An update in the etiopathogenesis of striae distensae: A review article.

Abstract

Striae distensae (SD), also known as stretch marks, are common skin lesions causing significant psychological stress and cosmetic disfigurement. They are common to be seen during pregnancy, rapid weight change, puberty, many other pathological conditions including Cushing disease, anorexia nervosa, even excessive use of certain drugs. Clinically, they appear as either red raised linear bands known as striae rubrae (SR) or white depressed atrophic bands known as striae alba (SA). They were first described histopathologically in 1889. Many theories have been established to explain the etiopathogenesis of SD, yet the exact mechanism is still unclear. Also, many treatment modalities have been applied to reach maximum efficacy with the least side effects. This review article aims to optimize the most recent and accepted concepts on etiopathogenesis and pathophysiology of SD which may help in finding the best lines of management with the most satisfactory outcomes.

Bullous striae distensae on Fitzpatrick scale V skin

“…The skin of striae distensae is inherently weaker than normal skin, but its precise pathophysiology is not fully established. 1 , 2 , 4 The initial insult is mechanical stress on the skin, such as stretching during rapid weight gain, resulting in dermal tears, activation of an inflammatory response and distortion of the extracellular matrix. 2 , 4 This remodeling results in scarred skin containing less elastin, collagen and fibrillin, with reduced tensile strength.…”

“… 1 , 2 , 4 The initial insult is mechanical stress on the skin, such as stretching during rapid weight gain, resulting in dermal tears, activation of an inflammatory response and distortion of the extracellular matrix. 2 , 4 This remodeling results in scarred skin containing less elastin, collagen and fibrillin, with reduced tensile strength. 1 , 2 , 4 This reduction in tensile strength, in combination with higher glycosaminoglycan content, precipitated the preferential distention and fluid accumulation within the striae, when compared to the adjacent normal skin, resulting in the bullous striae distensae.…”

“… 2 , 4 This remodeling results in scarred skin containing less elastin, collagen and fibrillin, with reduced tensile strength. 1 , 2 , 4 This reduction in tensile strength, in combination with higher glycosaminoglycan content, precipitated the preferential distention and fluid accumulation within the striae, when compared to the adjacent normal skin, resulting in the bullous striae distensae. 2 …”

“…The clinical indication for use is usually for their anti-inflammatory properties, however these same attributes impair wound healing, 10 as noted in our patient with abdominal incision wound dehiscence, suppress keratinocyte proliferation, and reduce collagen synthesis. 4 , 10 …”

“…Striae distensae, colloquially known as “stretch marks”, are prevalent in the adult human population. 1 , 2 , 3 , 4 Bullous striae distensae however, a complication of striae distensae, is exceedingly rare and sparsely encountered in medical literature. 5 , 6 , 7 , 8 It develops due to fluid accumulation within pre-existing striae and ameliorates upon resolution of the underlying etiological conditions.…”