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The pathogenesis of striae distensae (SD) is complicated and has not yet been fully elucidated. Hormonal changes, overstretched skin, and structural and functional changes in the skin may be crucial factors in the development of SD. Therapy aims to stimulate dermal collagen synthesis and improve skin texture. Mainstream treatments include topical medications, chemical peeling, laser and radiofrequency therapy, microdermabrasion, microneedle therapy, and filler injection therapy. In the present review, we summarize current perspectives on the pathogenesis and clinical therapy of SD.