Background: Striae distensae (SD) (stretch marks) are common dermal scars resulting from rapid skin stretching during puberty, pregnancy, or weight changes and disproportionately affect women. Management remains challenging, particularly in individuals with darker skin tones, due to variable efficacy and the risk of postinflammatory hyperpigmentation with certain therapies. Objective: To review current and emerging treatment modalities for SD across all Fitzpatrick skin types, with an emphasis on efficacy, safety, and the role of combination therapies. Methods: A comprehensive literature review was conducted using peer-reviewed clinical trials, observational studies, and dermatologic reviews evaluating topical, procedural, laser-based, and combination therapies for SD. Treatments were analyzed based on mechanism of action, clinical outcomes, skin type suitability, and reported adverse effects. Results: Topical tretinoin demonstrated modest efficacy dependent on concentration and treatment duration. Laser-based therapies, including ablative and nonablative fractional lasers, improved collagen remodeling and stretch mark appearance, with nonablative lasers showing better tolerability in darker skin types. Microneedling and fractional microneedling radiofrequency were effective and cost-efficient options across skin types. Combination therapies, particularly those integrating microneedling, radiofrequency, platelet-rich plasma, or fractional CO 2 lasers, yielded superior outcomes compared with monotherapy, especially for striae alba. Striae rubra generally responded more favorably than striae alba across treatment modalities. Limitations: Heterogeneity among studies, including inconsistent outcome measures, variable treatment protocols, and limited long-term follow-up, restricts direct comparison of therapeutic efficacy. Additionally, many studies included small sample sizes and lacked standardized assessment tools such as a uniform visual analog scale and Dermatology Life Quality Index scoring. Conclusion: Multiple therapeutic options exist for the management of SD, with treatment selection influenced by striae stage and Fitzpatrick skin type. Combination therapies demonstrate the most promising results, particularly for treatment-resistant striae alba and patients with darker skin tones. Standardization of outcome measures and further high-quality comparative studies are needed to optimize individualized treatment strategies.
Chaudhury et al. (Mon,) studied this question.