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Content
Evidence-based answers from the
Family Physicians Inquiries Network
clinical inquiries
Do any topical agents help
prevent or reduce stretch marks?
Evidence-based answer
A
Evidence-based
answer
no topical
agent
has been
proven to prevent or reduce stretch
marks. Randomized controlled trials
(RCTs) show that cocoa butter doesn’t prevent stretch marks (strength of recommendation [SOR]: A, 2 RCTs); neither does olive
oil (SOR: B, 1 small RCT).
A cream containing Centella asiatica
Evidence summary
Two double-blind RCTs that compared cocoa
butter with placebo to prevent stretch marks
in pregnant women found no difference.
In the first, investigators enrolled 300 Afro-
Caribbean women at 12 to 15 weeks’ gestation. Women used either 25% cocoa butter
cream or a placebo cream comprised of emollients and vitamin E daily. Investigators monitored compliance and assessed stretch marks
using a validated scale at 26 weeks, 36 weeks,
and after delivery. Cocoa butter cream didn’t
reduce stretch marks (44% vs 55% for placebo;
P=.09). Three women (1 using cocoa butter,
2 using placebo) discontinued the cream because of mild self-limiting reactions.1
In the second RCT, investigators randomized 210 nulliparous women (mainly
with intermediate skin color) to use cocoa
butter lotion with vitamin E or placebo. Women applied the lotion daily to their abdomen,
breasts, and thighs, starting at 12 to 18 weeks’
gestation. Investigators assessed the severity
of stretch marks either at delivery or postpartum using a validated scale. Cocoa butter
lotion didn’t prevent stretch marks (45.1% vs
48.8% for placebo; P=.730).2
Save the olive oil for cooking
A nonblinded RCT that compared twice-daily
jfponline.com
extract, vitamin E, and collagen hydrolysates doesn’t prevent new stretch marks
but might avoid additional stretch marks in
women who had already developed them
during puberty. Massage with vitamin E
ointment alone may reduce the number of
stretch marks (SOR: C, 2 small RCTs with
methodologic flaws).
Jeanne Moore, MD;
Gary Kelsberg, MD
Valley Family Medicine
Residency, Renton, Wash
Sarah Safranek, MLIS
University of Washington
Health Sciences
Libraries, Seattle
A ssista n t E D IT O R
Jon O. Neher, MD
Valley Family Medicine
Residency, Renton, Wash
olive oil massage with no treatment in 70 nulliparous women beginning at 18 to 20 weeks’
gestation found no reduction in stretch
marks (45.7% vs 62.9% without olive oil massage; P=.115). The investigators didn’t report
whether they performed a sample-size analysis to determine if the study was adequately
powered to demonstrate no difference.3
Mixed, but mostly negative, results
for multi-ingredient cream
A double-blind RCT found that Trofolastin cream containing Centella asiatica (also
known as Gotu kola, a member of the parsley family), vitamin E, and collagen hydrolysates didn’t prevent pregnancy-related stretch
marks among 80 women who applied the
treatment beginning at 12 weeks’ gestation.
When investigators evaluated a subgroup
of 18 women who had already developed
stretch marks during puberty, they found
that fewer of the women acquired additional
stretch marks during pregnancy (11% vs 100%
with placebo; P=.0001). The investigators
didn’t calculate whether the sample was large
enough to prove a significant difference.4
Fewer stretch marks with vitamin E
in small flawed study
An older systematic review (1996) included a
Vol 61, No 12 | December 2012 | The Journal of Family Practice
757
clinical inquiries
prospective RCT that randomized 50 women
at 20 weeks’ gestation to massage their abdomen, thighs, and breasts with vitamin E ointment or perform no massage. The trial found
fewer stretch marks with vitamin E ointment
massage (odds ratio=0.26; 95% confidence
interval, 0.08-0.84). The authors of the review
described this RCT as poorly randomized and
without blinding; investigators didn’t report
whether the sample size was adequate to demonstrate a significant effect.5
Visit us @
jfponline.com
Practical guidance
for panic disorder
Boadie W. Dunlop, MD, MSCR
4 ways to listen to
this audiocast:
Recommendations
.
No topical
agent—including
cocoa butter and
olive oil—has
been proven
to prevent or
reduce stretch
marks.
The American Congress of Obstetricians and
Gynecologists Web site states that although
many creams, lotions, and oils on the market
claim to prevent stretch marks, no proof exists that these treatments work. Using a heavy
moisturizer may help keep skin soft, but it
won’t help get rid of stretch marks.6
The American Academy of Dermatology
Web site also says that a moisturizer can improve the appearance of stretch marks and reduce itchiness; sunless tanning products can
hide the marks.7
JFP
1. Go to jfponline.com
2. Visit www.
myjfpmobile.com/1212
3. Scan this QR code to
listen to the
audiocast on your
smart phone
4. Text “PANIC” to
25827 from your
mobile phone and
follow the prompt.
INSTANT poll
References
1. Buchanan K, Fletcher HM, Reid M. Prevention of striae
gravidarum with cocoa butter cream. Int J Gynaecol Obstet.
2010;108:65-68.
2. Osman H, Usta IM, Rubeiz N, et al. Cocoa butter lotion for
prevention of stretch marks: a double-blind, randomized and
placebo-controlled trial. BJOG. 2008;115:1138-1142.
3. Taavoni S, Soltanipour F, Haghani H, et al. Effects of olive oil
on striae gravidarum in the second trimester of pregnancy.
Complement Ther Clin Pract. 2011;17:167-169.
4. Mallol J, Belda MA, Costa D, et al. Prophylaxis of striae gravidarum with a topical formulation. A double blind trial. Int J
Cosmet Sci. 1991;13:51-57.
5. Young GL, Jewell D. Creams for preventing stretch marks in
pregnancy. Cochrane Database Syst Rev. 2000;(2):CD00066.
6. Skin Conditions During Pregnancy. The American College
of Obstetricians and Gynecologists. Available at: www.acog.
org/~/media/For%20Patients/faq169.pdf?dmc=1&ts=201203
14T1222535345. Accessed April 20, 2012.
7. Mom and baby skin care. American Academy of Dermatology.
Available at: www.aad.org/media-resources/stats-and-facts/
prevention-and-care/mom-and-baby-skin-care.
Accessed
April 20, 2012.
Which occupational risk factors do you
find most often in patients with carpal
tunnel syndrome?
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• The refugee medical exam:
What you need to do
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and
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758
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Family Physicians Inquiries Network
clinical inquiries
Do any topical agents help
prevent or reduce stretch marks?
Evidence-based answer
A
Evidence-based
answer
no topical
agent
has been
proven to prevent or reduce stretch
marks. Randomized controlled trials
(RCTs) show that cocoa butter doesn’t prevent stretch marks (strength of recommendation [SOR]: A, 2 RCTs); neither does olive
oil (SOR: B, 1 small RCT).
A cream containing Centella asiatica
Evidence summary
Two double-blind RCTs that compared cocoa
butter with placebo to prevent stretch marks
in pregnant women found no difference.
In the first, investigators enrolled 300 Afro-
Caribbean women at 12 to 15 weeks’ gestation. Women used either 25% cocoa butter
cream or a placebo cream comprised of emollients and vitamin E daily. Investigators monitored compliance and assessed stretch marks
using a validated scale at 26 weeks, 36 weeks,
and after delivery. Cocoa butter cream didn’t
reduce stretch marks (44% vs 55% for placebo;
P=.09). Three women (1 using cocoa butter,
2 using placebo) discontinued the cream because of mild self-limiting reactions.1
In the second RCT, investigators randomized 210 nulliparous women (mainly
with intermediate skin color) to use cocoa
butter lotion with vitamin E or placebo. Women applied the lotion daily to their abdomen,
breasts, and thighs, starting at 12 to 18 weeks’
gestation. Investigators assessed the severity
of stretch marks either at delivery or postpartum using a validated scale. Cocoa butter
lotion didn’t prevent stretch marks (45.1% vs
48.8% for placebo; P=.730).2
Save the olive oil for cooking
A nonblinded RCT that compared twice-daily
jfponline.com
extract, vitamin E, and collagen hydrolysates doesn’t prevent new stretch marks
but might avoid additional stretch marks in
women who had already developed them
during puberty. Massage with vitamin E
ointment alone may reduce the number of
stretch marks (SOR: C, 2 small RCTs with
methodologic flaws).
Jeanne Moore, MD;
Gary Kelsberg, MD
Valley Family Medicine
Residency, Renton, Wash
Sarah Safranek, MLIS
University of Washington
Health Sciences
Libraries, Seattle
A ssista n t E D IT O R
Jon O. Neher, MD
Valley Family Medicine
Residency, Renton, Wash
olive oil massage with no treatment in 70 nulliparous women beginning at 18 to 20 weeks’
gestation found no reduction in stretch
marks (45.7% vs 62.9% without olive oil massage; P=.115). The investigators didn’t report
whether they performed a sample-size analysis to determine if the study was adequately
powered to demonstrate no difference.3
Mixed, but mostly negative, results
for multi-ingredient cream
A double-blind RCT found that Trofolastin cream containing Centella asiatica (also
known as Gotu kola, a member of the parsley family), vitamin E, and collagen hydrolysates didn’t prevent pregnancy-related stretch
marks among 80 women who applied the
treatment beginning at 12 weeks’ gestation.
When investigators evaluated a subgroup
of 18 women who had already developed
stretch marks during puberty, they found
that fewer of the women acquired additional
stretch marks during pregnancy (11% vs 100%
with placebo; P=.0001). The investigators
didn’t calculate whether the sample was large
enough to prove a significant difference.4
Fewer stretch marks with vitamin E
in small flawed study
An older systematic review (1996) included a
Vol 61, No 12 | December 2012 | The Journal of Family Practice
757
clinical inquiries
prospective RCT that randomized 50 women
at 20 weeks’ gestation to massage their abdomen, thighs, and breasts with vitamin E ointment or perform no massage. The trial found
fewer stretch marks with vitamin E ointment
massage (odds ratio=0.26; 95% confidence
interval, 0.08-0.84). The authors of the review
described this RCT as poorly randomized and
without blinding; investigators didn’t report
whether the sample size was adequate to demonstrate a significant effect.5
Visit us @
jfponline.com
Practical guidance
for panic disorder
Boadie W. Dunlop, MD, MSCR
4 ways to listen to
this audiocast:
Recommendations
.
No topical
agent—including
cocoa butter and
olive oil—has
been proven
to prevent or
reduce stretch
marks.
The American Congress of Obstetricians and
Gynecologists Web site states that although
many creams, lotions, and oils on the market
claim to prevent stretch marks, no proof exists that these treatments work. Using a heavy
moisturizer may help keep skin soft, but it
won’t help get rid of stretch marks.6
The American Academy of Dermatology
Web site also says that a moisturizer can improve the appearance of stretch marks and reduce itchiness; sunless tanning products can
hide the marks.7
JFP
1. Go to jfponline.com
2. Visit www.
myjfpmobile.com/1212
3. Scan this QR code to
listen to the
audiocast on your
smart phone
4. Text “PANIC” to
25827 from your
mobile phone and
follow the prompt.
INSTANT poll
References
1. Buchanan K, Fletcher HM, Reid M. Prevention of striae
gravidarum with cocoa butter cream. Int J Gynaecol Obstet.
2010;108:65-68.
2. Osman H, Usta IM, Rubeiz N, et al. Cocoa butter lotion for
prevention of stretch marks: a double-blind, randomized and
placebo-controlled trial. BJOG. 2008;115:1138-1142.
3. Taavoni S, Soltanipour F, Haghani H, et al. Effects of olive oil
on striae gravidarum in the second trimester of pregnancy.
Complement Ther Clin Pract. 2011;17:167-169.
4. Mallol J, Belda MA, Costa D, et al. Prophylaxis of striae gravidarum with a topical formulation. A double blind trial. Int J
Cosmet Sci. 1991;13:51-57.
5. Young GL, Jewell D. Creams for preventing stretch marks in
pregnancy. Cochrane Database Syst Rev. 2000;(2):CD00066.
6. Skin Conditions During Pregnancy. The American College
of Obstetricians and Gynecologists. Available at: www.acog.
org/~/media/For%20Patients/faq169.pdf?dmc=1&ts=201203
14T1222535345. Accessed April 20, 2012.
7. Mom and baby skin care. American Academy of Dermatology.
Available at: www.aad.org/media-resources/stats-and-facts/
prevention-and-care/mom-and-baby-skin-care.
Accessed
April 20, 2012.
Which occupational risk factors do you
find most often in patients with carpal
tunnel syndrome?
Online exclusive
• The refugee medical exam:
What you need to do
Photo rounds Friday
Test your diagnostic skills.
Physician’s Briefing News
Today’s headlines in family practice
G et u p d ate s f r o m u s o n
Fa c e b o o k
and
www.facebook.com/JFamPract
758
The Jour nal of Fam ily Prac tice | Dece m be r 2 0 1 2
T w i tte r
http://twitter.com/JFamPract
www.jfponline.com
758
