Atrophy of the skin (overview)

Clinical classification of atrophies of skin and/or subcutis:

• Generalized:
  • Senile atrophy
  • Cutis laxa
  • Ehlers-Danlos syndrome.
• Localized:
  • Large-surface, homogeneous:
    • Traumatic scars
    • Acrodermatitis chronica atrophicans
    • Atrophodermia idiopathica et progressiva Pasini Pierini
    • Pressure (mechanically induced atrophy e.g. in pressure sores)
    • Drugs like glucocorticosteroids and penicillamine (atrophy of skin and adipose tissue- steroid skin)
    • Actinic atrophy of the skin
    • Paralysis of one limb with diffuse skin atrophy
    • Diabetes mellitus (soles of the feet).
  • Small-surface:
    • Traumatic scars
    • Acne excoriée des jeunes filles
    • Condition following scarring skin diseases (boils, ulcers of various etiologies, lupus erythematodes chronicus discoides, atrophic lichen planus, scarring epidermolyses, necrobiosis lipoidica, acne vulgaris, etc.)
    • Aplasia cutis congenita
    • Atrophy blanche (in the context of CVI)
    • After glucocorticoid injections
    • Scarring alopecia
    • Idiopathic degenerative processes (inactivity; Sudeck's disease)
    • Lipoatrophia semicircularis (no atrophy of the skin)
    • Scleroderma circumskripte linear.
• Disseminated:
  • Striae cutis distensae (growth-related; pregnancy; Marfan syndrome)
  • Anetoderma
  • Lichen sclerosus et atrophicus
  • Atrophodermia vermiculata
  • Atrophies (scars) after ulcerated dermatoses
  • Panniculitis-like cutaneous T-cell lymphoma.

Atrophy of the skin (e.g. in an atrophic scar) is a loss of substance of the skin, combined with characteristic structural changes of the collagen fibre texture (reduction of collagen fibre bundles) and shrinking of the tissue. In atrophy of the skin, the skin is circumscribed or diffusely reduced in its consistency with simultaneous loss of elasticity. The atrophy of the skin can affect individual layers:

• Atrophy of the epidermis is manifested as thinning and cigarette-paper-like wrinkling
• atrophy of the dermis shows itself as a flat depression of the surface or thinning of lifted skin folds
• the atrophy of the fatty tissue shows itself as a trough-shaped or extensive depression of the skin surface.

If the atrophy affects all three layers of the skin (epidermis, dermis, subcutis), the main clinical feature is the change in the skin. The atrophic skin is smoother and can be folded like cigarette paper. The finer surface relief is missing. The skin is more transparent, allowing the enclosed or underlying components (e.g. larger vessels) to shimmer through. In the striae cutis distensae, the atrophy of the skin affects the epidermis and dermis in stripes, especially the elastic fibres. The subcutaneous fatty tissue can also disappear in isolation, e.g. when panniculitis melts or after injections of glucocorticoids. Atrophy of the entire skin (and the underlying fatty and muscle tissue) is found in various panatrophies, e.g. in aplasia cutis.

Clinical classification of atrophy of the skin and/or subcutis:

• Universal:
  • senile atrophy
  • lax cutis
  • Ehlers-Danlos Syndrome
  • medicines such as glucocorticosteroids and penicillamine (atrophy of skin and subcutaneous fatty tissue)
• Localized:
  • Large area, homogeneous:
    • Traumatic scars
    • Acrodermatitis chronica atrophicans
    • Atrophodermia idiopathica et progressiva Pasini Pierini
    • Pressure (mechanically induced atrophy, e.g. in decubitus)
    • medicines such as glucocorticosteroids and penicillamine (atrophy of skin and subcutaneous fatty tissue)
    • Actinic atrophy of the skin
    • Paralysis of a limb with diffuse skin atrophy
    • Diabetes mellitus (soles of the feet).
  • Small area:
    • Traumatic scars
    • Acne excoriée des jeunes filles
    • Condition following scarring skin diseases (boils, ulcers of various aetiologies, lupus erythematodes chronicus discoides, atrophying lichen planus, scarring epidermolyses, necrobiosis lipoidica, acne vulgaris, etc.)
    • aplasia cutis congenita
    • Atrophie blanche (within the scope of a CVI)
    • After glucocorticoid injections (steroid skin; steroid injections)
    • Scarring alopecia
    • Idiopathic degenerative processes (inactivity; M. Sudeck)
    • Lipoatrophia semicircularis (no atrophy of the skin).
• Disseminated:
  • Striae cutis distensae (growth-related; pregnancy; Marfan syndrome, medicinal)
  • Anetodermia
  • lichen sclerosus et atrophicus
  • Atrophodermia vermiculata
  • Atrophies (scars) after ulcerated dermatoses
  • Panniculitis-like cutaneous T-cell lymphoma
  • Clinical pictures of the Epidermolysis bullosa group

1. Altmeyer P (2007) Dermatological differential diagnosis. The way to clinical diagnosis. Springer Medicine Publishing House, Heidelberg