Striae Distensae

Author: Samer Alaiti, MD, RVT; Chief Editor: William D James, MD more...

Updated: Aug 17, 2011

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Background
Pathophysiology
Epidemiology
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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 on the thigh.

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.

Skin distension apparently leads to excessive mast cell degranulation with subsequent damage of collagen and elastin. 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.

Frequency

United States

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

International

International figures may reasonably mirror the numbers in the United States.

Mortality/Morbidity

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

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.

Proceed to Clinical Presentation

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

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].
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].
Kligman A. Topical tretinoin: indications, safety, and effectiveness. Cutis. Jun 1987;39(6):486-8. [Medline].
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].
Fox JL. Pulse dye laser eliminates stretch marks. Cosmetic Dermatology. 1997;10:51-2.
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].
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].
McDaniel DH. Laser therapy of stretch marks. Dermatol Clin. 2002;20:67-76. [Medline].
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].
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.
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].
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.
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].
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].
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. 9^th ed. Philadelphia, Pa: WB Saunders; 2000:645-6.
Burton Jl, Lovell CR. Disorders of connective tissue. In: Champion RH, Wilkinson DS, Ebling FJG, et al, eds. Textbook of Dermatology. 6^th ed. London, England: Blackwell Science; 1998:2008-9.
Dover JS. Sports dermatology. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, eds. Dermatology in General Medicine. 4^th ed. New York, NY: McGraw-Hill; 1993:1618-19.
Medical Economics Staff. Physician's Desk Reference. 53^rd ed. Montvale, NJ: Medical Economics Company; 1999:2177.

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.

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