Poikiloderma of Civatte is an acquired, irreversible sun-induced dermatosis, an area of mottled pigmentation (hyper and hypo) with telangiectasias and atrophy often present on the V region of the chest, lateral neck, and lateral face. It is always present in sun-exposed areas but shaded areas of the neck, such as the area under the chin, are spared. Cumulative UV radiation is the predominant underlying cause; however, postmenopausal hormonal changes and contact sensitization with perfumes and cosmetics can exacerbate the condition.

 

Breaking down the subtypes will help direct the treatment options. There are two main types of poikiloderma – telangiectatic and hyperpigmented – and of course, an overlap between the two. Choosing which subtype is dominant is based primarily on clinical presentation and dermoscopic findings. Atrophy is ubiquitous; thus, collagen remodeling is a necessary treatment for both.

Telangiectatic poikiloderma is characterized by a linear and reticular dilated network of vessels. Laser treatment options include IPL, V-beam, and KTP lasers. Multiple treatments are usually necessary and if the patient has concomitant flushing and burning symptoms associated with poikiloderma, topical rosacea treatments such as topical oxymetazoline, as well as avoidance of fragrance, and strict use of a broad-spectrum mineral sunscreen, should be initiated prior to laser treatments.

 

Hyperpigmented poikiloderma is characterized by mottled hyperpigmentation caused by the increased melanin irregularly distributed in the basal layer of the epidermis and melanophages within the dermis. The best treatment for this is with 1,927-nm fractionated resurfacing modalities. Although IPL has been used in this area and is often recommended in the literature for the lentigines, the results are transient, and it is much harder to blend the color of the skin with the surrounding area of the neck, lateral chest, shoulders, and arms. The 1,927-nm fractionated laser allows for a smoother transition and blending of the skin and helps with some collagen remodeling of the dermis. 

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Other treatment works well for poikiloderma of civette is skin resurfacing utilises different modalities such as microdermabrasion, epiblading, chemical peels, iontophoresis (ultrasound dermal delivery) and hydrating facials. And most importantly is the sunscreen application for 365 days a year is non-negotiable. 

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REFERENCES

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Katoulis, A. C., Sgouros, D., Bozi, E., Pappa, G., Theotokoglou, S., Konstantinou, M. P., Voudouri, A., Voudouri, M., Theofili, M., Tzima, K., & Hofmann-Wellenhof, R. (2023). Diagnosis and Differential Diagnosis of Poikiloderma of Civatte: A Dermoscopy Cohort Study. Dermatology practical & conceptual, 13(1), e202307. https://doi.org/10.5826/dpc.1301a7

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