Striae Distensae Clinical Presentation

  • Author: Samer Alaiti, MD, RVT; Chief Editor: William D James, MD   more...
 
Updated: Aug 17, 2011
 

Physical

Early striae present as flattened, thinned skin with a pink hue that may occasionally be pruritic. Gradually, they enlarge in length and width and become reddish purple in appearance (striae rubra). The surface of striae may be finely wrinkled. Mature striae are white, depressed, irregularly shaped bands, with their long axis parallel to the lines of skin tension as depicted below. They are generally several centimeters long and 1-10 mm wide. Gradually, some striae may fade and become inconspicuous. The natural evolution of stretch marks is similar to that of scar formation or a healing wound.

Mature striae distensae on the abdomen secondary tMature striae distensae on the abdomen secondary to pregnancy (lesions present for 21 y).
  • In pregnancy, striae usually affect the abdomen and the breasts.
  • The most common sites for striae on adolescents are the outer aspects of the thighs and the lumbosacral region in boys and the thighs, the buttocks, and the breasts in girls. Considerable variation occurs, and other sites, including the outer aspects of the upper arms, are occasionally affected.
  • Striae induced by prolonged systemic steroid use are usually larger and wider than other phenotypes of striae, and they involve widespread areas, occasionally including the face.
  • Striae secondary to topical steroid use are usually related to enhanced potency of the steroids when using occlusive plastic wraps. They usually affect the flexures and may become less visible if the offending treatment is withheld early enough.
Next

Causes

  • The factors that lead to the development of striae are poorly understood. No general consensus exists as to what causes striae. One suggestion is that they develop as a result of stress rupture of the connective tissue framework. It has also been suggested that they develop more easily in skin that has a high proportion of rigid cross-linked collagen, as occurs in early adult life. This is evident in striae due to pregnancy, lactation, weight lifting, and other stressful activities as shown below. Increased adrenal cortical activity has been implicated in the formation of striae, as in the case of Cushing syndrome. Additionally, the cellular and extracellular matrix alterations that mediate the clinical phenotype of stretch marks remain poorly understood. Mature striae distensae on the abdomen following pMature striae distensae on the abdomen following pregnancy (lesions present for 18 y).
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Samer Alaiti, MD, RVT  Clinical Associate Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Medical Director, Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc

Samer Alaiti, MD, RVT is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American College of Physicians-American Society of Internal Medicine, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and American Society of Lipo-Suction Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Barbara R Reed, MD  Clinical Professor, Department of Dermatology, Dermatology Service, Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center; Consulting Staff, Denver Skin Clinic

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Zein E. Obagi, MD, to the development and writing of this article.

References

  1. Kang S, Kim KJ, Griffiths CE, Wong TY, Talwar HS, Fisher GJ, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol. May 1996;132(5):519-26. [Medline].

  2. Goldfarb MT, Ellis CN, Weiss JS, Voorhees JJ. Topical tretinoin therapy: its use in photoaged skin. J Am Acad Dermatol. Sep 1989;21(3 Pt 2):645-50. [Medline].

  3. Kligman A. Topical tretinoin: indications, safety, and effectiveness. Cutis. Jun 1987;39(6):486-8. [Medline].

  4. Goldberg DJ, Marmur ES, Schmults C, et al. Histologic and ultrastructural analysis of ultraviolet B laser and light source treatment of leukoderma in striae distensae. Dermatolog Surg. 2005;31(4):385-7. [Medline].

  5. Fox JL. Pulse dye laser eliminates stretch marks. Cosmetic Dermatology. 1997;10:51-2.

  6. Jimenez GP, Flores F, Berman B, Gunja-Smith Z. Treatment of striae rubra with the 585-nm pulsed-dye laser. Dermatol Surg. 2003;29(4):362-5. [Medline].

  7. McDaniel DH, Ash K, Zukowski M. Treatment of stretch marks with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg. Apr 1996;22(4):332-7. [Medline].

  8. McDaniel DH. Laser therapy of stretch marks. Dermatol Clin. 2002;20:67-76. [Medline].

  9. Suh DH, Chang KY, Son HC, Ryu JH, Lee SJ, Song KY. Radiofrequency and 585-nm pulsed dye laser treatment of striae distensae: a report of 37 Asian patients. Dermatol Surg. Jan 2007;33(1):29-34. [Medline].

  10. Goldman A, Rossato F, Prati C. Stretch marks: treatment using the 1,064 nm Nd:YAG. laser. Dermatol Surg. May 2008;34(5):686-91.

  11. Hernandez-Perez E, Colombo-Charrier E, Valencia-Ibiett E. Intense pulsed light in the treatment of striae distensae. Dermatol Surg. 2002;28(12):1124-30. [Medline].

  12. Kim BJ, Lee DH, Kim MN, Song KY, Cho WI, Lee CK, et al. Fractional photothermolysis for the treatment of striae distensae in Asian skin. Am J Clin Dermatol. 2008;9(1):33-7.

  13. Obagi ZE, Obagi S, Alaiti S, Stevens MB. TCA-based blue peel: a standardized procedure with depth control. Dermatol Surg. Oct 1999;25(10):773-80. [Medline].

  14. Alexiades-Armenaka M, Sarnoff D, Gotkin R, Sadick N. Multi-center clinical study and review of fractional ablative CO2 laser resurfacing for the treatment of rhytides, photoaging, scars and striae. J Drugs Dermatol. Apr 2011;10(4):352-62. [Medline].

  15. Arnold HL, Odom RB, James WD. Abnormalities of dermal connective tissue. In: Odom RB, James WD, Berger TG, eds. Andrew's Diseases of the Skin Clinical Dermatology. 9th ed. Philadelphia, Pa: WB Saunders; 2000:645-6.

  16. Burton Jl, Lovell CR. Disorders of connective tissue. In: Champion RH, Wilkinson DS, Ebling FJG, et al, eds. Textbook of Dermatology. 6th ed. London, England: Blackwell Science; 1998:2008-9.

  17. Dover JS. Sports dermatology. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:1618-19.

  18. Medical Economics Staff. Physician's Desk Reference. 53rd ed. Montvale, NJ: Medical Economics Company; 1999:2177.

 
Previous
Next
 
Mature striae distensae on the abdomen following pregnancy (lesions present for 18 y).
Significant improvement following 3 consecutive blue peels (20% trichloroacetic acid to the level of the papillary dermis) completed at 6-week intervals.
Striae distensae on the thigh.
Striae distensae after treatment with topical tretinoin 0.1% cream for 3 months and 2 treatments with the flashlamp pulsed dye laser.
Mature striae distensae on the abdomen secondary to pregnancy (lesions present for 21 y).
Significant improvement is achieved using tretinoin 0.1% daily for 8 weeks.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.