Aesthetics investigates the recent consumer headlines that claim stretch mark creams don’t work and asks professionals how patients seeking solutions to their scarring concerns can be appropriately advised
A new study published in the British Journal of Dermatology (BJD), which researched the cause of stretch marks at a molecular level, suggests that current topical treatments aimed at treating and preventing stretch marks don’t work.1 The study, led by Dr Frank Wang et al,2 researched striae gravidarum, (a form of scarring of the skin on the abdomen, due to sudden weight gain during pregnancy) in 27 pregnant women. The researchers found that during pregnancy, and up to eight weeks after, elastic fibres in the dermis become disrupted. These fibres normally allow for the recoil of the skin, but, once disrupted, the study suggests that the fibres struggle to repair themselves. Following this new research, Dr Wang has suggested that topical creams couldn’t plausibly repair this damage.
Until now, there hasn’t been much investigation into the formation and treatment of stretch marks as they are not seen as medically dangerous.1 However, consultant dermatologist Dr Justine Kluk believes this study provides important information on the pathogenesis of stretch marks and is a significant step forward for treatments. She says, “Until now, there wasn’t a very good understanding of what was happening at a molecular level in stretch mark formation. Now that the basic understanding is there, the foundations have been laid for developing better treatments.” Consultant clinical and cosmetic dermatologist Dr Vishal Madan explains, “When treating stretch marks, we’re effectively dealing with a scar which also has tearing of the top layers of the skin. Its a very difficult thing to reverse.” This is something that patients can find very difficult to live with, and something that Dr Kluk believes is important to recognise, “Stretch marks are clearly not dangerous, however they are common and can be quite prominent. Many women feel that they are unsightly or disfiguring. I think it is valid to conduct more research in this area so that new treatment options can be explored. We should also be sensitive to patients who come to us with these concerns because some will find it psychologically distressing and difficult to deal with.” Consultant dermatologist Dr Anjali Mahto agrees, “I think the problem we have had in the past is that scientists are focused on treating disease, and stretch marks falls into the cosmetic category, so there is not as much concern with treating it. But I think more and more we are now realising that psychodermatology is a real field of medicine and so I think more money will now be put into looking for effective treatments.”
At present, there is an abundance of topical treatments marketed at reducing and preventing stretch marks available to consumers over the counter. In light of Dr Wang’s research, however, we are led to question if all current products are insufficient, or can some make a visible difference? In addition, how should aesthetic practitioners advise patients looking to treat stretch marks topically?
“What you can safely say is that cocoa butter is a great moisturiser, but it doesn’t do anything for stretch marks” - Dr Anjali Mahto
“Personally, I have never believed that these creams work,” says Dr Mahto, adding, “in my opinion, I haven’t found a cream that can totally protect against stretch marks. Once you’ve got stretch marks, I don’t think there’s anything you can put on the skin that’s going to get rid of them. But what the Dr Wang et al study does suggest, is that we might be better off trying to find creams that can protect the elastic strands from breaking-down in the first place.”
Dr Madan adds, “Although there are yet to be studies that prove creams aimed at treating and averting stretch marks work, there are still benefits in women using them. Stretch marks are variable lesions and vary from person to person. So one person’s stretch marks may respond to one topical treatment, but it doesn’t mean others will as well,” however, he continues, “I’ve not personally seen good results from topical therapies alone, and it depends a lot on what stage of development the stretch mark is at. If someone has got very established, white/silvery stretch marks, then it is unlikely that any topical treatment will make any improvement. However, if someone is in the very initial phase of the slightly red stretch marks, then it may be possible to improve them with certain treatments.”
“Until now, there wasn’t a very good understanding of what was happening at a molecular level with stretch mark formation. Now that basic understanding is there, it should be much easier to identify and target the treatments” - Dr Justine Kluk
A wide range of ingredients is used in topical stretch mark products, but their role in avoiding and improving stretch marks is unclear. “Some products have hyaluronic acid (HA) in them as some practitioners believe by putting HA on the skin, it will help plump and moisturise the affected area which will improve the appearance. But HA is a big molecule, and for it to actually penetrate the skin, is probably pretty unlikely,” says Dr Mahto. “Some products contain vitamin A or retinoids, and apparently there is some evidence to suggest these can help with the appearance of stretch marks. The only problem with retinoids is, they are class C drugs, so they’re not licensed for use in pregnancy.”
One particular ingredient that appears to be often promoted in topical stretch mark products is theobroma oil, more commonly known as cocoa butter. Touted for its ability to prevent and improve the appearance of stretch marks,3 often alongside other ingredients, many dermatologists believe it is nothing more than a good moisturiser, yet research by Statista indicates that one of the most well-known consumer brands of cocoa butter, which promotes it’s benefits in improving the appearance of stretch marks, was used by 1.2 million people in the UK in 2014.4 “What you can safely say is that cocoa butter is a great moisturiser,” says Dr Mahto, “but it doesn’t do anything for stretch marks. Many of these ‘old wives tales’ are totally propagated and picked-up by the media. Some pregnancy magazines will say ‘cocoa butter is great for stretch marks!’ And that cycle never seems to break; nobody questions it and says, ‘hang on a minute – the science is all wrong!’” These products continue to sell, despite scientific evidence that indicates that they do not produce significant benefit in the treatment of stretch marks. “There is a study which compared cocoa butter with a placebo, to see if it prevented stretch marks from forming,”5 says Dr Madan. He explains, “The products were used daily, between 12-18 weeks of pregnancy, until delivery, and they studied 175 women. The results showed no significant difference between the cocoa butter group and the placebo group.”
Dr Kluk believes the message these products promote needs to be clearer to consumers, “There needs to be more honesty about what can realistically be achieved. Creams can potentially make the skin feel smoother and plumper in the short term, but if we don’t think that they’re actively going to reduce or eliminate stretch marks in the long run, and science seems to say that they won’t, then consumers should be made aware of this.”
Dr Madan believes it’s important to assess patients looking for treatment for stretch marks carefully, “Its not as simple as seeing a patient and then giving them a treatment option. You have to take their history, and this will include symptoms. Some may be keen to get rid of the redness and others will have problems with the itchiness associated, and that is something that is understated. Recognising and understanding how to treat a patient’s symptoms is important.”
Dr Kluk adds, “I’d advise my patients considering a pregnancy to try and keep their skin in the best condition they can, through regular application of moisturiser in the absence of any proven preventative treatments. One cannot easily predict how much stretch each patient will experience during a pregnancy and there are a number of other unmodifiable risk factors for the development of stretch marks, so it is hard to give any other specific advice at this time.”
Following the recent study, Dr Wang et al are said to be continuing their research with the end goal of helping pregnant women prevent or effectively improve the appearance of stretch marks.1
Looking towards the future, however, could it ever be possible to create a topical treatment to treat stretch marks? “I think there is a possibility of improving stretch marks by re-stimulating collagen, but anything that boosts natural collagen, in a permanent way, is not yet available,” says Dr Madan, adding, “I believe the key is prevention.” Dr Mahto concludes, “Do I think you can put something onto the skin that will penetrate once stretch marks are there? Probably not. The problem is, we don’t really know who is going to get stretch marks and who isn’t. So if your mum got them, then it’s likely that you will. If you had stretch marks previously, you’ll probably get them again. But until we can figure out which patients are at risk, it’s going to be really tricky to find a better treatment.”