Colored striae in adolescent children

In 50 years the focus of discussion on striae has changed from pathogenesis to remedies. This report elegantly describes striae and proposes mechanisms that have not been disabused since publication. The author noted striae in adolescents during a somatotyping study requiring nude examinations. Striae distensae, commonly known as stretch marks, are the end path of various physiologic states including pregnancy, adrenocortical excess, and changes in body habitus seen in rapid weight change. Sisson noted pink striae, during adolescent development unrelated to obesity, but related to other markers of adolescence such as acne, breast development, pubic hair growth, and menarche. He hypothesized that the stimulation of the hypothalamic pituitary adrenal axis in puberty predisposed to the development of striae. The pathophysiology of striae remains without a consensus. Mechanical shear and stretching forces on the skin have been proposed and adrenal hyperactivity in pathologic states has been implicated but not proven. Rapid weight gain and/or loss resulting in tension on the skin parallel to the tensile direction may result in striae. Adrenocortical hyperactivity is proposed as a cause in Cushing's disease and the changes associated with pregnancy and puberty. Hypercortisolism is thought to cause an increase in protein catabolism, which then compromises the integrity of collagen and elastin fibers in the extracellular matrix. Genetic predisposition is also presumed.