Infected Edematous Striae Distensae
Skin stria usually has different contributing factors, and the use of steroids can result in the appearance of large striae. Bullous striae distensae is a condition which describe the distention of these stria as a result of fluid accumulation. Striae distensae has other complications as it could get ulcerated, edematous, emphysematous and urticated, however, the bullous striae have not been commonly reported. Physicians are usually worried about the appearance of this condition which does not need specific management other than reassurance. However, in this special case, the management is different.
A 13-year-old girl was admitted to the hospital for anasarca and diagnosed to have nephrotic syndrome. She was discharged later and enalapril, prednisolone, cyclosporin and hydroxychloroquine were prescribed. Two days after discharge she presented to the ER with worsening edema, difficulty in speaking and breathing with swollen lips and conjunctiva. She was diagnosed with angioedema and intubated. Upon history taking, the mother confirmed that her daughter has been complaining of abdominal pain for two days. On abdominal examination, there was diffused redness and abdominal distention. She also had striae over the lower abdomen and upper thighs. The striae of her abdomen were fluid filled and tense (Figure 1). On palpating the abdomen, it was very tender. Her condition was diagnosed as bullous striae distensae, and as recommended from previous literature, reassurance is the management of choice as this condition clears when the anasarca resolves. However, in this special case, the bullous striae are remarkably tender, and such presentation for bullous striae distensae have not been reported in the literature. Monitoring the signs for sepsis was advised and within few hours her WBC and D-Dimer started to increase. Amoxicillin 1 gram BID was immediately started. Two days after starting the antibiotic the redness and the tenderness of her abdomen disappeared (Figure 2). However, when the patient was closely examined, one of the bullous striae was ruptured and oozing watery fluid. This could have been the main source of infection which led to the abdominal redness and tenderness. Covering the wound with aseptic technique was recommended. Perforation and infection can be a major complication of bullous stria and conservative management is not always the best choice. Also, looking for signs of inflammation and inflammatory markers could be the key to the best approach for such patients.
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Journal of Clinical & Experimental Dermatology Research