Topical tretinoin therapy for management of early striae

Abstract

From the University of Michigan Medical Center, Ann Arbor. Reprints are not available. (J Am Acad Dermatol 1998;38:S90-2.) Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/0/91117 Stretch marks, or striae, are common skin lesions that have no medical consequences but are frequently distressing to those afflicted. These disfiguring marks are usually caused by excessive stretching of the skin that occurs with pregnancy, adolescent growth spurts, obesity, and weightlifting.1,2 Patients’ quality of life can be enhanced with effective management of these unsightly marks. Until recently, therapeutic options for striae have been poor, at best. Stretch marks undergo a clinically recognizable evolution,3 similar to that involved in scar formation or wound healing. Initially, they appear active with a pink to violaceous color, without notable surface depression. Over time, the color gradually fades, and the lesions exhibit a normal or lighterthan-normal skin color, accompanied by fine wrinkles and surface depressions. These characteristics are representative of atrophic, permanent stretch marks. Therefore, it is believed that stretch marks may be the result of damage to the extracellular matrix of dermal collagen and elastic fibers. In the past, topical and surgical therapies have unsuccessfully focused on treatment of permanent striae. New studies indicate that topical tretinoin (0.1%) is effective in the management of early stretch marks to halt and potentially reverse their progression. Among its many pleiotropic effects, tretinoin is an established therapy for repair of dermal damage associated with photoaged skin.4,5 Specifically, significantly reduced collagen I formation in photoaged human skin is partly restored by topical tretinoin use.6 In addition, more recent data provide solid evidence for tretinoin’s ability to antagonize induction of matrix-degrading enzymes (collagenase, stromelysin, gelatinase) after human skin injury by UV radiation.7,8 Therefore, it is likely that tretinoin might repair damage from another cause: excessive stretching. Earlier studies on topical tretinoin therapy for management of striae have yielded variable results.9,10 However, the majority of the patients in these studies were treated for stretch marks that had already evolved into white, atrophic, scarlike lesions. As such, it was hypothesized that the use of tretinoin cream on early-stage striae might be a more effective therapeutic approach. In a recent clinical trial, 26 white subjects exhibiting early erythematous stretch marks were randomized to treatment with either topical tretinoin cream (0.1%) or color-matched vehicle cream. Striae were treated on a nightly basis for 24 weeks.11 Patients were instructed to increase the Topical tretinoin therapy for management of early striae