Poikiloderma of Civatte is a common, benign skin condition identified by a distinct pattern of discoloration, primarily affecting the neck and upper chest. This chronic dermatological condition is not considered a health concern, but its visual impact can lead individuals to seek treatment. The term “poikiloderma” itself comes from Greek words meaning “variegated skin.” While it often appears on sun-exposed areas, it typically avoids the shaded skin under the chin.
Characteristics of Poikiloderma of Civatte
The hallmark feature is a mottled, reddish-brown discoloration, which often includes areas of lighter or normal skin tone. This uneven pigmentation is frequently accompanied by the presence of telangiectasias, which are fine, dilated blood vessels that contribute to the reddish hue. Another characteristic change is skin atrophy, where the affected skin becomes thin and may develop a wrinkled or crepe-like texture. These changes typically appear symmetrically on both sides of the neck, extending to the V-shaped area of the chest. It is notable that the area directly under the chin usually remains unaffected, as it receives less direct sun exposure; while often asymptomatic, some individuals may experience mild burning, itching, or increased sensitivity in the affected regions.
Factors Contributing to Its Development
The development of Poikiloderma of Civatte is primarily linked to chronic, long-term sun exposure. Ultraviolet (UV) radiation from the sun is considered a major contributing factor, explaining why the condition predominantly affects sun-exposed areas. Fair-skinned individuals, particularly those with Fitzpatrick skin phototypes I and II, are more susceptible to developing this condition due to their increased vulnerability to UV damage. Genetic predisposition also plays a role, suggesting that some individuals may have an inherited susceptibility to the condition. Hormonal changes, such as the decrease in estrogen levels during menopause, are further identified as potential contributors, making postmenopausal women more prone to developing Poikiloderma of Civatte; additionally, the use of photosensitizing agents, including certain fragrances, cosmetics, or skincare products, can enhance the skin’s sensitivity to UV radiation, potentially triggering or worsening the condition.
Treatment and Management Options
Managing Poikiloderma of Civatte primarily involves protective measures and various cosmetic treatments. Sun protection is a fundamental strategy to prevent further damage and can help improve existing symptoms. This includes consistent use of broad-spectrum sunscreen with an SPF of 50 or greater, wearing wide-brimmed hats, and using protective clothing. Avoiding direct sun exposure during peak UV times is also recommended.
For existing discoloration and texture changes, light-based therapies are often considered the most effective. Intense Pulsed Light (IPL) therapy uses broad-spectrum light to target both the red (vascular) and brown (pigmented) components of the condition, offering a reduction in both and often improving skin texture. Pulsed Dye Lasers (PDL) specifically target the dilated blood vessels responsible for the redness, effectively reducing telangiectasias. Fractional non-ablative lasers can also be used to improve overall skin texture and pigmentation by stimulating collagen remodeling. While light-based therapies are highly effective, multiple treatment sessions are typically required to achieve optimal results.
Topical treatments, such as retinoids (e.g., tretinoin) and alpha-hydroxy acids, may be used as adjunctive therapies to improve skin texture and reduce hyperpigmentation, though they are generally less effective than light-based procedures for significant discoloration. Some skin-lightening creams containing hydroquinone can also address hyperpigmentation.