EpistemisStretch marks
Specialty: Skin.
Why it occurs
- Rapid mechanical stretching of the dermis that exceeds the elasticity of the skin, causing the rupture of collagen and elastin fibers (common in pubertal growth, abrupt weight gain or rapid muscle hypertrophy)
- Physiological pregnancy (abdominal stretching and hormonal effect of relaxin and estrogen on the extracellular matrix)
- Endogenous hypercortisolism or Cushing's syndrome (excess cortisol inhibits collagen synthesis by dermal fibroblasts)
- Prolonged and chronic use of high-potency topical or systemic corticosteroids
- Topical application or injection of corticosteroids in areas of body flexures.
Initial workup
Visual clinical evaluation to differentiate active red/violet stretch marks (striae rubrae) from mature white stretch marks (striae albae). If hypercortisolism is suspected: free cortisol in 24-hour urine, overnight suppression test with 1 mg dexamethasone, and plasma ACTH levels.
red flags
Presence of wide purple stretch marks (greater than 1 cm thick) atypically located on the abdomen, flanks, armpits and thighs, accompanied by recent onset arterial hypertension, severe proximal muscle weakness, central obesity with a moon face and buffalo hump (strong suspicion of endocrine Cushing's syndrome).
Standard management
- Tretinoin cream 0.1% — first choice topical retinoid applied daily at night on active red stretch marks to promote collagen remodeling; strictly contraindicated during pregnancy
- Creams rich in gotu kola and rosehip oil — applied preventively or in the initial phase to improve tissue elasticity of the dermis
- Occlusive emollients based on cocoa butter or liquid Vaseline to maintain epidermal hydration
- Referral to dermatology for complementary therapy with non-ablative fractionated laser in the late phase.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4