Striae distensae are characterized by distinct microstructural features as measured by non-invasive methods in vivo

Stretch marks or striae distensae (SD) are characterized by epidermal atrophy following repeated over-stretching of the skin tissue. The objective of this study was to investigate the skin texture and microstructure of SD lesions compared to those of normal adjacent skin in vivo using non-invasive methods.

A population of 26 women and 3 men with SD were examined after giving written informed consent. Following clinical grading, skin replicas were collected, confocal microscopy was performed on SD lesions and healthy neighboring skin. Skin surface texture parameters were calculated using 3D image analysis of the skin replicas and epidermal and dermal microstructure were evaluated by analysis of the confocal images. In a parallel study, histological analysis was performed on 6 skin biopsies taken from abdominal reduction surgeries in areas where skin exhibited SD.

Analysis of the skin surface texture showed that the SD area was more anisotropic and with higher skin roughness than the adjacent skin in terms of directions of skin microglyphics. Confocal microscopy demonstrated that SD were characterized by shallower dermal papillae (P < 0.05) and that dermal papillae height inversely correlated to the intensity of collagen alignment on the SD sites (P < 0.05). The histology findings confirmed the in vivo confocal microscopy findings.

The skin structure of SD is qualitatively and quantitatively different compared to healthy skin. Altered skin relief reflects structural modifications in the dermis. Flattening of the dermal-epidermal junction maybe functionally related to the observed collagen fiber alignment. Observations by non-invasive methods were in line with the histological findings and therefore relevant in studies assessing the efficacy of SD treatment options.