The atrophic lesion of macular atrophy presents much the same appearance whether it is of the primary or of the secondary type. It is usually oval, follows the lines of cleavage of the skin, bulges spontaneously or bulges and wrinkles when the skin is made lax, causes no subjective symptoms, is usually paler than the surrounding skin, shows a preference for certain regions of the body—particularly the trunk— and gives to the palpating finger the same sensation as does a hernial orifice.
In all cases the essential pathologic feature is the destruction of the elastica of the upper portion of the dermis. Associated with this there is evidence of a destructive inflammatory infiltrate in the early stages, but little or no inflammation is present in the late, atrophic, stages. Atrophy of the epidermis is purely incidental.
Much of the literature on macular atrophy deals with classification into primary and secondary
SCULL RH, NOMLAND R. SECONDARY MACULAR ATROPHY: A STUDY OF TWELVE CASES OCCURRING IN CONNECTION WITH VARIOUS DISORDERS, WITH CONSIDERATION OF THE PATHOLOGIC RELATIONSHIPS. Arch Derm Syphilol. 1937;36(4):809–820. doi:10.1001/archderm.1937.01480040126008
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