A 16-year-old male child presented with a two-month duration of asymptomatic fluid-filled lesions over his back. He was diagnosed with biopsy-proven focal segmental glomerulosclerosis five months ago and has been on treatment with high-dose oral and intravenous corticosteroids since then. Laboratory investigations showed a total protein level of 4.2g/dL, albumin of 1.9 g/dL, and 2+ urine protein. Clinical examination revealed generalized edema along with multiple striae over the abdomen and back on a background of ichthyosis [Figures 1 and 2]. The striae over the flanks were fluid-filled and on puncturing with a sterile needle, clear serous fluid was drained. Striae distensae is a well-known adverse effect of corticosteroid therapy. In patients with hypoproteinemia and anasarca, there could be a preferential accumulation of fluid in the striae, possibly due to the disintegrated collagen and lower tensile strength of the striae.[1,2] Although this condition is benign, its striking appearance is noteworthy for a dermatologist, and awareness regarding this rare presentation could prevent unwarranted investigations and therapeutic intervention.
Figure 1.
Multiple striae over the center of the back, along with bullous striae over the flanks
Figure 2.
Multiple linear fluid-filled striae present over the right flank on a background of ichthyosis
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References
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