Cosmetic Dermatology

Interventions for the Treatment of Stretch Marks: A Systematic Review

Cutis. 2014 August;94(2):66-72

Stretch marks are a common disfiguring skin condition that can have a deep psychological impact on affected patients. Although there are a variety of treatments available, no consistently effective therapies have been established. In this systematic review, we evaluate 8 randomized controlled trials (RCTs) to assess the efficacy and safety of currently available therapies for the treatment of stretch marks. Due to the limited number of patients and high or unclear risk of bias in the studies included in this assessment, the evidence from this review is insufficient to provide clear guidelines for practice. Therefore, more high-quality RCTs are needed.

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Practice Points

Given the negligible reported side effects, tretinoin cream 0.1%, a cosmetic oil formulation, onion extract cream, or the combined use of Active A and Active B could be considered for the treatment of stretch marks, though the evidence is insufficient.
High-quality, randomized, placebo-controlled trials are needed in the future.

References

1. Viennet C, Bride J, Cohen-Letessier A, et al. Mechanical behavior of fibroblasts included in collagen lattices. J Soc Biol. 2001;195:427-430.

2. Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol. 2004;51:881-885.

3. Salter SA, Kimball AB. Striae gravidarum. Clin Dermatol. 2006;24:97-100.

4. Elsaie ML, Baumann LS, Elsaaiee LT. Striae distensae (stretch marks) and different modalities of therapy: an update. Dermatol Surg. 2009;35:563-573.

5. Singh G, Kumar LP. Striae distensae. Indian J Dermatol Venereol Leprol. 2005;71:370-372.

6. Jiménez GP, Flores F, Berman B, et al. Treatment of striae rubra and striae alba with the 585-nm pulsed-dye laser. Dermatol Surg. 2003;29:362-365.

7. Watson RE, Parry EJ, Humphries JD, et al. Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol. 1998;138:931-937.

8. Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Oxford, United Kingdom: The Cochrane Collaboration; 2011. http://handbook.cochrane.org/. Accessed July 8, 2014.

9. Draelos ZD, Gold MH, Kaur M, et al. Evaluation of an onion extract, Centella asiatica, and hyaluronic acid cream in the appearance of striae rubra. Skinmed. 2010;8:80-86.

10. Kang S, Kim KJ, Griffiths CE, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol. 1996;132:519-526.

11. Morganti P, Palombo P, Fabrizi G, et al. Biweekly in-office injectable treatment of striae distensae vs a long-term daily use of topical vitamin C. J Appl Cosmetol. 2001;19:107-112.

12. 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;17:928-933.

13. Pribanich S, Simpson FG, Held B, et al. Low-dose tretinoin does not improve striae distensae: a double-blind, placebo-controlled study. Cutis. 1994;54:121-124.

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16. Yang YJ, Lee GY. Treatment of striae distensae with nonablative fractional laser versus ablative CO₂fractional laser: a randomized controlled trial. Ann Dermatol. 2011;23:481-489.

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Stretch marks (striae cutis distensae) are a common disfiguring skin condition characterized by linear bands of atrophic-appearing skin.¹ The prevalence of stretch marks associated with pregnancy ranges from 50% to 90%.² Although stretch marks do not pose a health risk, they often cause burning, itching, and emotional distress, and they can have a deep psychological impact on patients, particularly in young healthy women who are commonly affected by this condition.³

The cause of stretch marks currently is unknown, but they are known to develop in a variety of physiological and pathological states (eg, pregnancy, adolescent growth spurts, obesity, large weight gain, Cushing syndrome, Marfan syndrome, diabetes mellitus, long-term systemic or topical steroid use).^2-5 Clinically, newly formed stretch marks present as pink or purple linear lesions without substantial depression of the skin (striae rubra). Over time, the lesions lose their pigmentation, becoming depressed, atrophic, and white (striae alba).^2,3,6 The most commonly affected sites are the breasts, upper arms, abdomen, buttocks, and thighs.^3,4

Regardless of the etiology, the same histologic changes can be noted in the epidermis of all stretch marks, such as atrophy and loss of rete ridges, with features that are similar to scarring.³ Additionally, reorganization and diminution of the elastic fiber network of skin can be observed.⁷

A variety of treatment strategies are available for stretch marks, including topical preparations (eg, tretinoin, glycolic acid) and lasers.⁴ With current methods, no consistently effective therapies have been established yet. In this article, we present the results of a systematic review of the literature to address the effectiveness and safety of the available treatment options for stretch marks.

Methods

A literature search for randomized controlled trials (RCTs) related to the treatment of stretch marks was conducted on March 13, 2013, using the Cochrane Central Register of Controlled Trials, PubMed (from 1966), Embase (from 1974), Chinese Biomedical Literature Database (from 1978), China National Knowledge Infrastructure (from 1994), Chinese Science Journals Database (from 1989), and Wanfang Data (from 1995). Search terms included stretch marks, stretch mark, striae atrophicae, striae distensae, striae gravidarum, striae rubra, striae alba, lineae albicantes, striae, kikkisa, and random*.

We attempted to contact the original investigators of the 25 articles assessed for eligibility by e-mail to identify the randomization and answer other methodology questions to ensure that the studies included in the analysis were RCTs. Each of the 8 RCTs selected for inclusion was assessed independently by 2 investigators (L.L. and H.M.), and data extraction also was performed independently. Any differences in opinion were resolved by discussion. The risk of biases were assessed and 5 domains—random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data—were judged for each study included in the analysis using the Cochrane Collaboration’s domain-based evaluation tool as described in the Cochrane Handbook for Systematic Reviews of Interventions.⁸ Publication bias was not assessed due to insufficient data.

Studies ultimately were classified into 3 categories based on the risk of bias: (1) low risk of bias or low risk of bias for all key domains; (2) unclear risk of bias or unclear risk of bias for 1 or more key domains; and (3) high risk of bias or high risk of 1 or more key domains.

Results

Search Results

Figure 1 presents the literature search results. Of 300 total search results, 8 RCTs were selected for assessment,^9-16 which included a total of 240 patients (Table). The investigators of all 8 reports were contacted, but only 2 responses were received.^11,14 The full text of one article could not be obtained; therefore, we could not confirm that it was a true RCT and excluded it.¹⁷

^{Figure 1. Search results.}