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STRETCH MARKS
An event with a marked influence
during pregnancy!
Stretch marks are a frequent occurrence during pregnancy (50 to 90% of pregnant women according to studies), but they can also appear during puberty, in the event of obesity or rapid weight gain, treatment containing cortisone (corticosteroids) or during certain endocrine diseases.
Preventing and dealing with stretch marks represents a key concern for many women, because their unsightly appearance can have a considerable psychological impact.
Generally considered “significant” by mothers-to-be, they can sometimes detract from the pleasure and experience of pregnancy, even if they fade over time.
This feeling may be accentuated by the fact that stretch marks are often regarded as an epiphenomenon, priority being given to the medical supervision of the mother and child during pregnancy.
This text has been written by Dr Ouazzani, dermatologist.
About the author
• Medical officer in Dermatology, attached to hospitals (Hôpital Saint Louis-Paris, Centre Hospitalier St Cloud), she is a member of the Société Française de Dermatologie Pédiatrique.
• A contributor for 20 years to "Abstract Dermatologie", she has also worked for "Objectif peau" and "Dermatologie pratique".
• Speaking four languages, she is a representative at numerous international conferences, including the AAD (American Academy of Dermatology), which she attends every year.
Contents
How can you recognise them?
What are the promoting factors?
What type of cutaneous anomalies?
How do stretch marks arise?
What can be done?
Key points
Bibliographical references
How can you recognise them?
They appear as lines or linear bands that are initially bluish-purple red. They can be compared to scarred areas in which thinned, slacker skin forms depressed areas.
They are generally numerous and of varying depth, length, width and intensity of colour. These welts correspond to the mechanical traction lines of the skin, hence their characteristic distribution: parallel to the cutaneous tension lines and perpendicular to the direction of distension (c.f. diagram opposite).
Their colour will gradually fade to become “flesh-coloured” like normal skin or lighter, shiny and pearly white.
During pregnancy, they generally appear during the third trimester and are found on the abdomen (more than 40%), on the thighs (25%), breasts (25%) or hips (20%).
H. Osman et al. Risk factors for the development of striae gravidarum. Am. J. Obstet Gynecol 2007; 196 (1): 62.e1-62.e5.
What are the promoting factors?
There are few studies that have analysed the risk factors for the onset of stretch marks. However, a number of promoting elements have been identified as risk factors.
With regard to the mother:
- A young maternal age: mums are most at risk if they become pregnant under the age of 25.
- Weight:
• Rapid and significant weight gain during pregnancy.
• A high weight before pregnancy and/or at the end of pregnancy, a high Body Mass Index* (BMI).
- Medical history: a family or personal history of stretch marks during pregnancy.
… And the baby
- A high birth weight,
- A late birth.
* BMI is calculated by dividing your weight in kilos by your height squared (height x height). A BMI >= 25 indicates that you are overweight and a BMI >= 30 indicates obesity.
What type of cutaneous anomalies?
The process behind the appearance of stretch marks has not yet been clearly elucidated, however the changes observed in the skin have been well defined.
At the onset of stretch marks, the structure of the skin changes, and cutaneous damage appears.
The thickness of the skin is reduced. Thinning of the epidermis is observed. Changes to the connective tissue appear in the dermis: the fibres are disorganised, the elastin fibres are clearly diminished and the collagen fibres are impaired (less dense and narrower).
E Wetterwald. Vergetures. L. Dubertret et al. Thérapeutique Dermatologique. May be consulted at
www.therapeutique-dermatologique.org
The onset of stretch marks is essentially linked to excessively great, excessively rapid and excessively harsh stretching of the skin, which is then subject to distension that exceeds its elasticity capacities.
The combination of this intense traction of the skin and an increase in the level of certain hormones in the blood (cortisol, oestrogen) causes cutaneous alterations. The structure and the metabolic functions of the fibroblasts* are disrupted.
The elastin and collagen fibres that they produce in the deep layers of the skin (dermis) are of poorer quality and fewer in number.
Yet, these fibres play a very important role in providing support and structure for the skin. They ensure cutaneous elasticity and resistance to stretching.
During pregnancy, these two conditions (major stretching and hormonal changes) are combined and a context favourable to the onset of stretch marks is thus created.
*The fibroblasts are cells responsible for the synthesis of the support elements of the skin in the dermis (collagen, elastin fibres, etc.). They are notably involved in the inflammatory, cicatricial and fibrose processes.
How do stretch marks arise?
A 3-step process
1- A first inflammatory phase
Stimulation of the skin cells (the fibroblasts in the dermis) by the distension of the skin and hormones causes inflammation. The fibroblasts are thus going to “manufacture” less collagen, in particular.
2- A breakdown phase
The inflammatory substances and aggressive enzymes secreted are thus going to attack and break down the structure of the dermal connective tissue, in particular the collagen and elastin fibres.
3- A repair phase
In response to the attacks and inflammation, the skin will synthesise new collagen and elastin fibres intended to replace those that have been damaged. However, they are not repaired in an identical fashion: these new fibres are more fragile, finer, less numerous and less organised. Thinned scar tissue is thus going to replace the initial skin tissue and micro-scars form.
What can be done?
Stretch marks are similar to scars. They will fade over time, but will not disappear completely. However, taking proper action can help to reduce them.
The importance of prevention
Prevention is thus an essential element to be taken into account and anticipated!
The earlier it begins (from the beginning of pregnancy), the more effective it will be and the more satisfactory the results. Moreover, regular and persistent use of dermo-cosmetic skin care, including after giving birth, is indispensable in achieving optimal results.
It is possible to help to prevent the onset of stretch marks or to minimise them thanks to dermatological and dermo-cosmetic skin care.
It is necessary to take action by limiting the inflammatory phenomenon and boosting the skin’s regenerative capacities.
But be careful: certain dermatological treatments based on vitamin A acid are contraindicated during pregnancy and breastfeeding.
Reducing the risk factor that being overweight represents – whenever possible! – is also a significant element in terms of prevention.
Taking action on established stretch marks
When stretch marks have become established, dermo-cosmetic skin care has a full role to play in helping to reduce stretch marks and improve their aesthetic appearance. At this stage, it is preferable to turn to products whose efficacy has been clinically proven.
A medical treatment can also be envisaged, especially using laser. Used alone or in combination with dermo-cosmetic skin care, in certain cases it can allow you to obtain a significant reduction in recent (bluish purple) or older (white) stretch marks.
Do not hesitate to ask your doctor for advice.
In all cases, sun protection using high or very high protection sunscreens is indispensable in order to prevent irreversible pigmentation, aggravating the aesthetic prognosis…
Key points
• Fast and significant cutaneous distension
• Hormonal changes
• Associated risk factors
(young maternal age, rapid and significant weight gain during pregnancy, a family history of stretch marks, high weight of baby at birth, late birth)
• Inflammation and breakdown of the cutaneous
support tissue (elastic and collagen fibres)
Appearance of scar tissue
=> STRETCH MARKS
• Need for early prevention
Reduction in the risk factors (weight) if possible
and topical skin care
Bibliographical references
• M. Tunzi et al. Common Skin conditions during pregnancy. Am Fam Phys 2007 ;75(2) :211-18.
• R. Kumari, T.J. Jaisankar, D.M. Thappa. A clinical study of skin changes during pregnancy. Indian J Dermatol Venereol Leprol 2007 ;73(2) : 141.
• A. Ghasemi et al. Striae gravidarum : associated factors. J. Eur. Acad. Dermatol. Venereol. 2007 ;21(6) :743-6.
• A.L. Chang et al. Risks factors associated with striae gravidarum. J. Am. Acad. Dermatol. 2004 ;51(6) :881-5.
• G.S. Atwal et al. Striae gravidarum in primiparae. Br J. Dermatol 2006 ;155(5) : 965-9.
• S. Sellier et al. Facteurs de risques des vergetures de la grossesse. Ann. Dermatol. Venereol 2005 ;132(HS3) :29-30.
• H. Osman et al. Risk factors for the development of striae gravidarum. Am. J. Obstet. Gynecol. 2007 ;196(1) :62.e1-62.e5.
Sens de distension
Lignes de tension cutanée
Direction of distention
Lines of cutaneous tension