Tretinoin for stretch marks: what studies show

Tretinoin may make new stretch marks less noticeable, and it does not remove them. The evidence is a few small trials, and the largest one that compared tretinoin with a cream with no drug had 22 people. No tretinoin label covers stretch marks, so this use is a decision for a prescriber. For the drug itself, see the tretinoin guide.

Skinli gives general education and is not a doctor. Tretinoin is a prescription drug, and the prescriber picks the strength and the schedule. For the studies below, Skinli read the published summaries (abstracts) only.

What the AAD and the NHS say

The American Academy of Dermatology (AAD) explains what a stretch mark is: "A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly." It is direct about the limit of every treatment: "Like any scar, stretch marks are permanent, but treatment may make them less noticeable."

On tretinoin, the AAD says: "Tretinoin is a retinoid, which may also make early stretch marks less noticeable." It describes one study in which "people who applied this prescription cream every night for 24 weeks had less noticeable stretch marks."

The NHS, the health service in England, is more cautious about creams in general. It says many creams and lotions claim to prevent, reduce or remove stretch marks, and that there is little evidence they work. It lists retinoid creams, which it says are often called tretinoin, among a few treatments that may help. It adds two limits: "these may help if used on new stretch marks", and "they will not get rid of them."

Both bodies say stretch marks fade with time. The NHS says: "Stretch marks usually fade over time but may not disappear completely."

What the trials found

Five studies of tretinoin cream on stretch marks are in the sources read for this guide. Two of them had a comparison group that used a cream with no drug.

Study	People and length	Cream	Result
Archives of Dermatology, 1996	22 people with early marks, 6 months, compared with a cream with no drug	0.1 percent, daily	8 of 10 on tretinoin had "definite or marked improvement", against 1 of 12 on the cream with no drug
Cutis, 1994	11 people with marks from pregnancy, 7 months, compared with a cream with no drug	0.025 percent, daily	"There was no difference or improvement in the treated group compared with control subjects."
Advances in Therapy, 2001	20 women with marks on the abdomen from pregnancy, 3 months, no comparison group	0.1 percent, daily	The measured mark "decreased in length by 20%"
Journal of Dermatologic Surgery and Oncology, 1990	20 patients, 16 finished, no comparison group	Strength not given in the abstract	15 of the 16 improved
Dermatologic Surgery, 2014	32 women with early marks, tretinoin compared with 16 weekly sessions of dermabrasion, a procedure that rubs away the top layer of skin	0.05 percent, daily	Both groups improved, with no significant difference between them

The 1996 trial measured the marks. In the tretinoin group, the marks "had a decrease in mean length and width of 14% and 8%". In the group on the cream with no drug, the marks grew 10 percent longer and 24 percent wider over the same 6 months. The authors looked at skin samples and found no difference in collagen or elastic fibers between the groups. They wrote: "The processes that are responsible for the clinical improvement remain unknown."

Two cautions apply. The trials are small, and the two with a comparison group disagree: 0.1 percent cream helped, and 0.025 percent cream showed nothing. The two reports without a comparison group cannot show how much of the change came from the cream, because stretch marks also fade with time.

What reviews of the evidence conclude

Four reviews looked at all the published treatments together. None of them found a cream that reliably works.

• 2016, Journal of the European Academy of Dermatology and Venereology. The authors found 11 studies of creams and wrote that "tretinoin used therapeutically showed varying results whilst cocoa butter and olive oil did not demonstrate any effect." Their conclusion: "there is no topical formulation, which is shown to be most effective in eradicating or improving SD." SD stands for striae distensae, the medical name for stretch marks.
• 2017, Journal of the American Academy of Dermatology. "No treatment has proved to be completely effective." The review named its limits as "low-quality evidence, small sample sizes, and varying treatment protocols and outcome measures".
• 2020, Medicine. This analysis combined 14 trials with 651 people and ranked the treatments. It found "the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment". Tretinoin combined with radiofrequency, one of the in-office procedures the AAD lists, ranked first.
• 2024, Dermatologic Surgery. A review of 151 studies concluded: "Treatment options for striae are varied, likely indicating a lack of effective treatments due to the diversity in striae subtypes."

The AAD's view of creams is similar: "The in-office procedures have proven more effective than the creams, lotions, and gels."

New marks and old marks

Both bodies sort stretch marks by age. The AAD says: "When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color." Later the color fades and the mark becomes a shallow dip in the skin. The NHS describes them in a similar way: "Stretch marks can be pink, red, brown, black, silver or purple. They usually start off darker and fade over time."

The AAD's advice for any cream is: "Use the product on early stretch marks. Treatment seems to have little effect on mature stretch marks." The trials match that advice. The 1996 and 2014 trials enrolled people with early marks, and no abstract read for this guide reports a result for old, pale marks alone.

How tretinoin was used in the trials, and what the labels say

The four studies that give a strength used a cream once a day, for 3 to 7 months. In the 1996 trial the tretinoin group had better scores than the comparison group after 2 months. The AAD says of stretch mark creams in general: "If you see results, they take weeks to appear."

Those figures describe the trials, and no tretinoin label gives a schedule for this use:

• The generic tretinoin cream label on DailyMed says the cream is for acne. Its leaflet says in capital letters that the product "SHOULD NOT BE APPLIED TO OTHER AREAS OF THE BODY OR TO OTHER GROWTHS OR LESIONS."
• The Renova label, for fine facial wrinkles, says: "It is for use on the face."
• Skinli searched six tretinoin labels on DailyMed (the generic cream, Retin-A, Retin-A Micro, Altreno, Atralin and Renova). None mentions stretch marks.

A prescriber can still choose a drug for a use outside its label. The Retin-A Micro leaflet says: "Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet." The guide on how to get tretinoin explains the prescription step.

Side effects, pregnancy and steroid creams

Irritation. In the 2001 study, "Erythema and scaling, the most common adverse events, occurred in 11 patients" out of 20. Erythema means redness. The abstract says the reactions eased after the first month. The guide to tretinoin side effects covers what the labels list, and the labels also ask for sun protection on treated skin.

Pregnancy. The NHS lists pregnancy among the common causes of stretch marks, and it warns against retinoid creams at that time. The NHS says: "you should not use retinoid creams if you're pregnant as they may harm your baby". The AAD says: "If you're pregnant or breastfeeding, check with your doctor before treating stretch marks." See retinoids during pregnancy and breastfeeding.

Steroid creams. Steroid creams can cause stretch marks, and tretinoin belongs to a different drug class. The AAD says: "Applying a corticosteroid to your skin for a long time can also cause stretch marks." The NHS lists some steroid creams and tablets among the causes. The guide is tretinoin a steroid explains the difference.

Other options, and when to see a doctor

The AAD reports that common home remedies failed in studies: "none of the stretch marks faded when people massaged almond oil, cocoa butter, olive oil, or vitamin E into their stretch marks." It also warns about tanning: "When you tan, stretch marks become more noticeable because they don't tan."

For procedures, the AAD lists chemical peels, laser therapy, microdermabrasion, radiofrequency and ultrasound, and says none of them can get rid of stretch marks. The NHS says the treatments it lists, which include retinoid creams and laser treatment, are not available on the NHS, so people in England pay for them.

A dermatologist is the right person to ask about treatment. The AAD says: "A dermatologist can tell you if any of these treatments would be suitable for you, given your health, age, and how long you've had the stretch marks."

See a doctor for a different reason if your stretch marks are large and you also have other changes. The NHS says to see a GP, which is a family doctor, if you have large stretch marks together with more fat on the chest and tummy but slim arms and legs, a build-up of fat on the back of the neck and shoulders, or a red, puffy, rounded face. It says these could be symptoms of a condition called Cushing's syndrome.