We report a 13-year-old boy with multiple purplish, atrophic, horizontal linear striae in the thoracic area. He reported a growth spurt in the preceding 12 months. His past health was unremarkable, and he took no medications. To our knowledge, physiological striae atrophicae of adolescence where idiopathic striae were restricted to the upper back have rarely been reported. Physiological striae atrophicae of adolescence may, on occasions, be mistaken for child abuse. It is important that child care professionals recognize this condition so that false accusations of child abuse will not be made.
Physiological striae atrophicae of adolescence occurs mainly in healthy, nonobese individuals at around puberty in association with the adolescent growth spurt. The development of striae coincides with the markers of adolescence such as testicular enlargement, breast development, pubic hair growth, and menarche. By definition, there is no identifiable underlying cause such as an endocrine or connective tissue disorder. The condition is more common in boys, presumably because boys grow faster than girls at around puberty. The onset of striae is usually between 14 and 20 years of age in males and 10 and 16 years of age in females [
A 13-year-old boy presented with multiple transverse striae on the upper back. The striae were first noted six months ago. There was no history of trauma, excessive physical exertion, or weight lifting. He was otherwise healthy and was not taking medications. The child had gained 10.9 kg and had grown 15.8 cm over the preceding 12 months. No family members had similar skin lesions.
On examination, his weight was 55 kg (75th percentile) and height 160 cm (50th percentile). His heart rate was 68 beats per minute and blood pressure 110/70 mm Hg. Multiple purplish, atrophic, horizontal linear striae were noted at the back in the thoracic area (Figure
Multiple purplish, atrophic, horizontal linear striae on the upper back.
Physiological striae atrophicae of adolescence typically presents as red or purple, horizontal, linear streaks (striae rubra) in the lumbar area [
In contrast to physiological striae atrophicae of adolescence, lesions of striae distensae or “stretch marks” occur mainly in areas that are subject to distension, such as the lower abdomen, lateral thighs, buttocks, and, in the females, the breasts. The condition occurs more frequently in females than males with a female-to-male ratio of 2.5 : 1 [
Physiological striae of adolescence have to be differentiated from linear focal elastosis. The latter is characterized by asymptomatic yellow linear palpable bands, usually horizontally across the lower back.
Physiological striae of adolescence have been mistaken for nonaccidental injury. Heller reported two 13-year-old boys who were referred to the social services department because they had physiological striae manifested as horizontal linear marks in the lumbar and lumbosacral area, respectively [