Stretch marks are areas of skin that have been stretched beyond the elastic recoil potential of the skin. This stretching, or tensile load, results in micro-tears in the fibrous structure of the skin.

The structures that undergo micro-tears are collagen, elastin and ground substances.  The most common causes of stretch marks are expansion or rapid growth of the skin.  The most common causes for expansion or rapid growth of skin are weight loss, weight gain, pubertal growth spurts, and growth of breast tissue. It is even possible to develop them from weight training with expansion of the underlying muscle (made worse by anabolic steroid use).

Once the skin is overstretched, the micro-tears and disruptions occur in the collagen and elastin and a microscopic inflammatory response is created.  The inflammatory response leads to the increased presence of blood vessels and a process called neovascularization or new blood vessel formation.  This leads to one of the two types of stretch marks, which are red or purple stretch marks or white, silvery or greyish, atrophic stretch marks.

Purple or red stretch marks are usually early stretch marks that occur during the expansion phase of the skin and during the early phase of the disruption and micro-tears in the collagen and elastin.  The purple or reddish colour is due to the increased presence of blood vessels in the newly-injured skin.  This purplish and reddish discolouration may persist for several months or, rarely, several years after the appearance of the stretch mark.

White or Silvery Stretch Marks (atrophic stretch marks) are more mature than the purple and red stretch marks. White stretch marks occur after the blood vessels have faded and the inflammatory response has died down.  In general, the inflammatory response and the stretch mark leading to blood vessels is the body’s attempt to repair the collagen and elastin and the failure to do so results in a permanent whitish, silvery, shiny stretch mark that may be very wide and wrinkly or very thin and wrinkly. White stretch marks are a version of a Hypotrophic scar, which is an injury to the skin which healed without enough collagen, elastin and ground substances and the stretch mark skin looks thin, old, waxy and insubstantial. These older, whiter or silvery stretch marks do not have the same elastic properties of the skin, with decreased amounts of collagen and elastin and can be quite unsightly when positioned next to normal, smooth, untraumatized skin.  Generally, these older, white and silvery stretch marks do not tan the same as the adjacent normal skin and generally accompany skin laxity.

Fractional lasers and fractional radiofrequency devices are the preferred treatment for these stretch marks.

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