We report a 16-year-old adolescent male with multiple violaceous, atrophic, vertical linear striae isolated to the axillae and proximal arms of approximately one-year duration. In the past two years, he indulged in heavy weight-lifting. He experienced a growth spurt over the past few years. The patient was otherwise in good health and was not on any medications. Physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.
Physiological striae atrophicae of adolescence, also known as physiological striae atrophicae of puberty, occur mainly in healthy, nonobese individuals at around puberty in association with the adolescent growth spurt. We describe a 16-year-old adolescent male with physiological striae atrophicae of adolescence presenting with multiple purplish, atrophic, vertical linear striae isolated to the axillae and proximal arms. To our knowledge, physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.
A 16-year-old adolescent male presented with multiple linear striae affecting both axillae and proximal arms. The striae were first noted a year ago. For the past two years, he indulged in heavy weight-lifting in a fitness center. He spent at least one hour per day in heavy weight-lifting, several days per week. The patient had quite a rapid growth spurt over the past few years. He grew 10 to 12 cm and gained 5 to 6 kg per year in the past two years. The patient noted that the deltoid areas became larger with the growth spurt and weight-lifting. He was in good health and was not on any medications. There was no family history of similar skin lesions.
On examination, he was alert and not in distress. His height was 165 cm and weight 57 kg with a body mass index (BMI) of 20.9 kg/m2. His heart rate was 70 beats per minute and blood pressure 105/75 mm Hg. Multiple violaceous, atrophic, vertical linear striae were noted affecting the axillae and proximal arms (Figure
Violaceous, atrophic, linear striae in the right axilla and proximal arm.
Transverse linear striae on the back in adolescence were first described in 1917 by Weber who reported an 18-year-old tailor with this condition [
Typically, physiological striae atrophicae of adolescence occur in nonobese, healthy adolescents undergoing rapid linear growth at the time of puberty [
Characteristically, physiological striae atrophicae of adolescence present as violaceous or red, horizontal, linear streaks (striae rubra) in the lumbar area, giving rise to a “wash board” appearance [
The occurrence of physiological striae atrophicae of adolescence other than in the lumbar area is rare [
The association of physiological striae atrophicae of adolescence and weight-lifting has been reported only occasionally in the past [
We and other authors believe that physiological striae atrophicae of adolescence and striae distensae (stretch marks) are separate disease entities [
Physiological striae of adolescence have been mistaken in the past for bruises resulting from nonaccidental injury [
Physiological striae atrophicae of adolescence typically occur in the lumbar area. The occurrence of physiological striae atrophicae of adolescence isolated to both axillae and proximal arms has very rarely been reported. Awareness of this condition is important so that false accusations of child abuse are not made.
Professor Leung and Dr. Barankin have disclosed no relevant financial relationship.