Poikiloderma of Civatte

Poikiloderma is a term used to define skin which has a thinned appearance along with some redness from blood vessels and brown discoloration. Poikiloderma can be caused by several underlying disorders, however, poikiloderma of Civatte is a specific variant thought to be caused by cumulative sun exposure. The tendency to get poikiloderma of Civatte may be genetic. It is seen in both sexes, but particularly in postmenopausal women, thus hormonal changes have been theorized as a possible contributing cause. Another theorized cause of poikiloderma of Civatte is an allergic reaction to fragrances applied to the neck, which is activated by sun exposure (photoallergic reaction).

Presentation:
Poikiloderma of Civatte is manifested by somewhat thin appearing, finely wrinkled, reddish brown patches on the neck, upper chest, and sides of the face of the middle-aged and elderly. The areas shaded from the sun, such as the neck immediately beneath the chin, are classically spared from the discoloration.

Treatment:
Effective treatment of poikiloderma of Civatte is difficult. The ideal treatment combines elimination of both the blood vessel component as well as the brown pigmentation simultaneously. This can be achieved with intense pulsed light sources. Other reported treatments with variable success and side effects include bleaching creams, chemical peels, electrodessication, and lasers. The pulsed dye laser is also reported to be effective in treating poikiloderma of Civatte. Sun protection can possibly prevent the occurrence of this condition.

References:
Katoulis AC, Stavrianeas NG, Georgala S, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol 1999;24:385-7.
Goldman MP, Weiss RA. Treatment of poikiloderma od Civatte on the neck with an intense pulsed light source. Plast Reconstr Surg 2001;107:1376-81.

Gregg Severs, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.