Intradermal Injection of Normal Saline for Treatment of Fat Atrophy Following Corticosteroid Injection

A 20-year-old woman with a Fitzpatrick score of 2 presented via telehealth with “divots” on her forehead and scalp. She reported that 2 months prior to presentation she had received multiple steroid injections into her forehead and posterior skull by a neurologist for treatment of migraines. She had soon thereafter developed fat atrophy in 3 areas: 2 on her forehead and 1 on her occipital scalp. Although they were not painful or otherwise symptomatic, she was unhappy with the cosmetic appearance. She had no other skin or systemic symptoms. She visited the office the following day, and on examination, 2 atrophic plaques were noted on her bilateral forehead around the mid-pupillary lines, with a larger atrophic plaque on the occipital scalp (Figures 1 and 2). Given the location and timing of the lesions, they were consistent with skin atrophy induced by her prior steroid injections. Therefore, a biopsy was not performed.