Stretch marks on the skin are a very common occurrence in both men and women. The most common causes for stretch marks include rapid growth during adolescence and during pregnancy. They will occur most commonly around the axillae, hips and inner thigh. They first appear as a red streak. As they mature, the redness fades and they turned to a white colour.

Sometimes, stretch marks can occur due to a medical condition. If the skin is made thinner due to application of a topical corticosteroid, stretch marks can form anywhere on the skin. Chronic use of oral steroids can also cause stretch marks. Finally, elevated cortisol levels such as in Cushing’s syndrome can lead to stretch mark formation.

While the appearance of stretch marks can be similar between the benign form and those caused by medications, the thickness of the stretch mark is usually much wider in the latter type, which may be located in areas where not much tension is applied to the skin. The length of the stretch mark also tends to be much greater in the pathological form.

A careful drug history — looking for topical and oral steroid use — can help to distinguish between the benign and pathological form. A 24-hour collection for urinary cortisol helps identify patients with Cushing’s syndrome.

If the cortisol level is elevated, then a referral to an endocrinologist will be indicated.

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