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Stretch marks during pregnancy

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eMediNexus    21 April 2018

Striae gravidarum (SG), or stretch marks commonly develop during pregnancy, and affect up to 90% of women. SG can be disfiguring, and often cause emotional and psychological distress.1 These atrophic linear scars are one of the most common connective tissue changes during pregnancy. SG initially present as flat, pink-to-red bands (striae rubra or immature striae) that may become raised, longer, wider, and violet-red. Eventually, the marks grow faint and become hypopigmented (striae alba or mature striae), appearing parallel to skin tension lines as scar-like, wrinkled, white, and atrophic marks. SG may be associated with itching, burning, and discomfort and usually present on the breasts, abdomen, hips, and thighs.2

The pathogenesis of SG is largely unknown. Mechanical tension seems to play a pathogenic role by damaging dermal connective tissue, as the long axis of lesions is usually oriented perpendicularly to the direction of greatest skin stretching. However, this possibility is still debatable.1 The potential risk factors associated with the development of SG include family history of striae, personal history of breast or thigh striae, young age, baseline weight, body mass index > 26, alcohol intake, light skin color, increased weight gain during pregnancy, increased body mass index at delivery, increased abdominal and hip girth during pregnancy, as well as low serum vitamin C level, low serum relaxin level and low water intake during pregnancy. Neonatal factors include increased gestational age at delivery, increased birthweight, and increased height and head circumference.1

Certain topical preparations may have a potential role in the prevention and management of SG. Aloe vera is one such herb that reduces itching associated with striae and also prevents their progression when applied topically. In a double-blind clinical trial, 160 nulliparous women aloe vera was found to be more effective than base cream in decreasing itching and erythema and in preventing the spread of striae on the surface of abdomen.3 A triple-blind randomized controlled trial assessed the effect of sesame, sweet almond, and sesame and sweet almond oil on prevention of striae (primary outcome) in primiparous females. Striae at 35 to 38 weeks of pregnancy were observed in 59.2%, 16.7%, 14% and 82% of women in sweet almond, sesame, sesame and sweet almond oil and control groups, respectively. The occurrence risk of striae was significantly decreased in the sesame (adjusted OR = 0.04, CI = 0.01 to 0.13), sweet almond (0.27, 0.10 to 0.72), and sesame and sweet almond oil (adjusted OR= 0.03, CI = 0.01 to 0.10) groups, when compared with the control group. Abdominal itching was also significantly different among users of sweet almond (65.3%), sesame (10.5%), sesame and sweet almond oil (44%), and control groups (78%). Sesame oil group did not experience severe and very severe form of itching, while this was found in 34.7% women in the almond oil group.4 Sida cordifolia Linn. (SCL) (Malvaceae) syn. Country Mallow has long been known to promote the healing of wounds. The ethanolic extract of SCL has been shown to increase cellular proliferation and collagen synthesis at the wound site.5 The plant is a tonic, astringent, emollient, and aphrodisiac. It has an anti-inflammatory effect and a possible antioxidant effect.6 Withania somnifera (Ashwagandha) is an important herb in the Indian Ayurvedic system of medicine as a Rasayana (tonic). It is a potential anti-inflammatory agent.7 Vetiver (khus) grass is known for its skin soothing potential. Vetiver oil is used in aromatherapy and has a balancing/regulatory activity on skin. It exerts antiseptic, tonic and detoxifying effects on the skin. Vetiver oil replenishes moisture in dehydrated skin and prevents stretch marks.8

All these beneficial herbs can therefore be used during pregnancy to prevent and manage stretch marks.

References

  1. Korgavkar K, Wang F. Stretch marks during pregnancy: a review of topical prevention. Br J Dermatol. 2015 Mar;172(3):606-15.
  2. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. International Journal of Women’s Dermatology 2017;3(2):77-85.
  3. Hajhashemi M, Rafieian M, Rouhi Boroujeni HA, et al. The effect of Aloe vera gel and sweet almond oil on striae gravidarum in nulliparous women. J Matern Fetal Neonatal Med. 2017 May 19:1-6.
  4. Malakouti J, Khalili AF, Kamrani A. Sesame, Sweet Almond & Sesame and Sweet Almond Oil for the Prevention of Striae in Primiparous Females: A Triple-Blind Randomized Controlled Trial. Iran Red Crescent Med J. 2017 June;19(6):e33672.
  5. Pawar RS, Chaurasiya PK, Rajak H, et al. Wound healing activity of Sida cordifolia Linn. in rats. Indian J Pharmacol. 2013 Sep-Oct; 45(5): 474–478.
  6. Jain A, Choubey A, Singour PK, et al. Sida cordifolia (Linn) – An overview. Journal of Applied Pharmaceutical Science 2011;1(2):23-31.
  7. Singh N, Bhalla M, de Jager P, Gilca M. An Overview on Ashwagandha: A Rasayana (Rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011; 8(5 Suppl): 208–213.
  8. Burger P, Landreau A, Watson M, et al. Vetiver Essential Oil in Cosmetics: What Is New? Medicines (Basel). 2017 Jun; 4(2): 41.

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