Stretch marks are scars that have been formed in the deeper layers of the skin. In fact stretch marks (striae) consist of damaged skin collagen. Collagen fibers have been frayed under the influence of hormonal changes, repeated stress, stretch and strain. After a while this tension results in the breaking of the collagen fibers which causes an abnormal, crinkled surface texture. These less elastic and crinkled marks are called stretch marks.

As with all scars complete removal is impossible because once the skin is damaged it can hardly be repaired fully. But there are certain procedures that can significantly fade stretch marks to make them less noticeable.

A fairly new over the counter stretch marks product is the in 2009 released ScarAway Intensive Stretch Mark Therapy. This particular product might be promising because of the fact that it comes from the manufacturer of the high quality ScarAway brand. But does this new product live up to its expectations?

First lets take a look at its active ingredients. According to the manufacturer’s website; a synthetic peptide, a vitamin, and organic Marrubium extract. Marrubium vulgare is a gray-leaved bushy herb with white flowers which looks a bit like mint. It is also known as White Horehound or Common Horehound. This member of the Labiatae family is, according to Wikipedia, particularly rich in biodiversity and has been used since ancient times by humans for many purposes. Water extract of Marrubium vulgare is widely used as anti-hypertensive treatment in folk medicine. Some other members of the Labiatae family are Hyssopus, Lavandula, Majorana, Melissa, and Mentha.

Then there is the statement that the anti stretch marks effect of this new product has been measured in a 3 months clinical study.

The skin-protecting properties against stretch marks have been shown by a new cell culture assay simulating skin stretching in a glass/acryl box by stretching a monolayer of fibroblasts’ cultures. ScarAway’s innovative Stretch Mark Therapy is proven in vivo and vitro studies to protect stretched skin structure as well as diminish stretch marks.

Summary of efficacy (evaluation questionnaire) * Decreasing in stretch marks’ length 92% * Decreasing in stretch marks’ width 92% * Decreasing in stretch marks’ color 92% * Skin on stretch marks more supple 69% * Disappearance of stretch marks on the treated zone 31%.

(In vivo means: “experimentation using a whole, living organism as opposed to a partial  or dead organism, or an in vitro controlled environment.” source Wikipedia)

I remain skeptical. We don’t know how the studies have been conducted nor if they are done on human test persons. The mentioning of a evaluation questionnaire at best suggests this. I could not find any trials showing Marrubium vulgare to be beneficial to skin problems or the skin in general. Which peptide is in the ingredients and what it does also remains unclear.

But maybe there is a synergistic effect. And of course my theorizing here does not proof at all this product should not be able to diminish stretch marks. Medical scientists still do not agree on the exact action of silicone sheets. But they do work and because this product is so new only time will tell if it actually does work. The only review I found online is a positive one. I would love to hear your experiences with this product.

“I used ScarAway Intensive Stretch Mark Therapy during my pregnancy for months 5 through 9 when my skin started to get tight on my abdomen. I have stretch marks on my thighs and breasts from growing and puberty so I was quite resigned to getting them during pregnancy as well. I am happy to report that I had my daughter on December 23rd…healthy and beautiful and… I have NOT ONE STRETCH MARK! I never imagined I would come through with none at all. I used ScarAway Stretch mark cream every day at least morning and night…sometimes I massaged it on 1 or 2 more times during the day if I thought of it. During the last 2 months I applied it when I felt the tight, itchy feel, and it soothed that feeling right away. I am so happy for so many reasons. Thanks ScarAway!

(source)

Small study on Tretinoin

Many doctors and dermatologists state that there is no over the counter product that is able to improve stretch marks. Especially not older, white striae. But there are some studies showing vitamin A derivates such as tretinoin to be effective. Here’s a short study abstract I found.

In this small study, topical application of tretinoin 0.1% significantly improved the clinical appearance of pregnancy-related stretch marks. (Rangel, Arias, Garcia, & Lopez-Padilla, 2001). I will get back to on vitamin A and stretch marks later.

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centella asiatica

Centella Asiatica is a mildly antibacterial, anti-viral, anti-inflammatory herb indigenous to south and south east Asia. The plant grows in swampy areas in India, Sri Lanka, Indonesia, Malaysia, Iran, northern Australia,  Melanesia, and New Guinea.

The herb has been used for ages for its medicinal qualities in both traditional Chinese medicine and traditional Indian (Ayurvedic) medicine as well. It is also known as Gotu Kola, Asiatic or Indian Pennywort, Rau má in Vietnam and Saraswathi Plant” in India.

(photo by suatu ketika | Creative Commons)

Ascribed benefits of its culinary and medicinal use are stimulation of overall health, rejuvenation, boosting the nervous system and increasing concentration. Some extracts have been used traditionally to treat leprosy. In Thailand it is used as a detoxifying agent to aid treatment of opium addicts.

A popular folklore tale from Sri Lanka speaks of a prominent king from the 10th century AD named Aruna Withane who claimed that Gotu Kola provided him with energy and stamina to satisfy his 50-woman harem.  Source: Wikipedia

Centella Asiatica Scar Creams
Several studies show Centella asiatica’s ability to improve wound healing. Some aspects of the chemical compounds in this herb seem to aid scar treatment as well. More specific; the main substances; asiatic acid, asiaticoside and brahminoside seem to stimulate type 1 collagen production which leads to less prominent scars.

Also inflammation, which is a major factor in (abnormal) scar creation, is reduced. Apart from this, the process of myofibroblast production, which boosts wound healing by contracting the edges of the wound, is decreased. It is theorized that residue myofibroblasts are the reason for hypertrophic and keloid scar development.

Madecassol
A segment of the chemicals in the Asiatic acid are also described as madecassol. This madecassol has shown to be an effective treatment of keloid scars. (E1-Hefnawi H: Treatment of keloids with asiaticoside. Dermatologica 125:387, 1962)

Another scientist found that when taken orally madecassol turned out to be “an active scar improver with few side effects”.  His conclusion was that although more extensive study on its true mechanism of action and long-term safety needs to be done, it is promising regarding effective treatment of keloids. (Bosse JP: Clinical study of a new anti-keloid agent. Ann Plast Surg 3:13, 1979)

Landes reported about his 20 years of experience with madecassol ointment. He reported to use madecassol as additional treatment after cosmetic surgery. (Landes E: Konservative Therapie yon Narben und Falten. Z Hautkr 62:805, 1987)

No Side Effects
Studies as well as anecdotal reports have not shown any side effects of the topical application of Centella asiatica extract.  Because the plant and its three main chemical substances (terpenoids) are weak sensitizers skin irritations are considered unlikely, and have not been reported.


Centella Asiatica based Scar Creams
A well known scar cream is Alpha Centella cream. This product is used by some physicians, especially in Asia, to prevent and treat scars. The cream has two main ingredients.  Apart from the aforementioned three extracts of C. asiatica it also has extracts of the Bulbine frutescens plant in it. This herb possesses moisturizing and antibacterial properties and its action is sometimes compared with Aloe Vera (as is C. asiatica).

A newcomer on the market is Scartini serum with main ingredients Centella asiatica and lychee extract. As far as I know, this is the first cream with this centella asiatica (Gotu Kola) ingredient on the American consumer market, which could be promising. How much of the Centella asiatica ingredient is present in the product is unclear. Also the dermal benefits of lychee extract are not convincing when examining available research.


Conclusion
The positive effects of C. asiatica in wound healing are convincing (documented to aid wound healing in a large number of scientific reports) Also evidence for the improvement of, especially, keloid scar appearance is available but more research has to be done. Key effects appear to be speeding scar maturity, anti-inflammatory action and the decrease of excessive scar tissue (myofibroblast production). 

Or as this study abstract on New Innovations in Scar Management puts it:

“Centella asiatica has been documented to aid wound healing in a large number of scientific reports. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen and the resulting decrease in the inflammatory reaction and myofibroblast production.”
That’s why this report mentions Centella asiatica together with effective measures such as; pressure therapy, hydration, and silicone sheeting.

Since there do not seem to be any really effective scar ointments (except for the prescription cream Imiquimod (brand name Aldara) and silicone gel creams) Gotu Kolu based scar creams might be a worthy contribution to the effective scar products pool.