The different types of stretch marks are striae rubrae, striae albae, striae atrophicans, striae gravidarum, striae nigra, and striae caerulea.
Striae rubrae (red in color) are also called new stretch marks (acute stage), while striae albae (white in color) are called old stretch marks (chronic stage).
This article covers details on the types of stretch marks, their color and appearance, and how they are formed.
What are stretch marks?
Stretch marks (the medical term is striae) are indented streaks that occur due to overstretching of skin. This is a common skin concern, and these marks are harmless. However, one may not like them due to cosmetic reasons.
The commonly affected areas are the breast, abdomen, lower back, thighs, buttocks, upper arms, or calves.
Stretch marks can have various arrangements, including horizontal, vertical, or diagonal patterns.
How do they form?
The three main factors behind stretch marks are:
- Hormones.
- Stretching of skin.
- Alteration in the structure of collagen and elastic tissue in the dermis.
Our skin has three main layers:
- Epidermis – This is the uppermost layer, consisting of several layers, protecting our skin from outside elements. Melanocytes are special cells in this layer that give color to our skin.
- Dermis – This is the middle layer containing collagen and elastic fibers that give our skin strength and elasticity.
- Hypodermis – This is the deeper layer which mainly consists of fat and connective tissue.
As our body grows, our skin is able to adjust or stretch accordingly. Sometimes, this growth is sudden, as in pregnancy. Our skin cannot cope, leading to tears in the dermis damaging elastic fibers and collagen.
Hormones, steroids, and certain medical conditions can affect the collagen and elastic fibers, making them more likely to tear.
This can lead to inflammation and increased blood flow, giving red or pink color to the stretch marks. Over time, the color fades out, and the stretch marks look similar to a flattened scar.
Types
Stretch marks can be identified with different names based on what is causing them, their appearance or color, or if they are new or old.
The two main types of stretch marks are:
- Striae rubrae (Red or pink stretch marks)
- Striae albae (White stretch marks)
Other types of stretch marks are:
- Striae atrophicans
- Striae gravidarum
- Striae nigra (Dark gray or black stretch marks)
- Striae caerulea (dark blue stretch marks)
1. Striae rubrae
Striae rubrae are the classic red, pink, or purple stretch marks that are newly formed. They are also referred to as the early stretch marks or acute stage of stretch marks.
These are red or erythematous due to underlying inflammation and changes in vessels. The epidermis becomes flattened, and elastic fibers decrease.
They usually present as smooth and slightly elevated streaks perpendicular to the direction of skin tension. In some cases, they can be itchy.
Over time, they can become longer and broader.
2. Striae albae
Striae albae is classified as the old stretch marks or chronic stage of stretch marks. In these, the epidermis becomes atrophic and lacks skin appendages (hair follicles, sebaceous or sweat glands).
Over time, stretch marks become hypopigmented and appear like scars. They look pale as they lose the vessels. Their surface can have a wrinkled appearance.
This transition from striae rubrae to striae albae can be slow and may take months to years.
3. Striae atrophicans
Striae atrophicans are associated with thinning of the skin. These are usually seen with topical or oral use of steroids, Cushing disease or syndrome, and after a surgical procedure.
People with Cushing disease or syndrome usually have much broader (greater than 1 cm) striae.
Steroids can prevent fibroblasts from forming collagen and elastin fibers which are necessary for the elasticity of the skin. This makes our skin vulnerable to stretch marks.
4. Striae gravidarum
Striae gravidarum are striae distensae or stretch marks which occur secondary to pregnancy. They affect 50 to 90% of pregnant women. They typically appear in the late second or third trimester (around the 6th to 7th month of pregnancy). They commonly affect the abdomen, breasts, and thighs.
A physical stretch of the skin causes damage to the dermal component, and pregnancy hormones can affect elastin fibers leading to stretch marks.
Some associated risk factors include:
- Younger age at pregnancy.
- Family history of striae.
- Higher weight gain during pregnancy.
Striae gravidarum first appears as striae rubrae which are red to pink linear streaks. They can become long and wide and may be associated with itching or burning.
Over time, they fade and become mature striae or striae albae.
5. Striae nigra
Striae nigra are dark gray or black colored stretch marks are seen in people with darker skin tones due to higher melanin content. Over time, they can fade to lighter colors.
6. Striae caerulea
Striae caerulea are dark blue in color and are seen in people with darker skin tones. Over time, these too lose color.
New vs. old
New stretch marks
Looking at the types above, stretch marks that are pink, red, purple, blue, or dark gray are new stretch marks. So, basically, most types and colors of stretch marks come under new stretch marks.
Depending on how thin the overlying skin is, underlying blood vessels, and the skin tone of the person, stretch marks can have different colors.
If treated at this stage, there can be some improvement in stretch marks. In addition, some treatments may prevent further worsening of the new stretch marks.
Old stretch marks
These are striae alba, which are white in color. They have thin epidermis and can be depressed. The surface can look wrinkly. They can look shiny and glistening. They look very similar to scars.
These are the ones that can be tough to treat. Most studies where the treatments led to some improvements were done on new stretch marks.
Causes
Stretch marks are usually associated with pregnancy but can also occur in other situations.
The common causes of stretch marks are:
- Pregnancy.
- Rapid gain or loss of weight.
- Bodybuilding.
- Oral steroid use.
- Topical steroids.
- Medical conditions like Cushing disease/syndrome and Marfan syndrome.
Treatment
The most challenging part is the treatment of stretch marks. They are a form of scars, so nothing is proven to get rid of them completely.
There are several topicals used in various studies. These include – Retinoids like tretinoin, glycolic acid, centella asiatica, hyaluronic acid, cocoa butter, silicone gel, and ascorbic acid.
Of these, tretinoin and hyaluronic acid are promising with good evidence. Read more about tretinoin for stretch marks in this article.
Note: Retinoids should not be used during pregnancy. If you are breastfeeding, talk to your doctor before using retinoids.
Some in-office procedures may help by improving the color or stimulating collagen production. These include:
- Dermabrasion.
- Micro-needling.
- Lasers and light therapy (like IPL).
- Chemical peels.
- Radiofrequency.
Summary
Stretch marks are linear scars on the skin. Rapid stretching of the skin and damage to the dermis can lead to these scars. Depending on the age of the scars, color, and appearance, stretch marks can be of various types and have different names.
The various types of stretch marks include striae rubrae, striae albae, striae atrophicans, striae gravidarum, striae nigra, and striae caerulea.
New stretch marks are pink, red, purple, blue, or dark gray in color, while old stretch marks are white in color.
There are various treatment options – topicals or in-office procedures. However, none of them are proven to get rid of stretch marks completely.
References
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- Oakley AM, Patel BC. Stretch Marks. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Wollina U, Goldman A. Management of stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg. 2017 Jul-Sep;10(3):124-129. doi: 10.4103/JCAS.JCAS_118_17. PMID: 29403182; PMCID: PMC5782435.
- Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. Int J Womens Dermatol. 2016 Dec 6;3(2):77-85. doi: 10.1016/j.ijwd.2016.11.001. PMID: 28560300; PMCID: PMC5440454.
- Ud-Din S, McGeorge D, Bayat A. Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae. J Eur Acad Dermatol Venereol. 2016 Feb;30(2):211-22. doi: 10.1111/jdv.13223. Epub 2015 Oct 20. PMID: 26486318; PMCID: PMC5057295.
- Kharb S, Gundgurthi A, Dutta MK, Garg MK. Striae atrophicans: A mimic to Cushing’s cutaneous striae. Indian J Endocrinol Metab. 2012 Mar;16 Suppl 1(Suppl1):S123. doi: 10.4103/2230-8210.94240. PMID: 22701834; PMCID: PMC3354936.
- Hermanns JF, Piérard GE. High-resolution epiluminescence colorimetry of striae distensae. J Eur Acad Dermatol Venereol. 2006 Mar;20(3):282-7. doi: 10.1111/j.1468-3083.2006.01426.x. PMID: 16503888.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.