Stretch marks are cutaneous linear depressions oriented along the lines of tension to the skin. They correspond to areas of tension in the fat regions. Rather, they are circular on thighs, vertical on the outer side of the hips, lower back on the horizontal and circular around the umbilicus.
Often initially red, they fade and become inapparent sometimes with persistent depressed character to the touch.
They are extremely common and is seen especially during pregnancy. They are rarely observed in the context of a Cushing’s disease or Marfan syndrome.
The diagnosis is clinical. Histology is not necessary.
DIAGNOSIS:
During pregnancy:
Stretch marks are caused by the distension related to maternal weight gain on the one hand, and on the other hand to the pregnancy distension. They affect mainly the thighs, abdomen and breasts.
Hyperchromes often in women with dark skin, they fade after pregnancy.
They are readily favored by genetic background and family history.
In obese:
Stretch marks are being especially since weight gain was fast. The affected areas are mainly the hips and thighs.
Adolescents:
Many willingly and staggered, stretch marks are related to the growth and / or physical activity. The lumbar region and thighs are particularly affected.
Under a Marfan disease:
Stretch marks are accompanied by other clinical signs of the disease: large size, large upper limb Arachnodactyly, funnel chest, lens dislocation, thoracic aortic aneurysm, ectasia of the dura.
The patient should be referred to a specialist consultation. The prognosis is related to vascular complications (failure, aortic dissection or rupture).
As part of Cushing’s syndrome:
Stretch marks are located mostly on the abdomen and thighs. They are purple, deep, broad. Other signs of hypercortisolism are present: facial reddening, lunar Cushingoid facies nuchal hump, filling supraclavicular hollow, bloated abdomen, muscle atrophy, skin atrophy with visualization of the vascular network.
There is often a diabetes, hypertension, osteoporosis. Mental disorders can be observed.
The hypercortisolism diagnosis is confirmed by the elevation of urinary free cortisol of 24 hours and the braking test to dexamethasone.
The management is the responsibility of the specialist.
Cutaneous manifestations regress slowly and partially.
As part of a long-term corticosteroid:
Stretch marks can be seen after local corticosteroids and prolonged. They are accompanied by signs of skin atrophy associated with corticosteroid atrophy, skin smoothness, stellar scars, purpura Bateman, etc.
Stretch marks were also observed in retinoid (etretinate).
TREATMENT:
Treatment is extremely disappointing, despite the promises (expensive) cosmetic merchants, since no treatment has demonstrated its effectiveness (except a study tretinoin 0.1%).
Controlling weight gain during pregnancy and abdominal strength can be proposed.
Some offer laser treatment.
