Steroid atrophy presents as thinning of the skin and results from exposure to corticosteroids. Localized thinning occurs following the direct application of topical agents to the skin. Localized subcutaneous atrophy is one of the most common adverse effects of intramuscular corticosteroids. Atrophied skin may also be found over areas where intralesional steroids have been injected. Generalized thinning can occur as the result of long-term oral or inhaled steroid use, or from Cushing disease. Steroid atrophy can be seen as early as 1 week after starting superpotent topical steroids under occlusion and as soon as 2 weeks with less potent agents. Striae can also occur in thinned skin.

The delicate skin of the eyelids and periorbital area is thin by nature and, thus, is particularly susceptible to steroid atrophy. Therefore, only low-potency topical corticosteroids for short periods of time should be used to treat eyelid dermatoses.