Lesson of the Week: Lumbar physiological striae in adolescence suspected to be non-accidental injury

doi:10.1136/bmj.311.7007.738

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D Heller, senior clinical medical officera

^aFrenchay Health Care Services Trust, Community Services Directorate, Bristol BS16 5EB

Accepted 1 November 1994

Physiological striae in adolescence may be mistaken for non-accidental injury. Early recognition that these lesions are not a manifestation of physical abuse will avoid embarrassment to and inconvenience for patients, their families, and their general practitioners.

Case reports CASE 1

A 13 year old boy presented to his general practitioner with symptoms of a respiratory infection; during the examination the doctor noted horizontal linear marks on the back. No explanation for these seemed satisfactory and he was referred to the social services department in accordance with local child protection procedures because of a suspicion of physical abuse. Examination by a local community paediatrician was arranged in turn.

There was no history of injury, accidental or otherwise. Rapid linear growth over the previous few months was noted and later confirmed from school records. On examination, he had several horizontal linear striae in the lumbosacral region that were raised and had an angry …