a 14-year - old female patient presented to our clinic with the symptom of hollowness that had been present in both gluteal areas for 6 months . the patient , who did not have any history of topical medication , redness , pain or itching in the hollowed area and did not describe any signs , had been receiving corticosteroid injections due to urticaria for the last 6 months . the patient did not have any particularities in her personal history , and there were no persons in her family with similar symptoms . the patient 's dermatological physical examination revealed an atrophic , oval and plaque - like lesion symmetrically localized on both thighs with a diameter of approximately 3  4 cm linearly overlaid by two flesh - colored striae with a diameter of approximately 1  4 cm . the patient 's laboratory values were normal , and the deep incisional biopsy collected from the patient was found to be consistent with acquired localized lipoatrophy ( all ) . histopathological examination revealed partly necrotic - looking adipocytes embedded among fibrous septa in the subcutaneous tissue interspersed with a few inflammatory cells . the option of spontaneous healing was taken into account , and control visits at the dermatology outpatient clinic once every 3 months were recommended for our patient . lipoatrophy is characterized by a preceding inflammatory period and consequent fat loss in the subcutaneous tissue . as for lipodystrophy , it refers to the absence of subcutaneous fat tissue without any signs of inflammation . lipoatrophy may be congenital or acquired and localized or diffused depending on the area of involvement . primary and idiopathic lipoatrophy has clinical forms such as lipoatrophia semicircularis , lipodystrophia centrifugalis abdominalis infantilis and involutional lipoatrophy . secondary lipoatrophy develops due to reasons such as pyogenic abscesses , connective tissue diseases ( lupus erythematosus , morphea , dermatomyositis or overlap disease ) , neoplasm ( t - cell lymphoma ) and iatrogenic ( subcutaneous , intramuscular and dermal injections ) factors . all frequently develops secondary to dermal or intramuscular drug injections of corticosteroids as seen with our case . additionally , all has also been reported following insulin , vasopressin , recombinant growth hormone , adrenal cortex hormone and methotrexate injections [ 2 , 3 , 4 ] . lipoatrophy that develops due to subcutaneous corticosteroid injection results in two different histopathological pictures . in the first histopathological picture , there are small , retracted , slightly acidophilic or albuminous fat tissues surrounding the septal connective tissue accompanied by sparse inflammatory cells and prominent blood vessels . in the second histopathological picture , there are small , atrophic fat tissues around vascular structures . decreased adipocyte counts and small - sized lobules all diagnosis is based on the basis of clinical signs , physical examination , including deep incisional biopsy , and anamnesis . primary localized lipoatrophy is generally self - limiting and may not require treatment . if the clinical signs persist and the patient has cosmetic concerns , liposuction and localized fat transplantation can be performed in a combined fashion .