{"title":"Ulceration of Corticosteroid-Induced StriaeDistensae in Children with Nephrotic Syndrome","authors":"Indri Widya Sari, Rusmawardiana, F. Argentina","doi":"10.37275/JRP.V2I1.15","DOIUrl":null,"url":null,"abstract":"Striaedistensae(SD) is linear scar tissue in the epidermis and dermis due to excessive stretching of the skin.Striaedistensaeoccurs due to dysfunction of extracellular matrix components that play a role in skin elasticity increasing sensitivity to minor trauma and ulceration. One of the causes is the long-term use of corticosteroids. Systemic corticosteroids are the mainstay of treatment for nephrotic syndrome, so long-term prescribing of corticosteroids should be carried out with caution. It is reported case of a 15-year-old boy with nephrotic syndrome complains of red streaks appearing on his abdomen, back, buttocks, and lower limbs after 2 months of corticosteroid treatment. Pus-filled nodules develop which become ulcers on the red lines of the back. On physical examination found striaedistensae in the abdominal region, posterior trunk, gluteus, femoral and proximal 1/3 bilateral cruris posterior. Found 3 ulcers on the striaedistensae on the posterior trunk, oval to round shape, size 1x1x0,5 cm to 2x1,5x1 cm, base of necrotic tissue, pus contents, wall echoing, edges are not raised, surrounding tissue is erythematous-livid, tenderness, odor, and no induration. On examination of the ulcer swab with Gram stain found Gram-positive bacteria. The culture results showed Staphylococcus aureus. The patient was treated with topical 0.05% retinoic acid every night at SD, and ulcers were treatedsystemic antibiotics of 2 grams ceftriaxone per day for 1 week, as well as ulcer treatment by compressing 1%0 salicylic acid solution, hydrogel, and foam dressing. After 4 weeks of therapy, there was clinical improvement, thinning striae and reduced ulcer size.","PeriodicalId":112625,"journal":{"name":"Jurnal RSMH Palembang","volume":"47 3 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jurnal RSMH Palembang","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.37275/JRP.V2I1.15","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Striaedistensae(SD) is linear scar tissue in the epidermis and dermis due to excessive stretching of the skin.Striaedistensaeoccurs due to dysfunction of extracellular matrix components that play a role in skin elasticity increasing sensitivity to minor trauma and ulceration. One of the causes is the long-term use of corticosteroids. Systemic corticosteroids are the mainstay of treatment for nephrotic syndrome, so long-term prescribing of corticosteroids should be carried out with caution. It is reported case of a 15-year-old boy with nephrotic syndrome complains of red streaks appearing on his abdomen, back, buttocks, and lower limbs after 2 months of corticosteroid treatment. Pus-filled nodules develop which become ulcers on the red lines of the back. On physical examination found striaedistensae in the abdominal region, posterior trunk, gluteus, femoral and proximal 1/3 bilateral cruris posterior. Found 3 ulcers on the striaedistensae on the posterior trunk, oval to round shape, size 1x1x0,5 cm to 2x1,5x1 cm, base of necrotic tissue, pus contents, wall echoing, edges are not raised, surrounding tissue is erythematous-livid, tenderness, odor, and no induration. On examination of the ulcer swab with Gram stain found Gram-positive bacteria. The culture results showed Staphylococcus aureus. The patient was treated with topical 0.05% retinoic acid every night at SD, and ulcers were treatedsystemic antibiotics of 2 grams ceftriaxone per day for 1 week, as well as ulcer treatment by compressing 1%0 salicylic acid solution, hydrogel, and foam dressing. After 4 weeks of therapy, there was clinical improvement, thinning striae and reduced ulcer size.
纹状体(SD)是由于皮肤过度拉伸而在表皮和真皮层形成的线状疤痕组织。纹张的发生是由于细胞外基质成分的功能障碍,细胞外基质成分在皮肤弹性中起作用,增加对轻微创伤和溃疡的敏感性。其中一个原因是长期使用皮质类固醇。全身性糖皮质激素是治疗肾病综合征的主要药物,因此长期使用糖皮质激素应谨慎。报告一例15岁肾病综合征男童,经皮质类固醇治疗2个月后,腹部、背部、臀部及下肢出现红色条纹。充满脓液的结节形成,成为背部红线上的溃疡。体格检查在腹部、后干、臀肌、股肌和近侧1/3双侧股后肌中发现腱状肌。后干扩张纹3处溃疡,椭圆形至圆形,大小1x1x5cm至2x1 5x1 cm,坏死组织基部,脓液内容物,壁回声,边缘不凸起,周围组织呈红褐色,压痛,有气味,无硬结。革兰氏染色溃疡拭子检查发现革兰氏阳性细菌。培养结果为金黄色葡萄球菌。患者每晚SD点局部给予0.05%维甲酸治疗,溃疡给予全身抗生素头孢曲松2 g /天,连用1周,溃疡采用1%0水杨酸溶液、水凝胶、泡沫敷料压迫治疗。治疗4周后,临床改善,瘢痕变薄,溃疡缩小。