Usually there is flattening of the epidermal ridges. This suggests epidermal destruction as occurs in erythema mutiforme , lupus erythematosus, dermatomyositis and in lichen sclerosus. Epidermal consumption can also be a feature of melanoma and lentigo maligna on the face.
The commonest cause of epidermal thinning is ageing and sun damage with significant solar elastotic changes underneath but remember the regional differences in the body with eyelid skin epidermis being particularly thin relative to other areas.
Other rarer causes Poikilodermatous dermatitis as in MF or dermatomyositis, Chronic Lichen sclerosus, Degos disease (malignant atrophic papulosis), Post radiation, Some cases of discoid lupus and the atrophic variant of lichen planus.
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