Scars and Stretch Marks
Scars and stretch marks are both types of marks affecting the surface of the skin. Stretch marks can often look like long, thin scars. But the two are very different in the way they’re formed.
Most people have at least one scar on their body, and no two scars are the same, partly because the way scars heal varies widely from one person to another (according to the British Association of Aesthetic Plastic Surgeons, people with black skin or with fair freckled skin and red hair tend to produce poorer scars than others).
Part of the natural healing process, scars not only appear on the skin but can also affect internal parts of the body. When the skin or tissue is broken as the result of a cut or other wound, it starts to heal itself within a couple of days by producing collagen where the damage has occurred. Collagen continues to build up at the site of the wound to fill in the injured area, making the affected skin red, raised and often bumpy. However, most scars become paler and smoother in time – though it can take a year or two for them to fade.
What causes it?
Stretch marks – or striae – also affect the surface of the skin. These long, thin marks can develop wherever skin has been stretched, particularly in areas such as the stomach, breasts, upper arms, thighs and buttocks. They start off red or purple in colour, but gradually fade to silvery white.
Stretch marks often develop after a period of rapid weight gain. Teenagers may develop stretch marks as they go through puberty – teenage boys can develop them on their back, where they cause horizontal marks over the spine area. They are also common during pregnancy (see Stretch marks and pregnancy, below).
Other things that can cause stretch marks include certain health conditions such as Marfan syndrome or Cushing’s syndrome, as well as using steroid medicines inappropriately or for a long time. You may also be more likely to develop stretch marks if others in your family have been affected by them.
Stretch marks are the result of stretching and tearing in the middle layer of the skin (the dermis). This layer contains fibres that let your skin stretch naturally as you grow, usually without leaving any marks. But during periods of rapid growth, the fibres become overstretched and can break.
These tears in the fibres let the blood vessels in the skin below show through, making the stretch marks red or purple in colour. After a while the blood vessels become smaller, which reveals the fat underneath your skin. When this happens, your stretch marks turn pale and silvery white in colour.
Both scars and stretch marks can cause embarrassment and distress, especially if they’re very noticeable. Some people with scars on their face, for example, may feel they’re being stared at, and may become socially isolated in an attempt to avoid any negative attention.
Having visible stretch marks can also cause anxiety and can make some people feel very uneasy. If you’re feeling low or depressed because of a scar or stretch marks – or if it’s affecting your day-to-day life – ask your GP about the support they can offer you.
Types of scars
There are lots of things that can cause scars, including accidental injuries, surgical incisions, burns, scalds, bites and scratches, as well as some skin conditions. There are also different types of scars, the mains ones being as follows:
Scars that start out red and raised but flatten and turn pale in time are the most common type. The type of injury will determine how thin and neat the scar will be and how long it may take to heal (wider wounds where there’s more surface tissue damage tend to heal less neatly and less quickly).
According to the NHS, 10 - 15 percent of all wounds result in keloid scars. These wounds produce an overgrowth of scar tissue caused by too much collagen being produced in the skin. The scar can grow lumpy and usually extends beyond the area of the wound being healed.
Keloid scars can affect any part of the body, but tend to be more common on the shoulders, neck, cheek, upper chest and head (often the earlobes). They’re most likely to affect younger people between the ages of 10 and 30, and are also thought to run in families. Keloid scarring also tends to be more common in people with dark skin, including those from African, African-Caribbean and south Indian backgrounds.
You know a scar is a keloid when it looks rubbery, raised and occupies an area larger than the original wound. But it doesn’t usually appear straight after a cut or wound has been made – indeed, it can take a keloid scar about three months to start developing.
A keloid scar may also become itchy, painful or tender, or the skin may feel as if it’s burning, and it may continue growing for a few weeks to a few months. If it makes the skin tight or if it’s near a joint, a keloid scar can also restrict your movement. However, like flat scars, keloids start out as red or purple in colour then turn paler in time.
If you know you’re prone to keloid scarring, it’s a good idea to avoid having cuts or breaks in your skin – including tattoos or piercings – and, wherever possible, to avoid having skin surgery on areas of the body that are the most susceptible to scarring.
These are also scars that have become unusually thickened thanks to an overproduction of collagen during the healing process. Unlike keloid scars, they don’t extend beyond the area of the original wound. They can, however, continue to thicken for several months, after which they start to become flatter and paler (though it can take several years for them to settle down fully).
Like keloid scars, hypertrophic scars in certain areas of the body can restrict your movement, since the scar tissue is less flexible than the rest of your skin.
Chickenpox and acne scars
Some people who have had skin conditions such as chickenpox or acne can be left with sunken or pitted scars. Discover more on acne treatments.
This type of scar is called a scar contracture, and is caused when the skin tightens over a burn wound. Scalding, on the other hand, can cause hypertrophic scars, especially in children.
Stretch marks in pregnancy
The medical name for pregnancy stretch marks is striae gravidarum. These usually appear on the stomach, but can also affect areas such as the breasts, hips, buttocks and upper thighs. They’re particularly common during pregnancy – estimates suggest up to nine out of 10 women develop them – thanks to the way the skin becomes stretched when a pregnancy develops. However, hormonal changes during pregnancy can also affect the skin and make the appearance of stretch marks more likely.
Skin elasticity can play a part in the development of stretch marks – if you have particularly elastic skin, you may not get many or even any stretch marks while you’re expecting (pregnancy hormones are thought to affect the skin’s levels of elastin, the substance that gives skin its elasticity).
Weight gain is thought to be involved too, and women who gain more than the average amount of weight during pregnancy are thought to be more susceptible to getting stretch marks than those who put on less weight (according to the NHS, most women gain between 10 - 12.5kg when they’re pregnant, though weight gain during pregnancy varies a great deal).
Another factor in the development of pregnancy stretch marks is your genes. For instance, if your mother had stretch marks when she was pregnant, there’s a good chance you will get them too (or not, if she didn’t).
Exactly when they appear varies from one women to the next, though most stretch marks tend to develop during the third trimester and particularly at the very late stage of pregnancy (stretch marks on the breasts may, however, appear after the birth). And while they can be very visible during pregnancy, within about a year of your baby being born your stretch marks should fade and become far less noticeable.
Can stretch marks be prevented
There’s probably nothing you can do to stop stretch marks developing during pregnancy completely, but there may be ways to keep them to a minimum, so they’re not so visible:
Avoid excessive weight gain
Try to eat as healthily as possible when you’re pregnant, and there’s a good chance you’ll only gain as much weight as necessary. Try to make sure your weight increases slowly and steadily, which may help your skin to stretch more slowly too. If you suddenly gain a lot of weight, you’re much more likely to develop stretch marks. Speak to your doctor or midwife about eating healthily in pregnancy – they can tell you how many calories you should be eating at the different stages, and can keep an eye on how much weight you’re gaining.
Keep your skin hydrated
Looking after your skin by moisturising it regularly may help support it and boost its elasticity (if your skin becomes too dry, your chances of developing stretch marks increases). Make sure you use creams, oils or lotions that are suitable for use during pregnancy – your doctor, midwife or pharmacist can help you choose (some ingredients in skincare, such as retinoids, should always be avoided during pregnancy).
Scrub away dead skin cells
Many skin experts also recommend exfoliating your skin a couple of times a week while you’re pregnant, as this may help encourage the production of collagen and elastin.
Treatments for scars and stretch marks
While most scars and stretch marks flatten and fade over time, some may need treatment, especially if they’re affecting your emotional health or – as in the case of some scars – they’re restricting your movement.
Keloid and hypertrophic scars that are causing problems can often be minimised by the use of silicone gels or sheets, which are available over the counter at pharmacies. Or if you’re referred to a dermatologist, they may recommend treating a keloid or hypertrophic scar with one or more steroid injections to help flatten them and reduce any associated inflammation.
Depending on how severe your scar looks, you may also need the help of a plastic surgeon. Surgical procedures can be performed on scars to change their width, shape, position or to loosen a scar that’s restricting movement. However, any surgery carries the risk of causing new scars that may even end up looking worse than the original ones.
Laser therapy – which isn’t widely available on the NHS – can also be used to make a scar paler in colour, while a procedure called laser resurfacing can help improve the appearance of pitted scars. Some cosmetic surgery practitioners also offer injected dermal fillers to reduce the depth of pitted scars (this, however, is a temporary fix, which means you’ll need regular treatments to maintain the effect).
Stretch mark treatments
There are lots of products marketed as creams or lotions for stretch marks. These may work for some people if they’re applied during the early stages of stretch-mark development (that is, when the stretch marks are still red or purple in colour). However according to the NHS, it’s unlikely these products make stretch marks fade any more than they would naturally over time.
Laser therapy is often used for stretch mark removal. The success of laser therapy on stretch marks varies from one person to the next, but in general it may help to fade them and make them less visible. Unfortunately you may need several treatments, which can work out expensive.
Natural help for scars and stretch marks
If you have an injury or surgery, it’s important to look after the scar or scars it will leave behind.
Wash your skin with non-scented soap and pat – don’t rub – the affected area dry. Make sure the skin surrounding the scar is kept moisturised: apply a moisturising cream, such as an emollient cream (available from pharmacies), twice a day. Applying oils can also be an effective way of keeping scar tissue and stretch marks moisturised – try a natural oil such as rosehip oil or vitamin E oil (buy capsules, pierce and apply directly to the skin), or an oil blend that includes vitamins and plant extracts such as Bio Oil.
Try to wear loose-fitting clothes that won’t rub or irritate the affected area, and above all try not to scratch the scar or pick at it. Then once the wound has closed completely and there’s no longer any scab it’s a good idea to massage your scar – try the following three times a day for about five minutes each time:
Place your index and middle finger on the scar and apply just enough pressure to turn the fingertips from pink to white.
Using small circular movements, massage firmly along the length of the scar, spending more time on thick or bumpy areas.
Also make sure your scar is protected from sunlight, as the skin will be more sensitive than elsewhere and may burn easily. Apply a high-factor sunscreen (SPF30 minimum) to the area for 12 - 18 months after a scar forms whenever you’re in strong sunlight.
Once a scar has healed completely you can try using special make-up or skin camouflage cream to disguise it. For more information on using camouflage make-up, visit www.changingfaces.org.uk.
Meanwhile, nutritional supplements that may help with scars and stretch marks include:
Antioxidant plant pigments found in richly coloured fruit such as blueberries, blackberries, cranberries, raspberries and black grapes, anthocyanidins may help with skin repair and may also be useful for the prevention of stretch marks, since they’re thought to boost the production of elastin in the skin.
As well as being applied directly to the skin, taking oral vitamin E capsules may worth trying, since vitamin E is an antioxidant that’s thought to help support skin healing.
This important element may be useful too, as it’s thought to help with skin repair. According to some experts, many people don’t get enough zinc in their diets (zinc is found in foods such as oysters, crab, beef, lobster, chicken, chickpeas, kidney beans, cashew nuts, almonds and Cheddar cheese).
Managing scars isn’t easy, but over time they can change and fade, just remember to keep them protected. To discover more articles on a range of other common health conditions, feel free to visit our health library.
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.