Skin Disorders: Types, Causes and Thin (Atrophic) Skin Conditions

The main groups of skin disorders

Atrophic skin disorders: diseases that cause thin skin

Skin atrophy means thinning of one or more skin layers. Atrophic skin looks thin, shiny, wrinkled like cigarette paper, or translucent with visible blood vessels. It bruises easily, tears with minor trauma, and heals slowly. See atrophic skin condition.

Common causes of thin skin

• aging: the dermis loses collagen and elastin, and the fat layer thins, especially on the forearms and backs of the hands
• sun damage (photoaging): years of UV exposure break down collagen, causing thin, wrinkled, blotchy skin and purple bruises (actinic or senile purpura)
• steroid use: long-term strong topical steroids, especially on the face, groin and skin folds, and oral steroids cause thinning, stretch marks and easy bruising
• Cushing syndrome: excess cortisol from the body itself causes the same changes plus purple stretch marks

Atrophic skin diseases

• lichen sclerosus: white, thin, crinkly, itchy patches, mostly on the genitals, which can scar. Treated with strong steroid ointment
• morphea (localized scleroderma): hardened patches that may later become thin and depressed
• atrophoderma of Pasini and Pierini: smooth, slightly sunken patches on the back
• anetoderma: small areas of loose, sac-like skin from loss of elastic tissue
• discoid lupus: scarring, thinned patches on sun-exposed skin and scalp
• striae (stretch marks)
• acrodermatitis chronica atrophicans: late Lyme disease, mostly in Europe
• poikiloderma: thin skin with mottled pigment and visible vessels, in sun damage and some lymphomas

Genetic and connective tissue disorders

• Ehlers-Danlos syndrome: thin, stretchy, fragile skin with wide scars and easy bruising, especially in the vascular type
• cutis laxa: loose, sagging skin
• progeria and Werner syndrome: premature aging with thin skin
• focal dermal hypoplasia (Goltz syndrome), rare

Caring for thin, fragile skin

• moisturize daily, especially after washing
• protect from the sun with clothing and broad-spectrum sunscreen
• pad furniture edges and wear long sleeves to prevent skin tears
• use topical steroids only as directed, for the shortest time
• clean skin tears gently, replace the flap if possible, and cover with a non-stick dressing. See a nurse or doctor for large tears
• prescription tretinoin can improve sun-damaged skin over months

Causes of skin disorders in general

• genetics
• immune system activity (allergy and autoimmunity)
• infections (bacteria, viruses, fungi, parasites)
• sun exposure
• irritants and allergens
• hormones
• medicines
• internal diseases, such as diabetes, liver and kidney disease and thyroid disorders, which often show up in the skin

Diagnosis

A primary care doctor or dermatologist will examine the skin, often with a dermatoscope, and ask about the history, triggers, medicines and family history. Tests include:

• skin scrapings (KOH) for fungi
• swabs for bacteria and viruses
• patch tests for contact allergy
• blood tests for autoimmune and internal diseases
• skin biopsy, the most definitive test for many conditions and for any suspected cancer

Skin cancer warning signs

Use the ABCDE checklist for moles: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, and Evolving (changing). Also watch for any new or changing spot, a sore that bleeds or does not heal, or a pearly or scaly bump. See skin cancer.

Frequently asked questions

What are the most common skin disorders?

The most common skin disorders include acne, eczema, psoriasis, rosacea, hives, contact dermatitis, fungal infections, warts, seborrheic keratoses and sun damage. Skin cancers, especially basal cell carcinoma, are also very common.

What disease causes thin skin?

Thin skin is most often caused by aging, sun damage and long-term steroid use. Diseases that cause it include Cushing syndrome, lichen sclerosus, morphea, discoid lupus, and genetic conditions such as Ehlers-Danlos syndrome and cutis laxa.

What is an atrophic skin disorder?

An atrophic skin disorder is any condition that thins the skin's layers, making it shiny, wrinkled, fragile and prone to bruising and tearing. Examples include steroid-induced atrophy, lichen sclerosus, atrophoderma, anetoderma and stretch marks.

Can thin skin become thicker again?

Sometimes. Steroid-induced thinning often improves over months after stopping the steroid. Sun-damaged skin can improve with sun protection and prescription retinoids. Thinning from aging and genetic conditions cannot be fully reversed, but good skin care reduces injuries.

When should I see a dermatologist?

See a dermatologist for a changing or unusual mole, a sore that does not heal, persistent rashes or itching, severe acne, hair or nail problems, or any skin condition that does not respond to treatment from your primary care doctor.