While the apple’s dent was simply a harmless imperfection, steroid-induced skin atrophy can create a similar appearance in the skin—a visible depression or “dent” caused by thinning of the skin and underlying tissues. Patients sometimes describe these areas as looking like a “divot,” “crater,” or “sunken spot.” In reality, the process is more complex than an apple dent, but the image serves as a useful visual reminder of what can happen when corticosteroids affect collagen production and local fat tissue.
Just as the apple has lost some of its normal contour, steroid-induced atrophy results in localized loss of tissue volume. The skin may appear depressed, shiny, wrinkled, lighter in color, or accompanied by small visible blood vessels. Fortunately, unlike many dents in apples, most cases of steroid-induced skin atrophy gradually improve with time.
Understanding why these dents occur—and how to prevent them—is an important part of safely using intralesional corticosteroid therapy in dermatology.
In my opinion, the secret to reducing the risk of atrophy is for hair specialists and dermatologists to use 2.5 mg per mL triamcinolone as their baseline NOT 5 mg/mL and to limit injection to every 6-12 weeks (not every 2-4 weeks)
