Fluid Within Striae – An Unusual Phenomenon

Seshadri, Divya; De, Dipankar; Rathi, Manjusha; George, Jacob; Aj, Kanwar

doi:10.17659/01.2013.0077

Cited by 7 publications

(15 citation statements)

References 5 publications

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“…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.…”

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confidence: 99%

Fluid-filled striae in a patient with hypoalbuminemia

Jogova

Hwang

2017

CMAJ

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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.

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Fluid-filled striae in a patient with hypoalbuminemia

Jogova

Hwang

2017

CMAJ

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“…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.…”

Section: Blisters Within Striae As a Results Of Hypalbuminaemia In Sy...mentioning

confidence: 62%

“…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.…”

Section: Blisters Within Striae As a Results Of Hypalbuminaemia In Sy...mentioning

confidence: 62%

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

Soto‐García

Leis

Carmona-Olveira

et al. 2022

Acad Dermatol Venereol

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“…• Not Mentioned breast and abdomen. 3 Rare secondary changes within SD have been mentioned in the literature, including edema, urticaria, dyspigmentation, ulceration, dehiscence, and subcutaneous emphysema. Fluid filling these striae are an unusual finding.…”

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confidence: 99%

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

Alrefaie,

Aljoudi,

Nukaly

et al. 2024

Clinical Case Reports

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Striae distensae is a common cutaneous phenomenon that begins as reddish linear atrophic plaques (striae rubra) that over time progress to silvery‐white coloration (stria alba). Striae distensae in rare occasions becomes edematous, ulcerative, emphysematous, or urticated. Bullous striae distensae is a sequela of conditions causing interstitial edema along with systemic glucocorticoids use. To our knowledge, only eight cases of bullous striae distensae have been reported in the literature. Herein, we report a 17‐year‐old female, known case of nephrotic syndrome, presented to our clinic with abdominal fluid‐fill cutaneous lesions only for 5 days. She had used systemic glucocorticoids for more than a decade before she was labeled as steroid resistant nephrotic syndrome. Cushingoid body habitus were observed during physical examination, in addition to translucent bullae overlying her previously known stretch marks. Punch biopsy of the lesions revealed dermal edema with thinned collagen bundles. Based on these clinicopathological findings, a diagnosis of bullous striae distensae was made. Awareness of this rare complication and unusual clinical presentation is fundamental to avoid unnecessary and excessive interventions whether investigatory or therapeutic in order to provide appropriate management of the underlying condition.

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Fluid Within Striae – An Unusual Phenomenon

Cited by 7 publications

References 5 publications

Fluid-filled striae in a patient with hypoalbuminemia

Fluid-filled striae in a patient with hypoalbuminemia

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

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

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