Physiological striae atrophicae of adolescence are associated with growth spurt in the teenage years. They usually present as multiple, horizontal, linear purplish, or white striae. They were first reported back in 1935 [1]. These striae do not have any identifiable underlying cause. The condition is more common in boys. The onset of striae is usually between 14 and 20 years of age in males and 10 and 16 years of age in females [1].

We report a 14-year-old boy presenting to the family medicine clinic with a history of striae on his back for the last four months (Figure 1). The striae were noticed incidentally, there was no history of pain, itching, physical exertion, or injury. There were no striae elsewhere on the body. The boy was thin and tall. No personal or family history of joint problems or connective tissue disorders was reported. The patient was not on any medications. On examination, the height of the boy was 176 cm and weight was 52 kg. Subsequent follow-up showed resolution of the striae with some residual scaring (Figure 2).

Physiological striae atrophicae of adolescence usually occur during the growth spurt. They are common in boys than girls [1]. They typically present as red or purple, horizontal, linear streaks (striae rubra) in the lumbar area [2]. Over time, the color fades and the lesions become atrophic and silvery (striae alba). They are usually several centimeters long and 1–10 mm wide, with the long axis perpendicular to the direction of skin tension [3]. They are also reported to appear in unusual sites such as axilla, upper arms [4], and upper back [1]. Previously they have been grouped together with other similar linear lesions like striae distensae [5],[6]. Striae distensae or stretch marks mainly result from distention of skin commonly seen in pregnant women (striae gravidarum), Cushing’s syndrome, Marfan’s syndrome, obesity, and corticosteroid use [5],[6]. Striae distensae are more common in girls and are more common at sites which are associated with distention, such as lower abdomen, breast, and thighs [1],[6]. 

In contrast, it is believed now that only distention of the skin is not the reason for the striae of adolescents, but genetic and hormonal factors play a part as well. They can appear in healthy and nonobese adolescents [1],[4].

It is important to distinguish these striae from the striae caused by other diseases. Cushing disease, Marfan’s syndrome, Ehlers–Danlos syndrome, and complication of corticosteroid treatment are common differential diagnosis in this age group [7]. Linear focal elastosis is another dermatological presentation which looks similar; however, they are yellow palpable linear marks on the back and more common in older age [1],[4] . Various treatments such as topical tretinoin and laser treatment have been tried with variable results but any cure for the lesions have not been found yet [4],[5]. The presentation of the striae in teenagers, without any obvious cause, has also resulted in suspicion of non-accidental injury and this has widely been reported in the literature [1],[8],[9].

The physiological striae atrophicae of adolescence possibly are totally distinct entities than other striae, such as striae distensae. The most important aspect of their management is prompt diagnosis and reassurance to the patient/parents regarding the benign nature of the problem and its gradual resolution. Health care professionals dealing with children should be aware of this condition, so it could be distinguished from nonaccidental injuries and unnecessary referral to social services and false accusation of child abuse could be avoided.