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Striae Distensae

  • Author: Samer Alaiti, MD, RVT, RPVI, FACP; Chief Editor: William D James, MD  more...
 
Updated: Mar 23, 2016
 

Background

Striae distensae, a common skin condition, do not cause any significant medical problem; however, striae can be of significant distress to those affected. They represent linear dermal scars accompanied by epidermal atrophy.

See the image below.

Striae distensae in pregnancy. Baby is due in less Striae distensae in pregnancy. Baby is due in less than 2 weeks. Courtesy of Patrick Fitzgerald and Wikimedia Commons.
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Pathophysiology

Striae distensae affect skin that is subjected to continuous and progressive stretching; increased stress is placed on the connective tissue due to increased size of the various parts of the body. It occurs on the abdomen and the breasts of pregnant women, on the shoulders of body builders, in adolescents undergoing their growth spurt, and in individuals who are overweight.

Factors leading to the development of striae have not been fully elucidated. Striae distensae are a reflection of "breaks" in the connective tissue. Skin distension may lead to excessive mast cell degranulation with subsequent damage of collagen and elastin.[1] Prolonged use of oral or topical corticosteroids or Cushing syndrome (increased adrenal cortical activity) leads to the development of striae. Genetic factors could certainly play a role, although this is not fully understood.

In a letter to the editor of the Journal of Investigative Dermatology, Tung et al conducted genome-wide association analysis and found evidence that implicates elastic microfibrils in the development of nonsyndromic striae distensae.[2]

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Epidemiology

Frequency

Approximately 90% of pregnant women, 70% of adolescent females, and 40% of adolescent males (many of whom participate in sports) have stretch marks.

Race

Stretch marks affect persons of all races.

Sex

Striae affect women more commonly than men.

Age

Stretch marks affect adolescents, pregnant women, and patients with excessive adrenal cortical activity.

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Prognosis

Striae distensae are usually a cosmetic problem; however, if extensive, they may tear and ulcerate when an accident or excessive stretching occurs.

Adolescents with striae can expect their striae to be less visible with time.

Treatment with tretinoin, flashlamp pulsed dye laser, and chemical peels significantly improves the clinical appearance of early, active stretch marks.

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Contributor Information and Disclosures
Author

Samer Alaiti, MD, RVT, RPVI, FACP 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, RPVI, FACP is a member of the following medical societies: 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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

References
  1. Sheu HM, Yu HS, Chang CH. Mast cell degranulation and elastolysis in the early stage of striae distensae. J Cutan Pathol. 1991 Dec. 18(6):410-6. [Medline].

  2. Tung JY, Kiefer AK, Mullins M, Francke U, Eriksson N. Genome-wide association analysis implicates elastic microfibrils in the development of nonsyndromic striae distensae. J Invest Dermatol. 2013 Nov. 133(11):2628-31. [Medline].

  3. 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].

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

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

  6. Al-Himdani S, Ud-Din S, Gilmore S, Bayat A. Striae distensae: A comprehensive review and evidence-based evaluation of prophylaxis and treatment. Br J Dermatol. 2013 Oct 11. [Medline].

  7. 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].

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

  9. 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].

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

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

  12. 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].

  13. 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.

  14. 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].

  15. 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.

  16. 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. 2011 Apr. 10(4):352-62. [Medline].

  17. Naein FF, Soghrati M. Fractional CO2 laser as an effective modality in treatment of striae alba in skin types III and IV. J Res Med Sci. 2012 Oct. 17(10):928-33. [Medline].

  18. Lee SE, Kim JH, Lee SJ, Lee JE, Kang JM, Kim YK. Treatment of striae distensae using an ablative 10,600-nm carbon dioxide fractional laser: a retrospective review of 27 participants. Dermatol Surg. 2010 Nov. 36(11):1683-90. [Medline].

  19. Yang YJ, Lee GY. Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO(2) Fractional Laser: A Randomized Controlled Trial. Ann Dermatol. 2011 Nov. 23(4):481-9. [Medline].

  20. Ryu HW, Kim SA, Jung HR, Ryoo YW, Lee KS, Cho JW. Clinical improvement of striae distensae in Korean patients using a combination of fractionated microneedle radiofrequency and fractional carbon dioxide laser. Dermatol Surg. 2013 Oct. 39(10):1452-8. [Medline].

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

 
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Striae distensae on the torso of a 13-year-old boy. One-day duration. Courtesy of Wikimedia Commons.
Female torso with striae distensae from pregnancy. Courtesy of Parenting Patch and Wikimedia Commons.
Striae distensae in pregnancy. Baby is due in less than 2 weeks. Courtesy of Patrick Fitzgerald and Wikimedia Commons.
 
 
 
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