Steroid atrophy is usually an iatrogenic consequence of using corticosteroids topically. It can occur on the face, axilla, groin or vulva and is characterized by thinning of the skin, atrophy, and formation of striae, as well as, telangiectasias. Diagnosis is mainly clinical and the condition reverses partially if the medication is stopped immediately after the symptoms appear.
Steroid atrophy was first described by Epstein et al. in 1963  and is known to occur following the use of topical as well as systemic corticosteroids . Risk factors for the condition include the strength of the steroid formulation prescribed, duration and the frequency of use  . Skin areas with a less depth of the dermal layer e.g. on the face and other areas e.g. groin, axilla, and vulva are more susceptible    while the palmar and plantar surfaces are less prone  to steroid atrophy.
Three stages in steroid atrophy have been reported: the first stage of pre-atrophy, followed by atrophy and the terminal stage of tachyphylaxis . Patients present initially with a burning sensation in the area where the topical steroid is being applied. Continued use of the medication leads to vasoconstriction with a resolution of symptoms . Atrophic thinning of the skin with telangiectasia is more common on the face while striae are more frequently seen in the axilla, groin, and vulva. The disorder is characterized by a transparent, fragile appearance of the skin, dryness, laxity with telangiectasia   and an increased tendency for bruising, which has been described as steroid purpura .
The condition may improve if the medication is discontinued as soon as the patient presents with symptoms. Otherwise, long-term steroid use leads to irreversible striae and more prominent telangiectasias. Dermatological features of steroid atrophy resemble those of the skin in the elderly. However, steroid atrophy is usually not associated with malignant change while striae are not observed in aging skin.
The diagnosis of steroid atrophy is based on the typical clinical appearance of the skin: increased skin transparency, consistency resembling that of a cigarette paper, and increased fragility with a tendency to bruise easily . History will reveal either a short or long-term use of steroids, with symptoms related to the area in which the medication was applied.
As the condition in chronic stage is irreversible and as there is a potential for complications following an invasive procedure, surgical skin biopsies are not routinely performed. But if they are performed then, the following features are noted on histology: flattening of the epidermal-dermal areas , diminished epidermal width , reduced keratinocyte size , decreased number of fibroblasts   and narrowing of the lipid lamella of the stratum corneum .
Several non-invasive techniques and assays to diagnose the condition have been devised both for clinical and experimental use. Evaporimeter assesses water loss from the transepidermal layer while the loss of cholesterol and fatty acids can be detected with stratum corneum lipid measurement . Skin thinning can be measured using a screw gauge, laser microscope and ultrasound  . However, these tests are cumbersome and patients have to use the medication for up to six weeks before results can be obtained .