Localized involutional lipoatrophy (LIL) was first described in 1986 as a distinctive idiopathic form of localized lipoatrophy characterized by loss of adipose tissue without antecedent inflammation. Clinically, LIL usually presents as a solitary, asymptomatic, well-demarcated, atrophic depression and often involves areas of antecedent intramuscular or intra-articular injections. Histologically, changes in the subcutaneous fat in LIL resemble fetal adipose tissue. Only rarely has there been any description of epidermal or dermal changes occurring with LIL. We describe two cases of LIL with overlying hypopigmentation and atrophy, and with morphea-like changes on histology. Recognition of these changes may have clinical and diagnostic implications.