In these times of increasing body positive movements and loving the skin we’re in, there is still the pressure from the celebrity and beauty industry to attain an unrealistic ‘flawless, blemish-free, perfect’ skin and body which will still see customers seeking advice and support on skincare for example stretch marks (striae) which I will be exploring in this article. Although the majority of cases are self-limiting and do not cause any physiological harm to a person’s health, they may be considered unsightly for the customer and cause distress, thus it is important to still be well-equipped to help and advise these customers with empathy and a high standard of knowledge and patient care.
Definition
Stretch marks (striae) are discoloured, slightly sunken (depressed), indented streaks and scar-like lines in your skin which are not painful or harmful and appear when your skin rapidly stretches or shrinks.
Areas that stretch marks generally appear are abdominal area, thighs, hips, breasts, upper arms, lower back and buttocks.
Stretch marks don’t require treatment, they often fade over time, with or without treatment, however they may never disappear completely.
Common causes of stretch marks
When skin rapidly stretches or shrinks, it causes the elastin and collagen in a person’s skin to break. Elastin’s main role is to allow skin to stretch. Collagen’s main role is to provide structure, strength and support to skin. As skin heals, stretch marks appear in areas where elastin breaks.
It is important to remember that stretch marks can affect both men and women due to a variety of reasons, some are listed below:
• pregnancy
• puberty
• sudden or quick weight gain or loss
• use of steroid creams or tablets long term
• genetic family history of stretch marks
• muscles getting bigger quickly through bodybuilding or weightlifting.
• growth spurt during adolescence.
• rarely, stretch marks can be due to a condition called Cushing’s syndrome which causes a high level of cortisol in the body due to prolonged high doses of prednisolone or hydrocortisone.
Progression
1. Early Stage (Striae Rubrae):
Stretch marks first appear as slightly raised, pink or reddishpurple lines.
They may be itchy and feel raised to the touch.
This stage is characterized by inflammation and damage to the skin’s connective tissues.
They are usually perpendicular to the direction of skin tension.
2. Intermediate Stage:
The initial redness and inflammation begin to fade.
The lines become more silvery or white in appearance.
They may still feel slightly raised or depressed.
3. Later Stage (Striae Albae):
The stretch marks become more hypopigmented and less noticeable.
They appear as atrophic (thin) and wrinkled lines.
They may have a slightly depressed appearance.
This stage is characterized by a loss of collagen and elastin in the affected skin.
Treatment options
As previously mentioned, stretch marks do not have any harmful effect on a person’s health, however they may cause distress and self-confidence issues which is why empathetic counselling and consultations are extremely significant to support customers who come to the pharmacy seeking help and advice.
Treatment improves the appearance of stretch marks, but they may not go away completely. Addressing your stretch marks when they first appear yields the best results. Older, deep stretch marks may be more challenging to treat. Stretch marks will eventually go away or become less noticeable on their own. In general, stretch marks take between six and 12 months to fade. With treatment, they often fade faster.
The first thing is to reassure the customer that having stretch marks is very normal and natural and there are several treatment options available to explore if they feel the need to pursue them. Creams, gels, lotions, and cosmetic surgery have all been proposed as treatments for stretch marks. There are several topical options available over-the- counter claiming to reduce or prevent the appearance of stretch marks, however there is little evidence to suggest that they get rid of them completely and totally.
There are also various other treatments available including microdermabrasion or laser treatment but specialist advice about the suitability of these need to be sought.
Topical treatments are preparations containing active ingredients that are applied to the surface of the skin.
Retinol
Retinol comes from vitamin A. It’s an ingredient in many OTC antiaging skin care creams because of its ability to improve wrinkles, skin texture and the skin’s hydration levels. Retinol creams may require at least six months of regular use before noticeable results are seen.
Side effects may include dry skin, irritation, discoloration and light sensitivity and medical advice should be sought for use during pregnancy and breastfeeding. Products containing retinol available include ‘Cerave Resurfacing Retinol Serum for Belmish prone skin’
Bio-Oil
Bio-Oil has been one of the most popular products on the market for use on uneven skin tone and especially being promoted for reducing stretch marks. It is a specialist oil mixture with vitamins and plant extracts which helps to improve the appearance of stretch marks and also helps improve skin elasticity, thereby reducing the possibility of stretch marks forming. The results of their clinical trial in Hamburg found that ‘Bio-Oil® Skincare Oil is efficacious in improving the appearance of stretch marks. A statistically significant result was achieved after only 2 weeks (day 15), evident in 95% of the subjects. After 8 weeks (day 57), 100% of subjects showed an improvement, with the extent of the improvement more than double that at 2 weeks. A continuous improvement of POSAS over the duration of the study.’
Palmers Cocoa Butter range
Palmers have a specific range of products for stretch marks during pregnancy including massage cream and oil. Their formula with a special combination of Cocoa Butter, Vitamin E, Collagen, and Elastin, with the lotion having the added benefit of Shea Butter. These non-greasy formulas relieve the dryness associated with stretched skin due to pregnancy and smooth stretch marks due to weight loss. Palmer’s Cocoa Butter Formula Tummy Butter is a highly concentrated formula with Cocoa Butter, Vitamin E, Collagen, Elastin, and soothing Lavender Oil that is widely recommended for stretch marks during and after pregnancy. The Tummy Butter penetrates as deep as the dryness and helps to restore vital moisture while smoothing marks and toning skin. Although studies show that they don’t effectively treat or prevent stretch marks, the massaging of creams and oils can be soothing and have a positive effect on customers, and a little TLC should never not be recommended!
Other
Treatment options
There are types of treatments done by dermatologists or plastic surgeons that can dramatically reduce the appearance of stretch marks which include laser treatment, microdermabrasion and cosmetic surgery.
Laser skin resurfacing
Laser skin resurfacing is a type of surgery where short, concentrated, pulsating beams of light are directed onto stretch marks. The laser removes layers of the skin very precisely, which stimulates the growth of new collagen fibres to create smoother skin.
An immediate difference should be seen after treatment and skin may continue to improve for up to a year, and the improvement may last for several years.
Side effects may include the appearance of small white bumps on the skin (milia), swelling, dark areas of skin (hyperpigmentation) and light areas of skin (hypopigmentation).
Dermabrasion
Dermabrasion is another type of surgery where a specialized instrument is used to scrape away the stretch marks. The process improves skin contour and results in smooth new skin. It usually takes at least two weeks for the skin to heal but full and complete results are seen several weeks or months after the procedure. Side effects may include milia, hyperpigmentation, hypopigmentation, swelling and enlarged pores.
Microneedling
During microneedling, the skin is poked with thin needles. The tiny punctures stimulate the growth of new collagen and elastin fibres to create firmer skin. Most people require between three and six treatments to see results. Some people see full, complete results within four to six months. But it may take longer. Side effects may include irritation, discoloration, swelling and flaky skin.
Making stretch marks less noticeable
There are several ways that a person can hide or improve the appearance of stretch marks acutely if needed such as the following:
Self-Tanners
Sunless self-tanners can help to fill in the colour of the stretch marks and make them appear closer to the same colour as the rest of the skin. However, regular tanning will not help as well because it can negatively affect the health of your skin. Also, stretch marks are less likely to tan.
Make-Up:
Using a foundation makeup that matches skin tone can help hide stretch marks.
Clothes with more coverage: Wearing long sleeves or longer pants can cover up areas that are affected by stretch marks.
Prevention:
Stretch marks cannot always be prevented. However, the following steps may help to reduce the risk:
• Avoid yo-yo dieting.
• Eat a balanced diet rich in vitamins and minerals. Consuming a suitable amount of vitamins A and C such as carrots, citrus fruits and milk can help support the skin, as well as the mineral zinc contained in nuts or fish. Rich in protein, such as lentils, beans, broccoli, lean beef and chicken.
• Drink six to eight glasses of water every day.
• Exercise increases circulation and helps your body produce collagen. Increased circulation and collagen help skin stay strong and stretchy.
Referral
It isn’t usually necessary to refer a customer regarding stretch marks. However it’s a good idea to keep in mind especially if stretch marks cover a large area of skin and the person would like to explore more options and also in case certain stretch mark creams or medications may cause bad skin reactions. Another cause for referral may be if the patient is experiencing low mood or a low self-image which is affecting their quality of life to help support them.
The importance of educating the person on the self-limiting nature of stretch marks and their non risk to health is significant and improving body image is key to supporting customers, however it is very important to respect a persons opinion on stretch marks and the effect it’s having on their self-image so we must approach each patient individually and provide as much support to their individual needs as possible. We are in a very good position to do so as community pharmacists and pharmacy teams to ensure everyone feels comfortable in their own skin.
Sources
https://my.clevelandclinic.org/ health/diseases/10785-stretchmarks#overview
https://www.mayoclinic.org/ diseases-conditions/stretchmarks/symptoms-causes/syc20351139
https://www.healthline.com/ health/do-stretch-marks-goaway#improving-stretch-marks https://uk.palmers.com/ content/21-cocoa-butterformula#:~:text=After%20 a%20few%20weeks%2C%20 skin’s,on%20a%20 healthier%2C%20firmer%20look.
https://www.bio-oil.com/ie/en/ products/SCO/information
Written by Fatimah Kara, Superintendent Pharmacist, Reidy’s Pharmacy Rathcoole
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