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Review
. 2016 Feb;30(2):211-22.
doi: 10.1111/jdv.13223. Epub 2015 Oct 20.

Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae

S Ud-Din  1   2 , D McGeorge  3 , A Bayat  1   2
Affiliations
Review

Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae

S Ud-Din et al. J Eur Acad Dermatol Venereol. 2016 Feb.

Abstract

Striae distensae (SD) are common dermal lesions, with significant physical and psychological impact. Many therapeutic modalities are available but none can completely eradicate SD. The most common therapy is the application of topicals used both therapeutically and prophylactically. Even though there are many commercially available topical products, not all have sufficient level of evidence to support their continued use in SD. The aim here was to assess the evidence for the use of topicals in SD and to propose a structured approach in managing SD. A systematic search of published literature and manufacturer website information for topicals in SD was carried out. The results showed that there are few studies (n = 11) which investigate the efficacy of topicals in management of SD. Trofolastin and Alphastria creams demonstrated level-2 evidence of positive results for their prophylactic use in SD. Additionally, tretinoin used therapeutically showed varying results whilst cocoa butter and olive oil did not demonstrate any effect. Overall, there is a distinct lack of evidence for each topical formulation. The majority of topicals failed to mention their effect on early vs. later stages of SD (striae rubrae compared to striae albae) and their role in both prevention and treatment. In conclusion, there is no topical formulation, which is shown to be most effective in eradicating or improving SD. A structured approach in identification and targeted management of symptoms and signs with the appropriate topical is required. Randomized controlled trials are necessary to assess the efficacy of topical products for treatment and prevention of different stages of SD.

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Figures

Figure 1
Figure 1
Comparisons between striae albae and striae rubrae. (a) An illustration of striae rubrae on the abdomen. (b) A diagram to demonstrate the difference in characteristics between striae rubrae and striae albae. Striae rubrae are considered as an early form of SD, which are erythematous, red and sometimes slightly raised linear lesions. They do not recur and are classified as temporary striae. Striae albae are atrophic, wrinkled and pale. They also do not recur but are permanent striae. (c) An illustration of striae albae on the abdomen.
Figure 2
Figure 2
Histological comparison between normal skin and striae distensae (SD) skin H+E stains (magnification ×8.0). The normal epidermis has basket weave appearance and well formed rete ridges. In contrast, SD shows loss of the rete ridge pattern. Additionally, normal dermis demonstrates parallel collagen bundles to the surface, which are evenly spaced, which is in contrast to SD dermis. ED, epidermis; PD, papillary dermis; RD, reticular dermis.
Figure 3
Figure 3
Factors associated with striae distensae. Risk factors and associations with acquiring striae distensae including ethnicity,18 chronic steroid use,17 pregnancy,59 Cushings syndrome,60 weight gain (BMI),61 obesity,17 adolescence,17 family history.62
Figure 4
Figure 4
Illustration demonstrating the common anatomical locations affected by striae distensae.
Figure 5
Figure 5
A flow chart demonstrating the methodology and process of selecting relevant articles for review.
Figure 6
Figure 6
Management of striae distensae. A flow chart to summarize the management of patients with striae distensae with particular emphasis on the topical formulations, which are used therapeutically and which have published evidence to support their use. *Kelo‐Stretch™, Apothederm™, Bio‐Oil®, StriVectin‐SR ®, Clarins®, RegimA®, Thalgo®, SilDerm™, Skinception™; **Kelo‐Cote®39, Tretinoin34,43,44; ***Laser therapy24‐26, light therapy27, acid peels28, collagen injections29, radiofrequency devices31, microdermabrasion32.
Figure 7
Figure 7
A flow chart to summarize the management of patients with striae distensae with particular emphasis on the topical formulations, which are used prophylactically and which have published evidence to support their use. *Cussons®, Liforma®, Kelo‐Cote®, Thalgo®, TriLASTIN‐SR ®, Kelo‐Stretch™; **Alphastria36, Cocoa butter37,45, Olive Oil38, Almond oil46, Trofolastin35.
Figure 8
Figure 8
A proposed strategic approach to create a specific management/treatment plan for patients with striae distensae.
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References

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