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Red and white stretch marks: why they appear and what works
Recent red stretch marks respond better to treatment than white ones. See what distinguishes each stage, what creams do and what is done in the clinic.
Rúben BritoAuthor
Dr Michelle CampagnoliClinical review · OM no. 69467
In this article
Stretch marks are among the most common marks on the skin: they appear in adolescence, in pregnancy, after gaining or losing weight, and in those who build muscle quickly. They are present in a large proportion of people, men included, and are not a health problem. But they bother many people, and the market for “anti-stretch-mark” creams is enormous.
There is one distinction that changes everything: the colour of the stretch mark. Recent stretch marks, red or purplish, are still in an active phase and respond considerably better to treatment. Old stretch marks, white or silvery, are a kind of mature scar and are much harder to improve. Knowing which stage yours are in is the first step towards having the right expectations.
Three ideas to remember.
Fica por baixo do resumo, se existir uma segunda foto.
What they are and how they form
Stretch marks (in medical terms, striae distensae) are linear scars of the dermis, the layer of skin where collagen and elastic fibres sit. They form when the skin is stretched faster than the connective tissue can keep up, at a time when that tissue is more fragile.
Three ingredients are usually present:
- Stretching of the skin: rapid growth, pregnancy, gain in weight or muscle mass.
- Hormonal changes that affect fibroblasts (the cells that produce collagen and elastin), such as those of puberty, pregnancy or excess corticosteroids.
- Genetic predisposition. There are families with many stretch marks and others with few, even in similar situations.
Under the microscope, skin with stretch marks shows fragmented elastic fibres and collagen reorganised into fine, parallel bundles, as in a scar. The epidermis above becomes thinner and smoother.
Where they appear
- Adolescents: thighs, hips, buttocks, breasts; in boys, also on the back and lower back.
- Pregnancy: belly, breasts, hips, thighs.
- Rapid increase in muscle mass: shoulders, arms, chest.
- Weight fluctuations: abdomen, flanks, thighs, arms.
Red or white: two stages of the same mark
| Feature | Red or purple stretch marks (striae rubrae) | White stretch marks (striae albae) |
|---|---|---|
| Stage | Recent, active | Old, mature |
| Colour | Pink, red, purplish | White, pearly, silvery |
| Skin relief | Sometimes slightly raised, may itch | Slightly sunken, with a fine wrinkled surface |
| What is happening in the skin | Inflammation, dilated vessels, changing fibres | Stabilised scar, fewer vessels, less pigment, thinner skin |
| Response to treatment | Better: colour and width can decrease considerably | More limited: improvement in texture and a little colour |
| Time | Months | Years, permanent |
With time, all stretch marks tend to go from red to white. They become less visible, because they lose colour, but they become harder to treat. That is why, when they bother you, it is worth acting early.
In darker skin, recent stretch marks may be darker than the surrounding skin, and old ones lighter. The logic is the same.
Causes and when to suspect something more
Common causes
- Puberty: rapid growth and hormonal changes. Very frequent, in girls and boys.
- Pregnancy: the best-known cause; they affect most pregnant women, especially in the third trimester (there is a dedicated article: Stretch marks in pregnancy: what prevents them, what doesn't and what to do afterwards).
- Rapid weight gain or loss.
- Rapid increase in muscle mass, especially in those who train with heavy loads or use anabolic steroids.
- Corticosteroids: potent corticosteroid creams applied for a long time, especially in folds (groin, armpits), and prolonged oral or injected corticosteroids.
When to see a doctor
Stretch marks, in themselves, are not dangerous. But, in some cases, they are a sign of something else.
Never use potent corticosteroid creams for long periods without medical advice, especially in folds and on the face.
Topical treatments: what the evidence says
| Topical | Evidence | Notes |
|---|---|---|
| Tretinoin (prescription retinoid) | Controlled trials showed a reduction in the length and width of recent stretch marks; little effect on old ones | It can irritate. Contraindicated in pregnancy and breastfeeding |
| Retinol and other over-the-counter retinoids | Fewer studies; effect probably milder | Same precautions in pregnancy |
| Topical hyaluronic acid | Some studies suggest a benefit in recent stretch marks, especially combined with other active ingredients | Safe in pregnancy |
| Centella asiatica | Some studies, mainly in prevention in pregnancy, in combined formulas | Hard to isolate the effect |
| Almond oil, cocoa butter, olive oil | Studies have not shown a consistent benefit in prevention or treatment | They moisturise and relieve itching; they do not treat |
| Combined “anti-stretch-mark” creams | Variable results; many studies funded by the manufacturers | Choose by ingredients, not by the promise |
Sources: Kang et al., 1996; Ud-Din et al., 2016; Hague and Bayat, 2017; Brennan et al., 2012.
A systematic review of topical treatments concluded that most studies are small and of limited quality, and that tretinoin in recent stretch marks is among the options with the most support. Massage during application may contribute to part of the observed effect.
Realistic expectation: topical products may help to soften recent stretch marks and improve texture. For white stretch marks, the effect is small.
Treatments in the clinic
| Treatment | For what type | How it works | What to expect |
|---|---|---|---|
| Pulsed dye laser and other vascular technologies | Red ones | Reduces dilated vessels and inflammation | Reduces redness; little improvement in white ones |
| Fractional laser (non-ablative or ablative) | Red and white | Creates micro-injuries that stimulate remodelling of collagen | Improvement in texture and width in series of sessions; risk of marks on darker skin |
| Microneedling | Red and white | Micro-perforations that stimulate collagen and elastin | Gradual improvement; less risk of marks than some lasers |
| Radiofrequency (including with microneedles) | Red and white | Heating of the dermis and stimulation of collagen | Improvement in texture and firmness |
| Peels | Mainly texture and colour | Renewal of the epidermis | Limited effect on the stretch mark itself |
| Platelet-rich plasma (combined) | Red and white | Growth factors applied with microneedling or laser | May boost results; evidence still limited |
Sources: McDaniel et al., 1996; Elsaie et al., 2009; Lu et al., 2020.
What studies suggest in general:
- Combinations (for example, microneedling or fractional laser with other treatments) tend to give better results than single treatments, but the studies are small and heterogeneous.
- Several sessions are needed, spaced weeks apart.
- No treatment completely eliminates a stretch mark, especially a white one. The goal is to make it less visible.
- Darker skin requires special care, because of the risk of post-inflammatory hyperpigmentation.
- In pregnancy, clinic treatments are generally postponed until after the birth and, in some cases, until the end of breastfeeding.
Camouflage counts too
A self-tanner evens out skin tone and makes white stretch marks less visible, without risks. Tanning in the sun, by contrast, accentuates the contrast, because the stretch mark does not tan.
At Luxmed, we assess the type and stage of your stretch marks and explain honestly what can be improved. The plan may combine care at home with treatments in the clinic, adjusted to your skin.
Talk to us
The assessment is a conversation, with no obligation. Tell us what concerns you and our team will reply.
Telephone 214 044 241 · info@luxmed.pt
This article is for information purposes and does not replace a consultation. The results of any treatment vary from person to person.
Frequently asked questions
Can stretch marks be cured?
They do not disappear completely, but can become much less visible, especially if treated while they are red.
Why are red stretch marks easier to treat?
Because they are in an active phase, with inflammation and vessels, in which the skin is still remodelling and responds better to stimuli.
Do stretch mark creams work?
Tretinoin has evidence in recent stretch marks. Moisturising creams and oils relieve itching, but there is little evidence that they treat or prevent stretch marks.
Can white stretch marks turn red again?
No. But some treatments cause temporary redness while they stimulate remodelling.
Do men get stretch marks too?
Yes, especially in adolescence, with weight changes or rapid increase in muscle mass.
Are purple stretch marks dangerous?
In most cases they are simply recent stretch marks. If they are wide, appear for no obvious reason and come with other signs (weight gain in the trunk and face, weakness, high blood pressure), speak to a doctor.
Can I have laser for stretch marks in summer?
Some treatments can be done with strict sun protection; others are better postponed, especially in tanned or darker skin.
Does a tan disguise stretch marks?
On the contrary: the stretch mark does not tan and the contrast increases. A self-tanner disguises it better.
Scientific references 7
- Kang S, Kim KJ, Griffiths CEM, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol. 1996;132(5):519-526. Artigo
- 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;30(2):211-222. Artigo
- Hague A, Bayat A. Therapeutic targets in the management of striae distensae: a systematic review. J Am Acad Dermatol. 2017;77(3):559-568.e18. Artigo
- Lu H, Guo J, Hong X, Chen A, Zhang X, Shen S. Comparative effectiveness of different therapies for treating striae distensae: a systematic review and network meta-analysis. Medicine (Baltimore). 2020;99(39):e22256. Artigo
- Elsaie ML, Baumann LS, Elsaaiee LT. Striae distensae (stretch marks) and different modalities of therapy: an update. Dermatol Surg. 2009;35(4):563-573. Artigo
- McDaniel DH, Ash K, Zukowski M. Treatment of stretch marks with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg. 1996;22(4):332-337. Artigo
- Brennan M, Young G, Devane D. Topical preparations for preventing stretch marks in pregnancy. Cochrane Database Syst Rev. 2012;(11):CD000066. Cochrane
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