of stretch marks, healthy choices in both contribute to a stable weight and healthy, more resilient skin.

The plethora of treatment options aside, the physiology of stretch marks remains poorly understood and treatment outcomes vary widely. Unswayed by the lack of a silver bullet, women and men affected by stretch marks continue to test the claims of manufacturers and skin care professionals in their remedy.

An understanding of the available options and which are appropriate to the type of stretch mark present can increase the likelihood of satisfactory results for the patient.

Anna Jean Lloyd is principal at Artindale Strategic Marketing & Communications, a medical and consumer health consultancy in Toronto, Ontario. 

 

1. http://americanpregnancy.org/weekbyweek/week13.htm

2. BioOil Stretch Mark Survey, June 2011American Pregnancy Association www.thinkbaby.co.uk Survey of New Moms)

3. http://www.dailymail.co.uk/news/article-2366377/Half-mothers-refuse-wear-bikini-stretch-marks.html

4. http://stretchmarkguide.org

5. Buchanan K, Fletcher HM, Reid M. “Prevention of striae gravidarum with cocoa butter cream.” Int J Gynecol Obstet 108 (2010) 65–68

6. http://www.bio-oil.com/en/product/accolades

7. McDaniel DH, Ash K, Zukowoski M. “Treatment of stretch marks with the 585 nm flashlamp pumped pulsed dye laser.” Dermatol Surg 1996;22:332–7.

8. Alexiades-Armenakas MR, Bernstein LJ, Friedman PM, Geronemus RG. “The Safety and Efficacy of the 308-nm Excimer Laser for Pigment Correction of Hypopigmented Scars and Striae Alba.” (Reprinted) Arch Dermatol Vol 140, Aug 2004

9. Rangel O, Arias L, Garcia E, et al. “Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study.” Adv Ther 2001;18: 181–6.

10. Elsaie ML, Baumann LS, Elsaaiee LT. “Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update” Am Soc Derm Surg 2009

Author: bodylanguage

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