Stretch marks
What are they?
These are stripe-like or linear scars that occur with rapid body size and shape changes, which can be due to weight and muscle gain, growth spurts and pregnancy. Although not a direct symptom of PCOS, it is relevant due to the difficulties with weight management and hormonal fluctuations associated with the metabolic dysfunction and insulin resistance often accompanied by the condition; stretch marks are likely to be prevalent. [44]
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There are two main types:
Striae rubrae (SR): which are soft, raised “tiger stripe” like scars that appear purple, red or pink in colour, these are immature/ new scars, meaning they have only recently occurred [5]
Striae alba (SA): these are typically atrophic/ indented “tiger stripe” like scars that have no colour or appear white or pale pink in colour. These are striae rubra in their mature form, which signify past growth. [5]
These scars can be found anywhere on the body; however, they are commonly apparent on the inner thighs, buttocks, waist, breasts, and arms.
Striae Alba
Striae Rubra
How do they occur?
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Stretch marks occur with rapid tissue growth that the skin cannot keep up with, leading to degeneration of connective tissue structures like the ECM (Extracellular Matrix), which houses collagen, elastic fibres and the glue holding these structures together (fibronectin), as well as an increase in inflammation of the affected area. [5] [14]
The regression of these connective tissue structures leads to the thinning of the skin affected and, as a result, becomes atrophied (indented) and permanent in nature. [14]
Although these scars are permanent, with consistent care and treatments, they can be reduced in appearance, depth, and the restoration of skin thickness and resilience can be attained.
Treatment options
Using hydrating products on the body that contain hyaluronic acid, niacinamide and ceremide’s will soothe and hydrate the skin, while maintaining skin elasticity and reducing tension on the skin. Retinoids and silicone gel may also aid in stimulating collagen production to aid in thickening the skin and rebuilding lost collagen.
There are limited studies representing the extent of potential for topical skincare treatment for supporting the treatment of stretchmarks and improvement of skin integrity; however, it remains insufficient as a stand-alone treatment. [5] [22]
Lasers
PDL (Pulsed Dye Laser)
PDL is a vascular-based laser, meaning it is attracted to the red blood cells in superficial vessels. Specifically, when treating acne, these vessels respond to the tension the skin is under and release inflammatory factors, which must become dilated to do so. The dilation of these vessels leads to the red, purple, and pink tones that characterise immature stretch marks (SR).
As a secondary benefit, PDL lasers stimulate collagen and elastin production, aiding in the harmonisation and strengthening of the skin’s texture. [22]
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Ablative and non-ablative fractional lasers:
Works by targeting water within the skin’s tissue, it creates uniform columns within the skin using the heat from the laser’s energy, whilst sparing surrounding tissue and stimulating connective tissue remodelling, inducing collagen, elastin and supporting framework fibres responsible for the skin’s structure and resulting in a reduction of depth and width of the scar.
Ablative lasers mimic this pattern; however, they do not bypass the superficial layers of the skin, hence creating a more significant “wound” and advanced collagen stimulation.
Other treatments
Microneedling:
Create controlled microchannels in the skin to stimulate a wound healing cascade, entailing acute inflammation, which stimulates collagen and elastin production to harmonise and strengthen the skin’s texture and barrier. Making it ideal for thickening both the epidermis and dermis, which will aid in the prevention of recurrence whilst improving the compromised structure. [25] [35]
TCA:
TCA (Trichloroacetic acid) is the most popular deep peel, obtaining abilities to reach the dermal layers of the skin (the second most crucial layer of skin, containing blood vessels and nutrient-rich properties used to stimulate skin cell production). TCA peels create a controlled injury to the skin by eliminating the entire superficial layers of skin and the topmost layer of the dermis and promoting complete skin rejuvenation, renewal, and growth to enhance skin integrity, tone, and texture. [25] [35] [38]