What Works Skin — Independent · Evidence-First · Ad-FreeIssue 014 · 20 April 2026 · Next: 04 Maywhatworksskin.com
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Concern · Anti-aging · Striae distensae

P. 32 · GUIDE

Two phases,
two prognoses.

Red phase responds. Silver phase rarely does.

Two clinical phases with two very different prognoses. Striae rubrae — the early, inflammatory red phase — respond meaningfully to topical retinoids and fractional laser. Striae albae — the mature, atrophic white phase — respond to procedures, not serums. The honest version of the conversation, not the brand-aisle version.

— § 01

The triggers worth tracking.

Red / purple linear streaks (striae rubrae)

The early, inflammatory phase. Pink to violaceous, slightly raised, often itchy. This is the window where topicals and energy-based devices still meaningfully respond.

70%
Pearly white, atrophic streaks (striae albae)

The mature phase. Hypopigmented, slightly depressed, parallel to lines of skin tension. Topicals plateau here; procedural options take over.

85%
Distribution along lines of skin tension

Abdomen, breasts, thighs, lower back, upper arms. Bilateral and parallel. The pattern is what distinguishes striae from scarring.

92%
Onset paired with rapid stretch or steroid load

Adolescent growth spurts, pregnancy, rapid muscle gain, prolonged systemic or topical corticosteroids. The trigger is mechanical and endocrine, not 'dryness.'

78%
⁂

— § 02

Ingredients that actually work.

Tier
Molecule
Role
Evidence
Tier B
Tretinoin 0.05–0.1%
Red-phase first-line
Kang 1996 and later RCTs show meaningful improvement in length and width of striae rubrae. Albae do not respond. Avoid in pregnancy.
Tier B
Centella asiatica + hyaluronic acid
Pregnancy-prevention adjunct
Modest reduction in incidence in pregnancy when applied prophylactically; the strongest of an otherwise weak prevention literature.
Tier C
Glycolic acid 10–20% leave-on
Adjunct exfoliation
Limited evidence as monotherapy; sometimes paired with tretinoin or ascorbic acid in clinic protocols for the red phase.
Tier A
Fractional non-ablative laser (clinic)
Procedural · both phases
The most-evidenced procedural option. Multiple sessions; works on both rubrae and albae, with stronger response on the red phase.
Tier B
Microneedling with PRP (clinic)
Procedural · albae
Useful for the white-phase striae that topicals cannot move. Series of 3–6 sessions; texture and tone improvement, not full resolution.
⁂

— § 03

The protocol.

  1. Phase 01 · Red phase, week 1–12

    Topical-first window

    Tretinoin 0.05% nightly to the affected sites (not in pregnancy). Daily moisturiser; this is the only phase where the topical literature is encouraging.

  2. Phase 02 · Red phase, month 4+

    Add fractional laser

    Series of 3–4 sessions of fractional non-ablative laser — the response is meaningfully better when the lesion is still pink than once it has gone white.

  3. Phase 03 · White phase, year 1+

    Procedural-led

    Topicals plateau. Fractional laser ± microneedling with PRP becomes the primary lever. Realistic goal is 30–50% improvement, not erasure.

  4. Phase 04 · Maintenance

    Sun-protect the area

    Mature striae burn and pigment differently than surrounding skin. Daily SPF on exposed sites prevents the cosmetic gap from widening over a decade.

Bottom line

The honest version of the conversation: the red phase responds and the silver phase rarely does. There is no topical that closes mature striae — and no honest brand should sell you one.