Stretch Marks (Striae): Causes and Treatment Options

What causes cracks?

In the development of striae distensae, it is not only mechanical stress that is involved;

Changes in dermal collagen and elastin structure,

genetic predisposition,

hormonal factors,

rapid tissue growth

They play a role together.

Most common periods:

pregnancy,

puberty,

rapid weight gain,

rapid weight loss,

bodybuilding and rapid muscle growth

It is in this form.

Why do cracks turn red first and then white?

Newly developing cracks are generally referred to as striae rubrae.

These:

red,

pink,

purplish,

sometimes dark brown

visible.

Over time, the visibility of blood vessels and inflammatory features decrease, and the fissures become lighter in color and atrophic. This late stage is called striae albae.

Striae rubrae generally respond better to treatment, while older white stretch marks are more difficult to treat. A 2024 systematic review also shows that treatment success varies depending on the type of stretch mark and the method used.

What causes stretch marks during pregnancy?

During pregnancy:

your wife,

breast,

hip,

thigh

Cracks may develop in these areas.

In addition to mechanical stress, hormonal changes also play a role.

Genetic predisposition plays a role; some people may develop noticeable stretch marks without significant weight changes, while others may develop fewer stretch marks despite considerable stretching.

Do stretch marks only occur from weight gain and loss?

No.

During rapid height growth in adolescence:

back,

hip,

thigh

Cracks may develop in these areas.

With rapid increase in muscle mass, especially:

shoulder,

chest,

arm

It can also occur in these regions.

Therefore, seeing stretch marks alone is not an indicator of obesity or rapid weight gain.

Can cortisone cause stretch marks?

Yes.

Long-term or improper use of strong topical corticosteroids can contribute to skin atrophy and the development of striae.

Larger and more prominent striae may be seen in conditions involving glucocorticoid excess, such as systemic corticosteroid use and Cushing's syndrome. The AAD also lists long-term corticosteroid use as one of the risk factors for striae.

Which stretch marks suggest a hormonal disorder?

The vast majority of stretch marks are benign and physiological.

However:

very wide,

dark purple,

rapidly developing,

unexplained,

to striae;

easy bruising,

muscle weakness,

noticeable fullness in the face,

hypertension,

metabolic changes

If present, endocrine causes such as Cushing's syndrome should be evaluated.

Focusing solely on cosmetic treatment would not be appropriate for these patients.

Will the cracks heal completely?

Usually not.

Striae are true dermal structural alterations.

With treatment:

color contrast,

width,

depth,

surface irregularity

can be reduced.

AAD explicitly states that current methods can make cracks less visible, but do not eliminate them completely.

Does stretch mark cream really work?

Many products are marketed as "stretch mark creams," but strong evidence is limited.

Especially:

cocoa butter,

olive oil,

almond oil,

vitamin E

There is no strong evidence that commonly used products like these prevent stretch marks or significantly eliminate existing ones. The AAD also states that these products have not shown a significant protective effect in studies.

Moisturizing can support skin comfort and barrier function, but it alone will not eliminate dermal cracks.

Does hyaluronic acid work for stretch marks?

Some studies have reported an improvement in the appearance of early-stage stretch marks with topical products containing hyaluronic acid.

However, this data:

product,

concentration,

working method

It is heterogeneous in terms of these aspects.

The AAD lists hyaluronic acid among topical options that may show limited benefit in early stretch marks.

Does tretinoin work for fractures?

Topical tretinoin is one of the most studied topical treatments, particularly for the early stages of striae rubra.

Stretch marks through collagen remodeling:

its width,

its length,

visibility

It can reduce it somewhat.

However, its effect on ancient striae alba is more limited. A 2026 review also states that the efficacy of tretinoin is modest and dependent on treatment duration/concentration.

Retinoids should not be used during pregnancy; suitability for pregnancy planning and breastfeeding should also be evaluated.

Is microneedling effective for fractures?

Yes, microneedling is currently one of the most effective options for treating striae.

It stimulates dermal collagen remodeling by creating controlled microtraumas.

A systematic review and meta-analysis from 2024 evaluated 11 studies; it showed that microneedling and microneedling-radiofrequency methods can provide significant improvement in the appearance of striae distensae. Similar efficacy has also been reported with some laser treatments.

It could be important, especially in darker phototypes, as it may offer an advantage in terms of reducing the risk of post-inflammatory hyperpigmentation.

Is gold needle/fractional radiofrequency effective for treating stretch marks?

Fractional microneedle radiofrequency (MNRF) stimulates collagen remodeling by delivering controlled radiofrequency energy to the dermis via microneedles.

A 2024 systematic review and meta-analysis found no significant clinical efficacy advantage between fractional microneedle RF and fractional CO₂ laser; both methods were demonstrated to be effective.

Therefore, the generalization that "gold needle is definitely better than laser" is not accurate.

Is fractional CO₂ laser effective for treating fractures?

Yes.

Fractional CO₂ lasers can stimulate collagen remodeling by creating controlled microthermal damage in the dermis.

Especially:

striae alba,

significant tissue loss,

wide cracks

It can be used for.

A 2025 meta-analysis comparing fractional CO₂ laser and microneedling reported that both methods provided significant clinical improvement, with no significant difference in overall efficacy. However, post-inflammatory hyperpigmentation was more common in the CO₂ laser group.

This is especially important in method selection for dark phototypes.

Can Er:YAG or other lasers be used?

Yes.

Treatment for striae varies:

ablative fractional,

nonablative fractional,

vascular,

pigment targeted

Lasers have been researched.

However, there isn't just one technology called "fracture laser.".

A 2024 systematic review reported various laser, microneedling, radiofrequency, and topical approaches to treating striae; it showed that no single method was clearly superior in all patients.

Which laser is preferred for red fissures?

In striae rubrae, the vascular component is more prominent, so vascular-targeted methods may be considered.

For example:

pulsed dye laser (PDL)

It can be used to reduce redness.

However, the risk of pigment changes should be considered in darker phototypes.

Which method is more effective for white cracks?

In striae alba, the problem is no longer just color; dermal atrophy and textural changes are evident.

Because:

microneedling,

fractional microneedle RF,

fractional lasers

These are more meaningful options.

Current literature suggests that combination therapies may yield better results than single therapies, particularly in older cases of striae alba.

Is platelet-rich plasma (PRP) effective for treating stretch marks?

PRP in the treatment of striae:

microneedling,

fractional laser,

radiofrequency

It has been researched together with [name of researcher/individual].

Although some studies have reported positive results, PRP alone cannot be said to be a standard or clearly superior treatment for stretch marks.

It can be considered more as an adjunct to combination therapy. A comprehensive review from 2026 also reports on the potential contribution of PRP in combinations.

Does mesotherapy for stretch marks work?

“Stretch mark mesotherapy” is not a single standardized treatment.

Used for:

product,

contents,

injection depth,

session protocol

It varies greatly.

Therefore, it is not accurate to present a specific mesotherapy product as the proven standard treatment for striae.

Why is combination therapy used for stretch marks?

At the same time in a crack:

color change,

dermal atrophy,

surface irregularity,

loss of elasticity

it could be.

Therefore, it should not be expected that all components of a method will correct to the same extent.

For example, in selected patients:

Microneedling/RF + fractional laser + pigment/vascular targeted therapy

Combinations can be considered.

However, a more aggressive combination isn't always better; skin phototype and PIH risk are important factors.

Is treatment possible for people with dark skin?

Yes.

However, in Fitzpatrick phototypes IV–VI:

postinflammatory hyperpigmentation,

prolonged color change

The risk should be assessed more carefully.

Microneedling and microneedling RF may be safer options in terms of pigmentation compared to ablative lasers in some patients. A 2024 meta-analysis reported that the risk of PIH was lower in microneedling treatments compared to some of the methods examined.

When is the best time to start stretch mark treatment?

Treatment response is generally higher in the early stages of striae rubra.

However, this doesn't mean that white stretch marks that have been there for years are untreatable.

In old cracks:

more sessions,

stronger dermal restructuring,

combination therapy

It may be necessary.

Is stretch mark treatment possible during pregnancy?

Aggressive cosmetic procedures are generally postponed during pregnancy.

Topical retinoids, especially tretinoin, should not be used during pregnancy.

Basic approach during pregnancy:

proper moisturizing,

skin comfort,

compliance with obstetric recommendations regarding controlled weight gain.

It is in this form.

There is no strong evidence that most currently available creams definitively prevent stretch marks.

How long after birth can treatment be given?

The exact duration varies depending on the method used.

Post-natal:

breastfeeding status,

stabilization of hormones,

whether weight changes are continuing,

abdominal skin tightening

Factors such as these are evaluated.

Topical retinoid or energy-based treatment plans are then customized accordingly.

Is it possible to prevent cracks from forming?

It cannot be completely guaranteed.

Genetic and hormonal factors play a strong role.

According to AAD:

almond oil,

cocoa butter,

olive oil,

vitamin E

Popular products like these have not been shown to reliably prevent cracks.

While limited data exist on preservatives in some products containing centella and hyaluronic acid, the results are inconclusive.

Will my stretch marks disappear if I lose weight?

No.

Losing weight doesn't directly eliminate stretch marks.

Even rapid weight changes can affect skin appearance in other ways.

The existing stretch mark is a dermal change; if treatment is required, it should be planned separately.

Does tanning hide stretch marks?

Often, on the contrary, it can make things more visible.

Striae alba may not tan as much as the surrounding skin, increasing contrast.

The AAD also states that true tanning can make stretch marks more noticeable.

Self-tanner can temporarily camouflage color contrast; it does not cure it.

When should you consult a dermatologist?

Evaluation may be helpful in the following situations:

If cracks appeared very quickly

If it appears very large and dark purple

If corticosteroids are being used

If accompanied by other symptoms suggestive of Cushing's syndrome

If cosmetic treatment is planned

If there is concern about the risk of spotting due to a dark phototype

If a method has to be chosen between laser, microneedling or radiofrequency

Dermatologist's Note

One of the most important distinctions in stretch mark treatment is:

Is the red one a new crack, or the white one an old crack?

That is the question.

In striae rubrae, the vascular and inflammatory components are more prominent, while in striae alba, dermal atrophy and tissue loss are more emphasized.

Therefore, instead of applying the same device or the same cream to everyone:

Color + Depth + Age + Skin Phototype

They should be evaluated together.

In my approach, especially for older white stretch marks, instead of promising "complete removal with a single device," combining methods such as microneedling, fractional radiofrequency, or fractional laser that target dermal restructuring when necessary is a more realistic approach.

Frequently Asked Questions

Will the fracture heal completely?

It usually doesn't disappear completely; its appearance can be significantly reduced.

Which is easier to treat, red or white stretch marks?

Generally, early red cracks respond better.

Does microneedling work?

Yes. The 2024 systematic review and meta-analysis provides supporting data in terms of effectiveness and safety.

Which is better: CO₂ laser or microneedling?

Current meta-analyses have found similar clinical efficacy; the risk of PIH may be higher with CO₂ lasers.

Do creams eliminate stretch marks?

No. Some topical treatments may provide limited improvement in early stretch marks; there is no strong evidence for many popular products.

Can tretinoin be used during pregnancy?

No; topical retinoids should not be used during pregnancy.