Striae gravidarum

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Striae gravidarum form circular stretch marks in a white female, two weeks before delivery of a healthy infant.

Striae gravidarum or pregnancy stretch marks, is a form of scarring of the skin of the abdominal due to sudden weight gain during pregnancy. These off-color blemishes are symptoms of pregnancy caused by the tearing of the dermis, resulting in atrophy and loss of rete ridges.[1] These scars often appear as reddish or bluish streaks on the abdomen, and can also appear on the breasts and thighs. Some striae disappear with time, while others remain as permanent discolorations of the body.[2]

Signs and symptoms[edit]

Striae begin as reddish purple lesions, and, over time, lose pigmentation and atrophy. They can cause a burning and itching sensation, as well as emotional distress. They are rarely harmful, but thought of more as a cosmetic nuisance.[2] Young women are generally affected the most and usually seek treatment for lesions from a dermatologist[3] and following pregnancy.[4]

Causes[edit]

Mechanical distention and rapidly developing areas of the body during pregnancy (such as the abdomen, breasts, and thighs) are most commonly associated with striae formation. Some have suggested that relaxin and estrogen combined with higher levels of cortisol during pregnancy can cause an accumulation of muocopolysaccharides, which increases water absorption of connective tissue, making it prime for cleavage under mechanical stress.[3][5] There also seems to be an association between higher body mass indices and in women with bigger babies and the incidence and severity of striae. Also, younger women seem to be at higher risk of developing striae during pregnancy.[3][6]

Prevention[edit]

Since ancient times, pregnant women have sought remedies to prevent stretch marks during pregnancy. Both ancient Greeks and Romans used olive oil, while Ethiopians and Somalians used frankincense.[7] Both of these treatments have surged in their use in recent years. Results of modern studies have offered conflicting results regarding the efficacy of various topical ointments. Conventional treatment includes topical 0.1% tretinoin (all-trans-retinoic acid) cream mixed with various lotions and moisturizers. Some unconventional prevention therapies include applying castor oil, taking thiosinaminum, applying seaweed wraps, using topical glycolic or fruit acids, and various other homeopathic creams and/or oils.[8] To date, nothing appears to definitively prevent striae gravidarum from forming.[6]

Treatment[edit]

Some success has been made in treating and eliminating striae gravidarum. Some studies have examined the use of 20% glycolic acid and 10% L-ascorbic acid with zinc sulfate and tyrosine, as well as laser treatments in reducing the appearance of striae.[8][9][10] In these studies, the most promising regimen was treatment with a laser, and the application of both glycolic acid and trentonin cream, which noticeably led to an improvement in elastin in skin tissue and a reduction in discoloration. For example, a small study of 20 women with three-month application of 0.1% tretinoin cream found a 20% reduction in the overall length of straie and a global improvement in their overall appearance. Erythema and scaling were common with this treatment (11/20), especially during the first month.[11]

Epidemiology[edit]

The prevalence and severity of striae gravidarum varies among populations. The current literature suggest that in the general population of the US, there is a 50%-90% prevalence of striae associated with pregnancy.[6] Many women experience striae gravidarum during their first pregnancy. Nearly 45% percent of women develop striae gravidarum before 24 weeks of gestation.[2] Interestingly, many women who develop lesions during the first pregnancy do not develop them during later pregnancies. Genetic factors such as family history and race also seem to be predictive in the appearance of striae.[12]

See also[edit]

References[edit]

  1. ^ Kroumpouzos, G; Cohen, LM (2003). "Specific dermatoses of pregnancy: an evidenced-based systematic review". Am J Obstet Gynecol 188: 1083–92. 
  2. ^ a b c "Stretch Mark". Retrieved 2011-11-10. 
  3. ^ a b c Chang, AL; Agredano, YZ; Kimball, AB (2004). "Risk factors associated with striae gravidarum". J Am Acad Dermatol 51: 881–5. doi:10.1016/j.jaad.2004.05.030. 
  4. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
  5. ^ Atwal, G.S.S.; Manku, L.K.; Griffiths, C.E.M.; Polson, D.W. (2006). "Striae gravidarum in primiparae". British Journal of Dermatology 155 (5): 965–9. doi:10.1111/j.1365-2133.2006.07427.x. PMID 17034526. 
  6. ^ a b c Thomas, RGR; Liston, WA (2004). "Clinical associations of striae gravidarum". Journal of Obstetrics and Gynaecology 24 (3): 270–27. doi:10.1080/014436104101001660779. 
  7. ^ "Botany". Retrieved 2009-11-10. 
  8. ^ a b Ash, K; Lord; Zukowski, M (1998). "Comparison of topical therapy for striae alba (20% glycolic acid/0.05% tretinoin versus 20% glycolic acid/10% l-ascorbic acid)". Dermatol Surg 24: 849–56. doi:10.1111/j.1524-4725.1998.tb04262.x. 
  9. ^ Wierrani, F; Kozak, W; Schramm, W; Grünberger, W (1992). "Attempt of preventive treatment of striae gravidarum using preventive massage ointment administration". Wiener klinische Wochenschrift 104 (2): 42–4. PMID 1609525. 
  10. ^ name="Bolognia">Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0. 
  11. ^ Rangel O et al. (Jul–Aug 2001). "Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study.". Adv Ther. 18 (4): 181–6. doi:10.1007/bf02850112. PMID 11697021. . An earlier study found that a weaker formulation (0.025%) was ineffective. (PMID 7956336)
  12. ^ Tunzi M, Gray GR (January 2007). "Common skin conditions during pregnancy". Am Fam Physician 75 (2): 211–8. PMID 17263216.