Doc talks: Obesity and the skin…not by any stretch?

Article by Dr Lim Kar Seng

Doc talks: Obesity and the skin…not by any stretch?

Dr Lim Kar Seng

Dermatologist
National University of Singapore, Faculty of Medicine
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Ms M, a 20 year old lady, came to see me as she had an upcoming college graduation ball to attend. She had chosen her dress for that momentous event, a dazzling sliver sleeveless dress. The problem was, Ms M was slightly on the overweight side – her BMI (Body Mass Index) was about 29. She had lost a bit of weight the last few weeks in preparation for her ball but the issue was that she had unsightly reddish-purple stretch marks over her arms, especially the inner arms. This was the reason she had come to see me, to see if anything could be done.

Obesity is a problem that increasingly afflicts our youth in affluent Singapore. Change in diet patterns as well as lack of exercise are the common reasons. Many people resort to taking diet pills, going on special diet plans, exercise programs etc to try to lose the extra kilograms. What many people don’t realize (or find out only when it’s too late), is that both the increase and sudden decrease in weight can cause stretch marks to appear. Stretch marks come about when the expansion or contraction of the skin and soft tissue underlying it occurs at a rate that’s faster than what the underlying collagen fibres can accommodate. Collagen is the substance that gives our skin its elasticity and firmness. Once the collagen fibres get stretched or break, the stretch marks start appearing. Red-purple stretch marks indicate a more recent mark whereas white stretch marks reflect older occurrences.

The best treatment for stretch marks is actually before they appear! In some savvy patients who are starting weight loss programs, they actually approach me for creams to prevent the stretch mark from appearing. This is the best stage to treat them as there are creams that contain a synthetic vitamin A substance (tretinoin) that would help in collagen remodeling to prevent stretch marks from happening.

However, once the stretch marks are there, one would need to consider options like fractional lasers (e.g. Mixto™ laser) which help to address the superficial aspects of the stretch mark (i.e. the skin surface and just below the skin surface). Results vary between individuals and repeated treatments may be required for optimal results. For the deeper marks, a radiofrequency device is sometimes used as well to target the deeper tissue to encourage collagen remodeling. Treatments such as Exilis™ or Thermage™ are useful for this.

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