Varicose veins
A vein whose valves have failed Small valves inside leg veins are meant to keep blood moving upward. When they leak, blood pools, the vein widens and it pushes up against the skin.
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Dermapedia / CompareConditions
Varicose Veins vs Stretch Marks
Varicose veins are blood vessels that have stretched and now bulge under the skin. They are blue, green or purple, you can feel them standing proud of the surface, and they often ache. Stretch marks are scars in the skin left by stretching too fast. They sit flat or slightly sunken, start red or purple, and fade to silver over years. Raised and blue means a vein. Flat and striped means a stretch mark.
At a glance
| The difference | Varicose veins | Stretch Marks |
|---|---|---|
| What it is | A vein whose valves have failed | A tear in the middle layer of skin |
| Can you feel it | Yes, raised and ropy | No, flat or slightly dipped |
| Does it hurt | Often aches | No |
| Does it need treating | Depends on symptoms | Only if you want to |
Stretch Marks
Side by side
The differences that matter
What it is
Varicose veins
A vein whose valves have failed
Small valves inside leg veins are meant to keep blood moving upward. When they leak, blood pools, the vein widens and it pushes up against the skin.
Stretch Marks
A tear in the middle layer of skin
The skin stretched faster than the collagen and elastin underneath could keep up with. Those fibres tore, and the mark is the scar that healed over the tear.
How it works, illustrated
Stretch Marks
Beneath the surface sits the dermis, the supportive layer. It is a woven mesh of collagen for strength, threaded with elastic fibers that let skin stretch and spring back. The body keeps making and replacing both, so the mesh stays strong enough to move with you.
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Rising cortisol — in pregnancy, in puberty, with steroid tablets or strong steroid creams, or in conditions that raise it — reduces how much collagen and elastin the skin makes and loosens what is already there. This is the part most explanations leave out, and it is why stretch marks are not simply a matter of being stretched.
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Skin copes with a great deal of stretching when it is given time. It is the speed that does the damage. When the weakened elastic fibers in the supportive layer are pulled faster than they can adapt, they tear apart and retract, leaving a gap. Nothing shows on the surface yet.
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Immune cells arrive at the tear and the blood vessels beneath widen, which is what turns the mark pink, red, purple or darker. It may itch. This is the striae rubrae stage, the skin is still actively remodeling, and it is the window where treatment has the most to work with.
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The gap is repaired the way any wound is repaired: collagen laid down in flat parallel bundles instead of the woven mesh it replaced, the elastic fibers never properly restored, and the surface above thinned. Once this settles the change is permanent. The fading that follows is the redness draining away, not the scar resolving, and everything on the lists below is pushing on this step.
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Colour
Varicose veins
Blue, green or dark purple
The colour comes from blood inside the vessel, so it is fairly even along the whole length.
Stretch Marks
Red or purple, fading to silver
New marks are pink, red or purple. Over a year or two they fade to pale silver or white.
Can you feel it
Varicose veins
Yes, raised and ropy
Run a finger over it and there is a cord standing up from the skin. It is soft and squashy, not hard.
Stretch Marks
No, flat or slightly dipped
The surface may feel a little thinner or crinkly, but there is nothing to feel standing up.
Shape
Varicose veins
Twisting cords
Snaking, branching, uneven in width, and the pattern goes wherever the vein goes.
Stretch Marks
Parallel stripes
Bands of a similar width, running side by side in the same direction — across the direction the skin was pulled.
Does it hurt
Varicose veins
Often aches
Heavy, tired legs. Aching or throbbing after standing for a long time, sometimes cramping at night or swollen ankles by evening. Putting your legs up helps.
Stretch Marks
No
New stretch marks can itch or feel slightly tender while they form. Once they settle they cause no symptoms at all.
Where they show up
Varicose veins
Calves, thighs, backs of the knees
Almost always the legs, because that is where gravity works against the veins.
Stretch Marks
Wherever the body grew fast
Thighs, hips, backs of the knees, stomach, breasts, upper arms and lower back. Teenagers in a growth spurt, weight changes, and rapid muscle gain from lifting.
Where it appears
Stretch Marks
Abdomen, breasts, hips and thighs
They run at right angles to the direction the skin was stretched, which is why they lie horizontally around the abdomen in pregnancy and vertically on the thighs and breasts. The abdomen, breasts, hips and outer thighs are the usual places.
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Buttocks, lower back, and the shoulders after rapid muscle gain
The buttocks and the lower back are common in growth spurts and in pregnancy. Rapid muscle gain puts them somewhere different — across the shoulders, the upper back, the chest and the upper arms.
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What happens over time
Varicose veins
Slowly gets worse
Left alone, varicose veins usually widen over years. They do not fade on their own.
Stretch Marks
Fades, but never disappears
The colour fades a lot. The texture change stays. A silver stretch mark is a permanent scar that has become hard to see.
Does it need treating
Varicose veins
Depends on symptoms
Treatment exists — sclerotherapy, laser and vein closure — and it works well. Whether you need it depends on whether the veins ache, swell or affect your skin, not on how they look.
Stretch Marks
Only if you want to
Stretch marks are harmless. Treatments fade them, they do not remove them, and none of them work as well as the advertising implies.
Stretch Marks
Daily sunscreen
Two separate jobs here. On new marks it stops ultraviolet light driving longer-lasting color changes, which matters most on deeper skin tones. On mature ones it stops the skin around them tanning, and since white marks contain little pigment and do not tan, keeping the surrounding skin pale is what keeps the contrast down.
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Self-tanner and camouflage makeup
Applied over the marks themselves rather than around them, self-tanner brings pale marks closer to the surrounding color and substantially reduces how visible they are on a given day. Camouflage makeup does the same for a single occasion. Neither changes the scar, and both need repeating, but for mature marks they do more for appearance than most of the creams sold for the purpose.
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Plain moisturizer
New marks often itch, and scratching adds inflammation to skin that is already inflamed, so a plain moisturizer used regularly is genuinely worth it for comfort. It does not need to be expensive. It has not been shown to prevent stretch marks or to remove them, so treat it as comfort rather than as treatment.
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Retinol
The over-the-counter version of tretinoin, and weaker. It is a reasonable thing to try on red marks if a prescription is not an option, used nightly over months, but the evidence sits behind tretinoin and the results are smaller. It has nothing to offer white marks, and it is not used in pregnancy.
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Centella Asiatica (Cica)
Of the massaged preparations sold for prevention in pregnancy, the ones containing centella asiatica or hyaluronic acid have the only supportive evidence, and it is limited and low quality. That is a long way from the claims on the packaging. Low risk, uncertain benefit, reasonable to try and not to rely on.
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Cocoa butter and oils
Cocoa butter has been tested in randomized trials against a plain placebo cream and did not show a clear benefit for preventing stretch marks. Olive oil and the bio oils sold alongside it are in the same position. They are pleasant to use and they soften itchy skin, and that is the honest reason to buy one.
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Collagen supplements
Neither collagen supplements nor drinking more water has been shown to prevent stretch marks. The tearing happens in the supportive layer during a rapid stretch under hormonal influence, and nothing taken by mouth has been shown to change that. Family history is doing most of the work here, and no supplement changes it.
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Fraxel (Nonablative Fractional Laser)
The best-evidenced device for mature white marks, and useful on red ones too. It puts columns of controlled heat into the supportive layer to force a fresh round of collagen remodeling, over three to six sessions spaced weeks apart. Expect partial improvement in texture and how noticeable they are, not removal. On deeper skin tones it is used at conservative settings after a test patch, because of the pigment risk.
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Microneedling
Fine needles make controlled micro-injuries that prompt new collagen in the scarred layer. Improvement is modest and needs a course of sessions, but it carries a lower risk of leaving dark marks than lasers do, which makes it the more sensible first device on deeper skin tones. It works on both red and white marks.
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Pulsed Dye Laser (V-Beam)
Targets the widened blood vessels that make new marks red or purple, so it is for the early stage only and does nothing for white ones. It can take the color down over a few sessions. On deeper skin tones it carries a real risk of leaving dark marks behind, so it is used cautiously and after a test patch, if at all.
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RF Microneedling (Morpheus8)
Microneedling with radiofrequency heat delivered at the needle tips, which reaches deeper into the scarred layer. Reported results are modest improvements in texture and firmness over a course of sessions. Because the energy is not aimed at pigment, it is another option worth discussing on deeper skin tones.
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Fractional CO2 Laser
An ablative laser that removes columns of skin rather than only heating them, so downtime is longer and the response can be larger. It is the highest-risk option on this page for post-inflammatory hyperpigmentation and for thickened scars on the chest, shoulders and upper back, which is why it is not a first choice on deeper skin tones.
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Excimer Laser
Targeted ultraviolet light used to bring color back into white marks so they blend with the skin around them. It changes the color difference, not the scar, and the effect fades over months unless it is repeated. Narrowband ultraviolet B is used the same way. It is a cosmetic option rather than a repair.
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Chemical Peel
Medium-depth peels have some evidence for modest improvement in mature marks, mostly when used alongside another treatment rather than on their own. Because they work by controlled injury, the same pigment cautions apply on deeper skin tones, and a test patch is worth insisting on.
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Microdermabrasion
It polishes the surface layer, and the tear that made the stretch mark is well below that. It is commonly sold as a stretch mark treatment and the published results are minimal. If a clinic is offering this as their answer, it is worth asking what else they do.
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Tretinoin
The one cream with real evidence behind it, and only on marks that are still red or purple. Used nightly over months it can make new marks narrower and less obvious by prompting collagen while the skin is still remodeling. It irritates, so it is built up slowly. It must not be used in pregnancy or while breastfeeding, which rules out the most common cause of stretch marks.
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The test you can do sitting down
Stretch Marks
A stretch mark does none of that. Press it and the colour does not shift. Lift the leg and it looks exactly the same. There is nothing inside it to move.
What actually helps each one
Varicose veins
Varicose veins respond well to treatment. Compression stockings ease the ache. Sclerotherapy closes small veins with an injection, and heat or glue closes larger ones through a pinhole. These are day procedures, and most people go back to normal activity straight away.
Stretch Marks
Stretch marks respond partially. Red and purple marks are the ones worth treating, because they are still new and vascular lasers, microneedling and prescription retinoids all help while they are at that stage. Silver marks are settled scars and improve very little.
See a doctor if
More photographs
Stretch Marks
Across skin tones
Stretch Marks
Light tone — pink then silvery
On light skin the new marks are the pink or red version that almost every photograph in circulation shows, and the mature ones settle to silvery-white. The contrast with the surrounding skin is small once they have faded, which is why people with light skin are often told stretch marks fade to nothing. That is a description of this tone, not of all of them.
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Medium tone — red-brown to pale
On medium and olive skin new marks read as reddish-brown or dull purple rather than bright pink, so they are less obviously the picture people are shown. Mature ones become pale and stand out more here than on light skin. The stage still matters more than the color, and new marks are still the ones worth acting on.
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Brown tone — violet then pale
On brown skin new marks are usually deep violet, reddish-brown or simply darker than the skin around them. Because every description in circulation says pink, this stage is regularly missed — and it is the stage where treatment does the most. Once they mature they turn pale, which on brown skin means more contrast rather than less, so they stay visible for years.
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Deep tone — dark, then high contrast
On deep skin tones the early marks can be dark brown, violet or near-black and are easily read as just a change in shade rather than as new stretch marks. The mature ones contain very little pigment, so against deep skin they stay clearly visible long after the same marks would have disappeared on light skin. People are often told stretch marks fade to nothing, and on this tone that is not what happens.
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Related topic illustrations
Stretch Marks
Vitiligo
Mature stretch marks are lighter than the skin around them, and on deeper skin tones that difference can be striking enough to raise the question. Vitiligo makes patches, not bands — rounded, sharply edged, often mirrored on both sides of the body, and completely milk-white with normal texture inside them. Stretch marks run in parallel lines in the direction the skin was stretched, are only partly lighter, and have a thin, finely wrinkled, slightly sunken surface you can feel.
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Tinea Versicolor
This is the mix-up that turns up in the same person and the same place: pale marks across the shoulders, chest and upper back of a young adult who also has stretch marks there from a growth spurt or from training. Tinea versicolor is a yeast overgrowth, so it makes small oval patches that merge into larger maps, with a fine dust of scale that shows when you scratch it lightly. Stretch marks are straight parallel bands, have no scale, and do not respond to antifungal shampoo — which is the practical test.
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Common questions
Questions Patients Ask
How do I tell if the lines on my legs are veins or stretch marks?
Feel them. A varicose vein stands up from the skin as a soft, ropy cord and pales when you press it. A stretch mark is flat or slightly sunken and does not change colour under pressure.
Are stretch marks and varicose veins related?
No. Stretch marks are scars in the skin. Varicose veins are blood vessels with leaky valves. They often appear around the same time because rapid weight change affects both, but neither one causes the other.
Why are my stretch marks purple?
New stretch marks are purple or red because the tear in the skin is still fresh and blood vessels show through the thinned surface. They fade to silver over one to two years.
Can varicose veins go away on their own?
Usually not. Left alone they tend to widen slowly over years. Compression stockings ease the symptoms, and injections or vein closure procedures treat the vein itself.
Do stretch mark creams work?
Not much. Nothing applied to the surface repairs a tear in the deeper layer of skin. Red and purple marks respond somewhat to vascular lasers, microneedling and prescription retinoids. Silver ones change very little.
Can you get stretch marks and varicose veins in the same place?
Yes, most often on the thighs and behind the knees. Look at each mark separately rather than assuming they are all the same thing.