Body
What stretch marks actually are
Short answer
A stretch mark is a tear in the dermis where skin stretched faster than it could produce collagen. Red and purple marks are recent and respond somewhat to treatment. White and silver marks are mature scar tissue and no cream removes them. Genetics decide most of who gets them. Fading is a realistic goal, removal is not.
What is happening under the surface
The dermis sits below the surface layer and contains the collagen and elastin that give skin its structure. When skin is stretched faster than the dermis can lay down new collagen, the existing fibres tear. What you see is that tear, viewed through a thinned surface layer.
That is why they sit slightly below the level of surrounding skin and have a different texture. They are scars, structurally, and they behave like scars.
The colour tells you the age. Fresh marks are red, pink or purple because you are seeing blood vessels through skin that has thinned. Over roughly six to twelve months the inflammation settles, the vessels recede, and they turn white or silver. That colour change is the window closing on how much you can influence them.
Who gets them
Mostly a matter of genetics and hormones rather than anything you did.
- Puberty growth spurts. Extremely common in teenagers of every body size.
- Pregnancy, affecting a large majority of pregnant people, usually in the third trimester.
- Rapid weight change in either direction.
- Muscle gain, which is why they turn up on the shoulders and arms of people who lift.
- Corticosteroid use, oral or strong topicals over time, which reduces collagen production.
- Family history, which predicts it better than almost anything else.
What has evidence behind it
| Treatment | Evidence | Realistic result |
|---|---|---|
| Tretinoin (prescription retinoid) | The best-evidenced topical, and only for red and purple marks | Meaningful fading of recent marks over several months |
| Consistent moisture and massage | Modest evidence, but low cost and low risk | Improves appearance and texture somewhat, best used preventatively |
| Centella asiatica and hyaluronic acid | Some evidence for prevention during pregnancy | May reduce how many form. Not a treatment for existing ones |
| Microneedling | Reasonable evidence, including for mature marks | Gradual improvement in texture over a course of sessions |
| Fractional laser | The strongest option for white marks | Genuine improvement in texture and colour. Costly, several sessions |
| Cocoa butter, bio oil, vitamin E | Poor evidence for prevention or treatment specifically | Moisturises. Popular, pleasant, not doing what the packaging implies |
Tretinoin is not used in pregnancy, which is inconvenient given how many stretch marks form then. During pregnancy the honest advice is consistent moisturising, and treatment afterwards if you want it.
Nothing removes a mature white stretch mark topically. Anything promising that is exploiting the fact that most people do not know they are scars.
A reasonable position on them
If they are new and red, that is the moment to act if you want to. A prescription retinoid over several months, daily moisture, and sun protection, because UV darkens and worsens the appearance of any scar.
If they are white, the choices are professional treatment or acceptance, and there is no shame in either. Something like 80% of people have them somewhere. They fade considerably on their own over years, and they are one of the most universal features of human skin.
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Questions people also ask
Do stretch marks go away?
They fade substantially over years but do not disappear. Red and purple marks are recent and respond somewhat to treatment. White and silver marks are mature scar tissue and no topical product removes them.
What is the best treatment for stretch marks?
For red or purple marks, a prescription retinoid such as tretinoin has the best topical evidence. For white marks, fractional laser and microneedling are the only options with meaningful results.
Does cocoa butter prevent stretch marks?
The evidence does not support it specifically. It moisturises, which is mildly helpful, but it does not prevent stretch marks in the way the packaging implies. Genetics is the strongest predictor of who gets them.
Can I use retinoids for stretch marks during pregnancy?
No, retinoids are avoided in pregnancy. Consistent moisturising is the reasonable approach during pregnancy, with treatment afterwards if you want it.
Why do I have stretch marks if I am not overweight?
They come from skin stretching faster than collagen can be produced, which happens in growth spurts, muscle gain and pregnancy regardless of body size. Athletes and slim teenagers get them routinely.
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