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Corticosteroid skin atrophy: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Corticosteroid skin atrophy is one of the side effects of long-term corticosteroid therapy, general or local. The degree of skin atrophy in these cases varies, up to thinning of the entire skin, which looks senile, easily injured. Focal skin atrophy develops in connection with the use of corticosteroid ointments, mainly in children and young women, as a rule, with improper, uncontrolled use of fluoride-containing ointments prescribed under an occlusive dressing.
Skin changes may involve the epidermis or dermis, less frequently the subcutaneous tissue, mainly after injections of suspensions containing corticosteroids. Atrophy is mostly limited, often strip-shaped, the skin in these areas becomes thinner, acquires a livid tint, especially if corticosteroids were used for dermatoses, the symptom complex of which includes telangiectasia (rosacea). A bluish tint may be due to the anti-inflammatory effect of fluorine. In addition, hemorrhages, purpura, and star-shaped pseudoscars may be observed in the foci of atrophy, especially in elderly people. Most often, atrophy of this kind develops on the face, inner thighs, in skin folds, and on the hands.
Pathomorphology of corticosteroid atrophy of the skin. The histological burr is similar to that of other types of atrophy, the diagnosis is established based on the anamnesis. Usually, one of the first signs is thinning of the epidermis with smoothed interpapillary outgrowths. In the papillary layer of the dermis, the fibers are loose, and dilation of the lumens of superficially located vessels is noted. Atrophy of the reticular layer of the dermis is detected only in long-standing elements.
Histogenesis of corticosteroid skin atrophy. The mechanism of development of atrophic changes from the use of corticosteroid drugs has not been established. Indications include inhibition of DNA synthesis, suppression of the synthetic activity of fibroblasts, a negative effect on fibrous structures and the main substance of connective tissue, vasoconstrictive effect, and changes in the function of tissue basophils. Along with a decrease in collagen synthesis, its accelerated destruction is assumed.
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