Fluid-filled striae in a patient with hypoalbuminemia

Abstract

A 57-year-old woman presented with progressive severe edema that affected her limbs and trunk and a one-week history of nonbloody diarrhea. On examination, she also had numerous linear, lobulated, fluid-filled skin lesions ( Figure 1) that flattened with transient pressure. These were a result of fluid gathering within pre-existing stretch marks. Investigations were consistent with hypoalbuminemia (serum albumin < 15 [normal 35-50] g/L; urine protein 0.12 g per 24 hours), secondary to protein-losing enteropathy associated with Clostridium difficile infection. Liver enzymes were normal. The lesions resolved following treatment with antibiotics and diuresis.Striae distensae, also known as stretch marks, are a form of dermal scarring that present initially as reddish-purple linear plaques (striae rubrae) before fading into hypopigmented, atrophic lesions (striae albae). 1 Striae distensae are associated with pregnancy, rapid weight gain, and systemic or topical corticosteroid use; they most frequently develop in women and teenagers. 1,2 In conditions characterized by severe edema, such as various causes of hypoalbuminemia and heart failure, interstitial fluid can collect preferentially within pre-existing striae distensae, where the tissue's tensile strength is reduced because of an atrophic epidermis overlying areas of abnormal dermal collagen. 2,3 Bullous autoimmune skin conditions and bullous infections must also be considered in the differential diagnosis. 3 Diuresis results in flattening of the fluid-filled lesions. 2 Awareness of this striking but benign skin finding in patients with hypoalbuminemia can prevent unnecessary interventions.

Blisters within striae as a result of hypalbuminaemia in systemic lupus erythematosus

“…The histologic analysis of striae reveals collagen fibres that are packed horizontally into thin, straight bundles in contrast with the wavy, thick and randomly arranged collagen fibres in normal skin. 3,4 We consider that in our patient, as in previous adult case reports, the altered dermal mechanics and lowered tensile strength of striae lead to their preferential stretching out by oedema fluid and resultant swelling and bullous appearance [2][3][4][5] Although this condition is underreported, previous case reports are either young patients receiving corticosteroids or presenting predisposing conditions such as anasarca or pregnancy. 2,[4][5][6] Systemic lupus erythematosus patients can also present bullous lesions for other reasons.…”

“…3,4 We consider that in our patient, as in previous adult case reports, the altered dermal mechanics and lowered tensile strength of striae lead to their preferential stretching out by oedema fluid and resultant swelling and bullous appearance [2][3][4][5] Although this condition is underreported, previous case reports are either young patients receiving corticosteroids or presenting predisposing conditions such as anasarca or pregnancy. 2,[4][5][6] Systemic lupus erythematosus patients can also present bullous lesions for other reasons. Blisters may appear in any type of lupus if the damage of basement membrane is intense enough.…”

“…These are a form of dermal scarring that present initially as reddish-purple linear plaques (striae rubrae) before fading into hypopigmented, atrophic lesions (striae albae). 2 They are associated with stretching of skin that accompanies rapid increase in size of a particular region. The histologic analysis of striae reveals collagen fibres that are packed horizontally into thin, straight bundles in contrast with the wavy, thick and randomly arranged collagen fibres in normal skin.…”

“…The patient's parents/guardians in this manuscript have given written informed consent to the publication of their case details. Diego Soto-García 1 Jose Manuel Busto Leis 2 Ana Carmona-Olveira 3 David Revilla-Nebreda 4 Marta de Uribe Viloria 5 Marta Feito-Rodríguez 2…”

Bullous striae distensae in a nephrotic syndrome patient: First case report from the Middle East of a rare presentation and review of the literature

“…Fluid filling these striae are an unusual finding. Very few cases have been reported discussing this phenomenon 4,5 . Upon literature review, it was notable that even in the very few case reports of BSD, almost all the patients were on long‐term oral steroids as well as having hypoalbuminemia, except for one patient as demonstrated in Table 1 4 .…”