Striae gravidarum (stretch marks) cause as much emotional distress for women as other skin problems such as acne, eczema and psoriasis, US dermatologist say, but there is still few proven measures to prevent or treat them.

A study involving 116 women conducted by clinicians at the University of Michigan Medical School found that the stretch mark lesions were associated with a constellation of negative impacts on emotional, psychological, and quality of life measures, and the permanency of the lesions resulted in long term adverse psychological effects.

Most women (75%) reported permanency of striae gravidarum as the top physical concern.

Discolouration and discomfort were less disconcerting physical concerns, which may be because these features improve with time or emollients, the study authors said.

One in five women rated their lesions as “very prominent” (21%) and half reported them as “moderate” (49%), they noted in the paper published in the International Journal of Women’s Dermatology.

Embarrassment and self-consciousness was the one most frequently reported impacts associated with stretch marks, with over one-third of women reporting “a lot” (16%) or a “moderate” (22%) amount.

Lesion severity significantly correlated with the degree of embarrassment/self-consciousness (r=0.543), as well as the impact of stretch marks on other life-quality facets, including overall quality-of-life (r=0.428), clothing choice (r=0.423), self-image/self-esteem (r=0.417), feelings of anxiety/depression (r=0.415), and social activities (r=0.313) (all p≤0.001).

Nearly one-quarter of participants felt that emotional distress related to SG was similar or more than that caused by other skin problems, such as acne, psoriasis, or eczema.

Study author Professor Frank Wang, a dermatologist at Michigan Medicine said his team had been working on the molecular mechanisms that cause SG lesions for 15 years, and found some insights into the substantial changes that occur in collagen and elastic fibres.

But for reasons his team is still investigating, these skin components are damaged and never fully reform, leading to permanent lesions.

“While there are some ways to reduce intense redness or texture of stretch marks, there is very little scientific evidence that any intervention completely prevents or treats lesions,” he said.

The study authors said women reported trying various therapies to prevent lesions or improve their appearance, including oils, emollients, massage, prescription and over-the-counter topical remedies, vitamins, lasers and more recently microneedling.

“None of these interventions fully erase stretch marks, and they can get very expensive,” said Professor Wang

He added that he was currently enrolling participants in a study that will examine the formation of the earliest stretch marks, involving skin biopsies taken as soon as they form during pregnancy.

Co-author Dr Timothy Johnson, an obstetrician at Michigan Medicine, said the emotional and psychological impacts of stretch marks could add to the stress and depression experienced during pregnancy and in the postpartum period, and the burden was compounded by embarrassment and shame.

“Pregnant women talk about stretch marks with me every single week at clinic, and it’s time we break the stigma and start talking about them openly with all patients. By doing this study, we have an opportunity to normalise stretch marks in the context of all other dermatological conditions,” he said.