Purple striae—thin, purple streaks on the skin—characteristically occur in hypercortisolism along with other cushingoid signs, such as a buffalo hump and moon face. Although hypercortisolism can be caused by adrenocortical carcinoma, adrenal adenoma, and pituitary adenoma, it usually results from excessive use of glucocorticoids.
The catabolic action of excess glucocorticoids on skin, fat, and muscle produces purple striae by inhibiting fibroblast activity, resulting in loss of collagen and connective tissue. This causes extreme thinning of the skin, which, along with erythrocytosis, is responsible for the striae’s purple color. Although purple striae are most common over the abdominal area, they may also occur over the breasts, hips, buttocks, thighs, and axillae. They develop gradually and, with treatment, may gradually fade or decrease in size.
Ask the patient when—and on what part of his body—he first noticed purple striae. To help determine the rate of progression, find out if he has photographs of himself before and over the course of striae development. Next, obtain a complete drug history. If the patient is receiving glucocorticoid therapy, find out the drug’s name, the daily dose and schedule, and the reason for treatment. Ask if the dosage has been altered recently and if the drug is given intramuscularly. Find out if the patient uses a topical corticosteroid, especially a fluorinated product; ask about concomitant use of occlusive dressings and, with large skin surface areas, the amount of corticosteroid applied.
Examine the patient and note all areas where purple striae appear. When checking for striae, remember that the patient’s skin is extremely thin and susceptible to bruising.
With this disorder, purple striae—usually more than 1 cm wide—develop gradually over the abdomen and possibly the breasts, hips, buttocks, thighs, and axillae. Inspection also reveals the cardinal signs of moon face, buffalo hump, and truncal obesity. Other findings include acne, ecchymoses, petechiae, muscle weakness and wasting, poor wound healing, excessive perspiration, hypertension, fatigue, and personality changes. Women may develop hirsutism, menstrual irregularities, and inability to achieve orgasm. Men may become impotent.
Excessive use of a glucocorticoid can cause purple striae and other cushingoid effects.
Help the patient cope with changes in his body image by clearly explaining the disease process and allowing him to openly express his concerns. Prepare him for diagnostic tests to confirm hypercortisolism and determine its cause. Expect to collect 24-hour urine specimens before and during the 2-day low-dose and 2-day high-dose dexamethasone tests. Explain that follow-up tests may be performed.
Although relatively rare in children, hypercortisolism may occur at any age. In infancy and early childhood, it usually results from adrenal tumor, systemic absorption of a topical corticosteroid applied excessively, or oral administration of a glucocorticoid. After age 7, it usually stems from inappropriate pituitary secretion of corticotropin, with bilateral adrenal hyperplasia.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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