eMedicine Specialties > Dermatology > Diseases of the Dermis

Striae Distensae

Author: Samer Alaiti, MD, FACP, Clinical Assistant Professor, Departments of Dermatology and Internal Medicine, University of California at Los Angeles School of Medicine; Medical Director, Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc
Contributor Information and Disclosures

Updated: Jan 22, 2009

Introduction

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.

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.

Clinical

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. 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.

  • 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.

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. 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.

More on Striae Distensae

Overview: Striae Distensae
Differential Diagnoses & Workup: Striae Distensae
Treatment & Medication: Striae Distensae
Follow-up: Striae Distensae
Multimedia: Striae Distensae
References
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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. 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.

  15. 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.

  16. 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.

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

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Further Reading

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Keywords

striae atrophicans, striae rubra, striae alba, stretch marks, striae cutis distensae

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Contributor Information and Disclosures

Author

Samer Alaiti, MD, FACP, Clinical Assistant Professor, Departments of Dermatology and Internal Medicine, University of California at Los Angeles School of Medicine; Medical Director, Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc
Samer Alaiti, MD, FACP 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.

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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