Influence of Gender on Expression of Estrogen, Androgen, and Glucocorticoid Receptors in Striae Distensae

Abstract

Striae distensae, commonly known as stretch marks, is a skin condition that is often asymptomatic but creates considerable cosmetic concerns for patients. Striae are visible linear scars which form in areas of dermal damage produced by stretching of the skin.In the early stages, striae may appear pink to red (striae rubra), which over time become atrophic and attain white color (striae alba). Several observations within the disease express gender influence. The highest incidence of striae is between 10 and 16 years of age among girls, and between 14 and 20 years of age among boys. The commonest sites are the outer aspect of the thighs and lumbosacral region in males, while in females; the disease affects thighs, upper arms, buttocks, and breasts. The causes of striae are not clear; some authors suggest Mechanical effect of stretching, which is proposed to lead to rupture of the connective tissue framework (e.g., pregnancy, obesity, weight lifting), others suggest Increase in the levels of body steroid hormones; Cushing's syndrome, local or systemic steroid therapy that has a catabolic effect on fibroblasts, others suggest Genetic factors (absence of striae in pregnancy in people with Ehlers-Danlos syndrome and their presence as one of the minor diagnostic criteria for Marfan syndrome suggest an important genetic element), and other authors suggest Immunosuppression states associated with pregnancy-induced hypertension medications, human immunodeficiency virus, or diseases such as tuberculosis and typhoid. The histological studies revealed: in the early stages, inflammatory changes may be conspicuous, but later the epidermis is thin and flattened. Recent SD shows a deep and superficial perivascular lymphocytic infiltrate around the venules. Collagen bands on the upper third of the reticular dermis are stretched and aligned parallel to the surface of the skin. In the latter stages, there is thinning of the epidermis due to flattening of the rete ridges and loss of collagen and elastin. Our study was conducted on 15 males and 15 females aiming at studying the influence of gender on expression of estrogen, androgen, and glucocorticoid receptors in SD. We included three groups of subjects Group I included 5 healthy females & 5 healthy males serving as controls, group II included 10 females having SD, and group III included 10 males having SD. Control group were subjected to one punch biopsy, while females and males having striae were subjected to two punch biopsies from lesional and non lesional skin.