Striae Gravidarum SOAP Note: Pregnancy Stretch Marks
This paper presents a comprehensive dermatological SOAP note for a 28-year-old African American woman at 28 weeks gestation who presents with dark irregular bands on her abdomen. The note documents her subjective complaints, relevant medical and family history, review of systems, and objective physical examination findings. The primary diagnosis of striae gravidarum is supported by clinical presentation, elevated BMI, and significant maternal weight gain. Three differential diagnoses — Cushing's syndrome, linea nigra, and steroid-induced skin atrophy — are considered and evaluated. The case illustrates how pregnancy-related skin changes are assessed within a structured clinical framework.
- Subjective Data: Patient history, HPI, medications, and social background
- Review of Systems: Systematic symptom review across body systems
- Objective Data and Physical Exam: Vitals, physical findings, and diagnostic lab results
- Assessment: Primary Diagnosis: Striae gravidarum diagnosis with supporting evidence
- Differential Diagnoses: Cushing's syndrome, linea nigra, and steroid atrophy considered
- References: Cited peer-reviewed sources in APA format
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The SOAP note format is followed precisely, presenting information in a logical clinical sequence from subjective complaint through objective findings, assessment, and differential diagnoses.
- The primary diagnosis is well-supported with cited literature, linking the patient's specific risk factors — elevated BMI, weight gain, and gestational stage — to the diagnosis of striae gravidarum.
- Differential diagnoses are each addressed with clear reasoning about why they were considered and then ruled out or deprioritized, demonstrating critical clinical thinking.
Key academic technique demonstrated
This paper demonstrates evidence-based clinical reasoning: each diagnostic claim is anchored to a peer-reviewed source rather than stated as clinical assumption alone. The student integrates quantitative data (BMI of 32, HCT, HGB, fetal heart rate) with qualitative history to justify the final diagnosis, modeling how standardized clinical formats accommodate both empirical and narrative evidence.
Structure breakdown
The paper follows the four-part SOAP structure: Subjective (chief complaint, HPI, medications, history), Objective (vitals, physical exam, diagnostics), Assessment (primary diagnosis with literature support), and Plan-adjacent Differential Diagnoses. References in APA format are appended at the end. This mirrors real clinical documentation practice and is appropriate for a graduate-level advanced practice or nurse practitioner course.
Subjective Data
Patient Initials: K.B. Age: 28 Gender: Female
Chief Complaint (CC): Dark irregular bands on the abdomen for the past two months.
History of Present Illness (HPI): K.B. is a 28-year-old married African American female at 28 weeks gestation who presents to the clinic with complaints of dark irregular stretch marks that began approximately two months ago. She states that the abdominal area can be itchy and that the bands have continued to darken; however, she denies pain. She denies any prior history of stretch marks and would like something to minimize the bands, noting that she has tried cocoa butter without any relief.
Medications: Benadryl 25 mg before bed; Prenatal Rx: 1 tablet daily; Cortisone OTC: applied nearly 5 times daily for itching.
Allergies: No known allergies.
Past Medical History (PMH): Denies any chronic diseases.
Past Surgical History (PSH): None.
Sexual/Reproductive History: Heterosexual. Currently sexually active with her husband. Denies use of oral contraceptives; no cramping; no excessive bleeding.
Personal/Social History: She is married and has been living with her husband for three years. Denies use of any substances at home. Denies consumption of caffeinated products. Reports having a good support system at home and works as a sales manager at a nearby fast food restaurant.
Health Maintenance: Denies any history of intimate partner abuse. Reports getting at least 8 hours of sleep daily. Reports regular hospital visits for prenatal checkups.
Immunization History: Up-to-date on immunizations; last tetanus immunization in December 2021. Reports refusing COVID-19 vaccination.
Significant Family History: Her mother and father are alive, aged 50 and 55 years respectively. Her mother has a history of anxiety and depression; her father has no significant medical history. She has two younger siblings — a brother (25 years) and a sister (23 years) — both with no significant medical history. Her 70-year-old paternal grandmother is alive with a history of hypertension; her paternal grandfather died in a car accident at age 75.
Review of Systems
General: Alert and fully oriented. Reports fatigue over the past two weeks. Denies fever and weakness. Reports change in appetite and weight gain.
HEENT: Head: Denies headache or head injuries. Ears, Nose, and Throat: Denies hearing loss; no ear drainage. Reports normal breathing; denies nose pain; denies sore throat. Eyes: No vision loss.
Respiratory: Denies history of asthma or any respiratory illnesses.
Cardiovascular/Peripheral Vascular: Reports occasional nausea.
Gastrointestinal: Reports itchiness in the abdominal area. Denies abdominal pain. Denies eructation or excessive flatulence.
Genitourinary: No breast pain or masses.
Musculoskeletal: No joint pain, tenderness, or swelling. Reports back pain over the past two months. Denies gout.
Neurological: Denies problems with memory. No headaches.
Psychiatric: Denies depression or anxiety.
Skin/Hair/Nails: Reports nails have been healthy since pregnancy began. No hair loss. Reports dark irregular bands on the abdomen. Denies skin problems in any other area of the body.
Objective Data and Physical Exam
Vital Signs: B/P: 134/88; Temp: 96°F (oral); Pulse: 77 bpm; Weight: 185 lbs; Height: 5 ft 5 in; RR: 20; Fetal Heart Rate: 127 bpm; BMI: 32.
General: Alert and oriented. Demonstrates full understanding of bodily changes during pregnancy. Mood appropriate; well-groomed.
HEENT: No dandruff. Face symmetrical. Skull normal. Eye color brown. No nasal discharge. No ear drainage. No nose pain. No sore throat. Lips dry.
Neck: Full range of motion in all directions.
Chest/Lungs: Clear breath sounds. No difficulty breathing.
Heart/Peripheral Vascular: No heart murmur. Negative for pleural rubs or gallops. No peripheral edema in the lower extremities.
Abdomen: Dark irregular bands observed. Patient reports occasional itchiness. No tenderness. Normal bowel sounds.
Genital/Rectal: Patient declined examination. Routine care managed by OB/GYN.
Musculoskeletal: Range of motion intact in all four extremities.
Neurological: Alert and fully oriented.
Skin: Stretch marks on the abdomen; dark irregular bands noted.
Diagnostic Results: UA: Negative for protein, nitrates, blood, and leukocytes. HCT: 35. HGB: 11.9. Creatinine: 0.9. Potassium: 3.5. Sodium: 135. Fasting glucose: 80.
Assessment: Primary Diagnosis
Primary Diagnosis: Striae gravidarum. According to Wollina and Goldman (2017), this is a common condition affecting between 50% and 90% of pregnant women. It is characterized by irregular bands on the abdominal area that appear in various colors, including black or dark grey (striae nigrae), purple or pink (striae rubra), or white (striae alba). This patient meets criteria for this diagnosis because she exhibits striae nigrae on the abdominal area. In addition, the patient reports significant maternal weight gain, which is a recognized predisposing factor for this condition (Brennan, Clarke, & Devane, 2016). Her BMI of 32 further supports the diagnosis, as being overweight increases susceptibility to striae gravidarum, particularly in the third trimester of pregnancy (Farahnik et al., 2017).
Always verify citation format against your institution’s current style guide requirements.