Key Terms
Striae
Stretch marks
Striae alba
Striae distensae
Striae gravidarum
Striae rubra
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Acrodermatitis chronica atrophicans
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Anetoderma
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Aging—extrinsic (photoaging)
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Aging—intrinsic
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Aplasia cutis congenita
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Atrophic lichen planus
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Atrophic scar
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Atrophoderma of Pasini and Pierini
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Corticosteroid atrophy
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Focal dermal hypoplasia
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Follicular atrophoderma
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Lichen sclerosus et atrophicus ( Chapter 27 )
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Lipodystrophies
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Poikiloderma atrophicans vasculare
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Postinjection lipoatrophy
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Striae distensae
Atrophic disorders are a group of heterogeneous diseases characterized by an atrophic (thinned) epidermis, dermis, or subcutis. Some atrophic diseases affect the epidermis (e.g., photoaging, topical corticosteroid overuse), whereas others affect the dermis (atrophoderma from intralesional steroid injections). Although the term atrophy implies that the skin was once normal, some disorders in this disease group (see box) are actually congenital and are caused by hypoplasia (focal dermal hypoplasia), in which the skin is less fully formed, or by aplasia (aplasia cutis congenita), in which a particular layer of the skin was never formed.
Important History Questions
When was this change in your skin noted?
This question is designed to distinguish congenital disorders (e.g., aplasia cutis congenita, focal dermal hypoplasia) from acquired disorders (e.g., photoaging, lichen sclerosus).
Over what period of time did these changes occur?
Some atrophic conditions foment quickly (e.g., striae distensae, anetoderma due to steroid injections) whereas others may develop over months, years, or decades (e.g., poikiloderma atrophicans vasculare, intrinsic aging, photoaging).
Have you used any steroids in the area, or have you had steroid injections or taken steroid pills?
Topical corticosteroids, especially potent forms, may thin the skin or produce striae. Localized atrophy may be caused by corticosteroid injections (intradermal or intramuscular). Even oral glucocorticosteroids, when taken in a higher dose and/or for extended durations, may lead to skin thinning and striae.
Have you been given any other injections in the area?
Injections of insulin, vaccines, antibiotics, of other injectable agents of any type may cause atrophy, especially if injected in the same area, for an extended duration, or with a suboptimal technique.
Do you have any other medical conditions?
Other medical conditions of interest include Borrelia infection (e.g., acrodermatitis chronica atrophicans, atrophoderma of Pasini and Pierini) and collagen vascular disease or cutaneous T cell lymphoma.
Important History Questions
When was this change in your skin noted?
This question is designed to distinguish congenital disorders (e.g., aplasia cutis congenita, focal dermal hypoplasia) from acquired disorders (e.g., photoaging, lichen sclerosus).
Over what period of time did these changes occur?
Some atrophic conditions foment quickly (e.g., striae distensae, anetoderma due to steroid injections) whereas others may develop over months, years, or decades (e.g., poikiloderma atrophicans vasculare, intrinsic aging, photoaging).
Have you used any steroids in the area, or have you had steroid injections or taken steroid pills?
Topical corticosteroids, especially potent forms, may thin the skin or produce striae. Localized atrophy may be caused by corticosteroid injections (intradermal or intramuscular). Even oral glucocorticosteroids, when taken in a higher dose and/or for extended durations, may lead to skin thinning and striae.
Have you been given any other injections in the area?
Injections of insulin, vaccines, antibiotics, of other injectable agents of any type may cause atrophy, especially if injected in the same area, for an extended duration, or with a suboptimal technique.
Do you have any other medical conditions?
Other medical conditions of interest include Borrelia infection (e.g., acrodermatitis chronica atrophicans, atrophoderma of Pasini and Pierini) and collagen vascular disease or cutaneous T cell lymphoma.
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