Treatment for Stretch Marks
Combination therapy with platelet-rich plasma (PRP) plus CO2 laser is the most effective treatment for stretch marks, showing superior patient satisfaction and histological improvement compared to other modalities. 1
Treatment Algorithm Based on Evidence Quality
First-Line Recommendation: Combination Therapy with PRP
For optimal results, combine autologous platelet concentrates (PRP) with energy-based devices rather than using any single modality alone. 1
PRP combined with CO2 laser demonstrated the most promising outcomes with better patient satisfaction, fewer side effects, and superior histological improvements including increased epidermal thickness and normalized dermal collagen fiber orientation 1
Alternative effective combinations include:
All combination approaches showed statistically significant improvement both subjectively and objectively compared to the same modality used alone 1
Timing Considerations
Initiate treatment as early as possible—the earlier treatment begins, the better the outcome. 1
- Early, active (red/purple) stretch marks respond better than mature (white) stretch marks 2
- Treatment of striae rubra (early stage) is more effective than striae alba (late stage) 3
Alternative Topical Therapy for Early Stretch Marks
For patients with early, clinically active stretch marks who prefer non-procedural treatment, topical tretinoin 0.1% cream applied daily for 6 months is an evidence-based option. 2
- In a randomized controlled trial, 80% of tretinoin-treated patients showed definite or marked improvement compared to only 8% with vehicle (p=0.002) 2
- Tretinoin decreased mean stretch mark length by 14% and width by 8%, while vehicle-treated marks increased in size 2
- Clinical improvement occurs despite unclear mechanisms of action at the histological level 2
Adjunctive Topical Therapy
A topical oil formulation containing plant extracts and vitamins can provide meaningful improvement when applied twice daily for 4 months. 4
- Demonstrated 71% improvement in clinical appearance at 4 months with 3-point reduction in clinical severity scores (p<0.001) 4
- Showed objective improvements including 30% erythema reduction, 71% hydration increase, and evidence of collagen remodeling on confocal microscopy 4
- Well-tolerated with no significant adverse events 4
Mechanism of Action and Histological Evidence
The combination of PRP with energy-based devices produces measurable structural improvements:
- Increased epidermal thickness 1
- Enhanced rete ridge formation 1
- Decreased perivascular inflammatory infiltrate 1
- Normalized orientation of dermal collagen fibers 1
- Improvement in epidermal atrophy 1
Critical Clinical Recommendations
Counsel patients to avoid further triggers of stretch mark formation: 1
Important Caveats and Limitations
The evidence base for stretch mark treatment remains limited with mostly poor-quality studies and no standardized assessment scales. 1
- Large, high-quality controlled trials are lacking 1
- Current treatment modalities show only modest improvement in most studies 1
- Stretch marks are therapeutically challenging and histologically resemble dermal scars 1
- A 2014 systematic review of 8 RCTs concluded that evidence is insufficient to provide clear practice guidelines due to limited patient numbers and high risk of bias 5
Despite these limitations, the 2025 guideline from Periodontology 2000 provides the most recent and highest-quality evidence supporting combination therapy with PRP, particularly when combined with CO2 laser. 1
What NOT to Do
- Do not use single-modality treatment when combination therapy is available—outcomes are consistently inferior 1
- Do not delay treatment—early intervention produces better results 1, 2
- Do not promise complete resolution—stretch marks are challenging to treat and results show "modest improvement" even with best available therapies 1