In Reply. —
While Dr Pottkotter raises three points worth emphasizing, we disagree vigorously with his conclusion. First, many of the manifestations of the "MASS phenotype," and of the Marfan syndrome, including striae, are common in people in the general population who do not have other evidence of a generalized connective-tissue defect. Second, diagnosis of pleiotropic conditions cannot be based on the presence of only one or two manifestations if inappropriate labeling is to be avoided. Thus, we do not suggest in our article that striae alone are sufficient to diagnose anything. Finally, the fact that striae on different people appear similar clinically and histologically does not imply commonality of cause. How striae are induced by puberty, hypercortisolism, pregnancy, obesity, and the Marfan syndrome is unknown, and while there may be some common pathways, the pathophysiology in the various situations probably differs in detail.Although striae are common in young