Saturday, 10 September 2016

Pubertal growth striae misdiagnosed as a sign of physical abuse

A 14-year-old boy presented with multiple horizontal striae of varying length on the mid-back. His parents sought explanation for these lesions when the boy was seen by another physician who assumed that the lesions were a sign of physical abuse.  On seeing the patient with his father, the diagnosis of pubertal growth striae was made.  The history was unremarkable and no signs of Marfan syndrome or Cushing syndrome were detected. Linear focal elastosis, where the lesions are yellow and raised, was excluded.  Only reassurance was necessary.

Transverse striae of the back are common among healthy young men.* They are characterised histologically by thinning of the overlying epidermis, with fine dermal collagen bundles arranged in straight lines parallel to the surface in the direction of the presumed stressThese adolescent growth striae may be mistaken for signs of physical abuse hence the importance of their recognition. There is no proven treatment but they become inconspicuous over time.

*Carr RD, Hamilton JF. Transverse striae of the back. Arch Dermatol 1969; 99: 26-30.

This page was last updated in August 2016

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology