Profhilo and Pregnancy Stretch Marks
Profhilo (hyaluronic acid injectable) should not be used during pregnancy or breastfeeding for stretch marks due to complete absence of safety data, and topical alternatives have not been proven effective for prevention or treatment of striae gravidarum.
Evidence Assessment
Injectable Hyaluronic Acid (Profhilo) - No Safety Data
No guidelines or studies address the safety of injectable hyaluronic acid products like Profhilo during pregnancy or lactation. The provided evidence focuses on systemic medications for rheumatic diseases, liver conditions, and other dermatologic treatments, but does not include dermal fillers or injectable aesthetic treatments 1.
The absence of safety data means Profhilo falls into the category of treatments that should be avoided until evidence becomes available, similar to how rheumatology guidelines classify drugs with insufficient pregnancy data 1.
Injectable procedures introduce additional theoretical risks beyond the medication itself, including potential systemic absorption, inflammatory responses, and unknown effects on pregnancy-related skin changes.
Topical Treatments for Stretch Marks - Limited Efficacy
High-quality evidence does not support the use of topical preparations for preventing stretch marks during pregnancy. A Cochrane review found no statistically significant difference in stretch mark development between women using topical preparations with active ingredients versus placebo (RR 0.74; 95% CI 0.53 to 1.03) 2.
One older study showed potential benefit for a cream containing Centella asiatica extract, alpha tocopherol, and collagen-elastin hydrolysates (OR 0.41; 95% CI 0.17 to 0.99), but only in women who had previously developed stretch marks in prior pregnancies 3.
Despite lack of evidence, 78% of pregnant women use anti-stretch mark products, with Bio-oil being the most commonly used (60.9% of users), though no high-quality trials support its effectiveness 4.
Clinical Recommendation Algorithm
During Pregnancy:
- Avoid Profhilo and all injectable hyaluronic acid treatments - no safety data exists 1, 5.
- Counsel patients that topical preparations have not been proven effective for stretch mark prevention or treatment 2.
- If patients insist on using something, topical moisturizers are unlikely to cause harm (though efficacy is unproven), as topical dermatologic medications generally have minimal systemic absorption 5.
During Breastfeeding:
- Continue to avoid injectable treatments due to lack of safety data 1.
- Topical treatments may be considered given minimal systemic absorption, though efficacy remains unproven 5, 2.
Postpartum (After Breastfeeding):
- Profhilo may be considered once pregnancy and lactation are complete, though evidence for its efficacy specifically for stretch marks (as opposed to skin laxity) should be discussed.
Key Clinical Pitfalls
- Do not assume that "natural" or topical products are automatically safe in pregnancy - always verify safety data 5.
- Manage patient expectations - stretch marks affect 50-90% of pregnant women and are largely determined by genetic factors, skin type, and mechanical stretching 2.
- Avoid promising prevention when evidence does not support it - this prevents unnecessary expense and disappointment 4, 2.