Stretch marks and veins and scars. Oh my!
This month’s dossier focuses on common patient complaints after pregnancy.
By Marie Leger, MD PhD
Stretch marks, or striae distensae as we call them (Latin!) can happen in anyone of any age, but they are more common in women. While I see them in men, too (most often in my eczema patients who use topical steroids) epidemiological data suggests that only 11 percent of men have them—while up to 88 percent of pregnant women can develop them. Interestingly, they are more common in younger pregnant women than older women—one study showed that about 80 percent of women under 20 got them during pregnancy, and only about a quarter of women over thirty. The cause of stretch marks isn’t well understood—but it’s thought that mechanical stress on the skin contributes. This makes sense—we see them when the skin is asked to do things quickly. Think growth spurts in kids, weight gain or loss (like pregnancy) When the skin from stretch marks is examined under the microscope, it looks like fibroblasts—the cells that make collagen and elastin—don’t migrate as well, and there is less collagen and elastin expression. It is difficult to prevent them. There is not a lot of evidence that topical applications (like coconut oil which, understandably, many people think is the cure for everything under the sun) help, though some of my patients find it comforting to at least try.
While stretch marks are notoriously difficult to treat, some prescription medications like tretinoin and even some procedural interventions can help after delivery and breastfeeding are complete. How? By promoting new collagen formation! Vascular lasers can help with the initial redness, but procedures that can help stimulate collagen can also improve skin appearance and texture longer term. Procedures like microneedling, radiofrequency microneedling, and fractionated and ablative lasers create strategic tiny skin injuries, and when the skin heals after treatment, fibroblasts migrate to the skin, new collagen is made, and skin appearance and texture can improve over time.
Scarring is another common patient concern after pregnancy. C-section scars sometimes become raised, firm keloids—particularly in patients with darker skin tones and patients of Asian, African, or Latinx descent. I often recommend to my patients who have a history of keloid scars (on the back or chest from acne or after piercings) to consult with a dermatologist early after a c-section. Depending on the kind of scar, a variety of approaches can help. A few approaches that I really like:
Silicone sheets—and many even come in long skinny shapes perfect for c-section scars—can help, particularly if used right away. These are easy to find in pharmacies and on line.
Intralesional injections for keloids—whether of the anti-inflammatory medication Kenalog or fluorouracil in my darker skinned patients are a workhorse of scar treatments! Fluorouracil is a favorite of mine in my darker skinned patients, as it doesn’t result in lightening of the skin as often as Kenalog does.
Laser treatments can also help here with itching, pigmentary and textural concerns.
Spider veins and varicose veins are also complaints after pregnancy. Unlike stretch marks, which are hard to prevent, compression stockings can be helpful here. As a resident physician at Bellevue, we were given 6 free pairs a year—this is a big deal, they are pricey! For people who are pregnant, on their feet a lot, or traveling they are quite amazing. When I was a resident the default color was a pretty craptastic tan. But there are now a variety of more stylish options available—from companies like Sigvaris, Medlite, and even the medical scrubs company Figs (banana and lifesavers and llamas adorn some of their options). Look for 20-30 mm Hg (a medium level of compression). While thigh highs and tights are probably the most effective at preventing spider veins, they are EXTREMELY CHALLENGING TO PUT ON. I can’t even imagine attempting this while pregnant and the additional 5-20 minutes wrestling with them is annoying to me. (I’m not alone—my patients used to look at me blankly when I asked how their waist-length stockings were working out at their follow up visits). So now I opt for the calf length ones and most of my patients do well with these, too. After delivery, there are a variety of options to treat spider veins—ranging from sclerotherapy to vascular lasers. The stockings are always a key to maintaining your results—so find some cute ones!