Abdominal striae

EF is a 45-year-old woman who presents to the dermatologist for evaluation of facial acne. She has a history of a 25 lb (11.36 kg) weight gain, irregular menses, and frequent vaginal yeast infections over the past 2 years. She complains of increased facial hair growth and lower extremity muscle weakness. Physical examination reveals facial acne, facial hirsutism, truncal obesity, thin skin, and purple abdominal striae. Her past medical history is significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, and rheumatoid arthritis. 

Patients with Cushing s syndrome may have the classic physical features of moon face, buffalo hump, hirsutism, and abdominal striae. 

Patients with secondary hypertension may complain of symptoms suggestive of the underlying disorder, but some are asymptomatic. Patients with pheochromocytoma may have a history of paroxysmal headaches, sweating, tachycardia, and palpitations. Over half these patients suffer from episodes of orthostatic hypotension. In primary aldosteronism, symptoms related to the hypokalemia usually include muscle cramps and muscle weakness. Patients with Cushing s syndrome may complain of weight gain, polyuria, edema, menstrual irregularities, recurrent acne, or muscular weakness and have several classic physical features (e.g., moon face, buffalo hump, hirsutism, and abdominal striae). 

A 32-year-old woman presents to her obstetrician/gynecologist with complaints of irregular periods, hirsutism, and mood swings. She also reports weight gain and easy bruising. On examination, she is found to have truncal obesity, a round moon face, hypertension, ecchymoses, and abdominal striae. The patient is given a dexamethasone suppression test which reveals an elevated level of cortisol. 

Summary A 32-year-old female with irregular menses, hirsutism, mood swings, weight gain, truncal obesity, hypertension, abdominal striae, ecchy-moses, and elevated cortisol levels. 

Abdominal striae Stretch marks of the abdominal region. 

Patients with this condition present with obesity with a characteristic moon face, abdominal striae, osteoporosis, hypertension and muscular weakness. Biochemical features include impaired glucose tolerance with a diabetic type of glucose tolerance curve (because of the glucocorticoid action of cortisol) and sodium retention with potassium depletion (because of the mineralocorticoid action of cortisol). 

In a pilot study, we reported safe and equally effective treatment of mature abdominal striae in women with phototypes II-IV utilizing subcision, focal TCA (20% peeling and the combination of both of these procedures. Clinically we found that there was a reduction in width of the striae with subcision while TCA application produced a reduction in overall length. Unlike the study of Luis-Montoya et al, we did not note necrosis or other significant adverse events following subcision. 

Li et al. (2001) investigated the effects of eucalyptus oil on percutaneous penetration and absorption of a clobetasol propionate cream using vertical diffusion cells. The in vitro penetration of the cream containing 0.05% clobetasol propionate through mouse abdominal skin was detected at 2,4,6, 8, 10, and 24 h (cumulative amount Q, pg/g) and at steady state (/, pg/cm /h). The quantity of clobetasol propionate within the whole stria of skin after 24 h (D, pg/g) was measured too. Eucalyptus oil was able to increase Q and J, whereas D was not influenced in that way, which indicates that eucalyptus oil would increase clobetasol propionate percutaneous absorption and cause unwanted side effects. 

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