Striae distensae (SD), also known as stretch marks, are common skin lesions causing significant psychological stress and cosmetic disfigurement. They are common to be seen during pregnancy, rapid weight change, puberty and many other pathological conditions including Cushing disease, anorexia nervosa or even excessive use of certain drugs. Clinically, they appear as either red raised linear bands known as striae rubrae (SR) or white depressed atrophic bands known as striae albae (SA). They were first described histopathologically in 1889. Many theories have been established to explain the etiopathogenesis of SD, yet the exact mechanism is still unclear. Also, many treatment modalities have been applied to reach the maximum efficacy with the least side effects. The aim of this review article is to optimize the most recent and accepted concepts on etiopathogenesis and pathophysiology of SD which may help in finding the best lines of management with the most satisfactory outcomes.