Dual Topical Therapy. The Future of Stretch Marks?

Abstract

Striae distensae, or stretch marks, are linear scars that result from mechanical stretching of dermal tissue. They are most prevalent in women and in pregnancy, puberty, and obesity. The psychological and cosmetic symptoms may present a pathological synergy with the physical distress that stretch marks represent, especially if the patient is going through pregnancy or puberty. The progression occurs in two phases: striae rubrae and striae albae which can be identified by histopathological examination, characterized by reduced elasticity and structural integrity. Tretinoin has demonstrated significant improvement in striae rubrae. Clinical trials show patients treated with tretinoin experienced improvements in appearance, and a reduction in length and width of the marks. In addition to improving patient satisfaction, the combination with glycolic acid has demonstrated to increase the elastin content. Other treatments such as hyaluronic acid have shown improvement especially when combined with other ingredients such as Centella asiatica; the use of other creams has only shown to reduce the severe stretch marks to a moderate level, inconclusive or lack of evidence. Preventive and early treatment on stretch marks should be encouraged due to the psychological importance it has on patients. Topical therapies, particularly tretinoin with glycolic or hyaluronic acid offer promising results especially in striae rubrae. Given the multifactorial pathogenesis of stretch marks, a therapy with a combination of ingredients that address multiple aspects of skin remodeling (e.g., collagen production, elasticity, and inflammation) may yield better results. For the severity and symptoms of striae rubrae the most effective treatment is Tretinoin, while the combination with glycolic acid is recommended for striae albae to reduce width and improve clinical status. Preventive topical therapies should be considered for at‐risk populations, for pregnant women tretinoin, pregnant women with previous stretch marks use trofolastin and for postpartum women Centella asiatica with hyaluronic acid.