Striae Distensae: A Comprehensive Review and Evidence-Based Evaluation of Prophylaxis and Treatment

S. Al-Himdani; S. Ud-Din; S. Gilmore; A. Bayat

Disclosures

The British Journal of Dermatology. 2014;170(3):527-547. 

In This Article

Abstract and Introduction

Abstract

Striae distensae are an extremely common, therapeutically challenging form of dermal scarring. Risk factors have been reported but much remains to be understood about their epidemiology, diagnosis and treatment. Up-to-date knowledge of the scientific research and the evidence behind both preventative and therapeutic agents are vital in order to understand striae and to offer patients the best therapeutic alternatives. We present a clinical review of the current literature concerning striae distensae and their prevention and treatment. A systematic review of the literature was undertaken using Medline, Embase and Google Scholar. Articles in English, Spanish, Portuguese, Turkish and French were included. Striae distensae occur in pregnancy, puberty and obesity as well as in numerous medical conditions and following therapeutic interventions. Proposed aetiological mechanisms relate to hormones, physical stretch and structural alterations to the integument. Assessment methods include subjective visual scoring and various imaging modalities. Treatments that we have evaluated include topical agents, used prophylactically or therapeutically, as well as light and laser therapies, which have shown improvements in the appearance of striae. Few high level evidence based medicine randomized controlled trials evaluating treatments for striae distensae exist. Topical therapeutic agents appear to lack efficacy in the prevention of striae distensae.

Introduction

Striae distensae (SD; striae, stretch marks, striae atrophicans, striae gravidarum) are common skin lesions, which can pose a significant psychological burden for patients. Since the first histological description in 1889,[1] SD have presented a considerable challenge in terms of both their evaluation and treatment. Although frequently encountered by both patients and clinicians, the prevalence of SD cited in the literature varies tremendously, ranging from 11% to 88%.[2–10] Additionally, anatomical sites affected vary, with areas commonly affected including the abdomen, breasts, thighs and buttocks.[2,3]

Two clinically and histopathologically recognizable forms of SD have been described: striae rubrae and striae albae.[11] The initial erythematous and violaceous-appearing lesions are referred to as striae rubrae. These fade into wrinkled, hypopigmented, atrophic scar-like marks named striae albae, which have been described as a permanent form of SD.[12] When occurring following pregnancy, the term striae gravidarum refers to the same entity, usually developing after the 24th week of gestation.[8,13] Although the vast majority of SD have been reported in pregnant women and adolescents,[6,13] they have also been described in association with Cushing syndrome and following the administration of both short- and long-term oral and topical corticosteroids.[13,14,15] Further to this, a number of key aetiological theories have been postulated. These include inadequate development of the skin (particularly elastic fibres and collagen),[16,17] mechanical stretching of the skin and endocrine imbalance.[18,19]

Several methods of assessing SD, visually or instrumentally, have been utilized in previous studies.[9,20] Here we present a comprehensive review of the literature, incorporating articles from multiple search engines and languages. We focus on the epidemiology, aetiology, clinical evaluation, prevention and treatment of SD.

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