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Poikiloderma of Civatte

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand and Vanessa Ngan, Staff Writer, 1998. Updated by Dr Anita Eshraghi, Dermatologist, Sweden. January 2018.


What is poikiloderma of Civatte?

Poikiloderma of Civatte is a benign, common and chronic condition, which belongs to the group of melanodermas (pigmented skin disorders). The term 'poikiloderma' refers to a skin change with atrophy where hypopigmentation/hyperpigmentation changes and dilation of the fine blood vessels (telangiectasiacan be seen in the affected skin.

The condition was first described in 1923 by a French dermatologist named Civatte.

Poikiloderma of Civatte

Who gets poikiloderma of Civatte?

Poikiloderma of Civatte is most common among middle-aged and elderly fair-skinned individuals, especially among those who are significantly exposed to the sun. The highest frequency is seen among postmenopausal women. The incidence is unknown since many patients have a mild form of the disease and may not seek medical advice.

What is the cause of poikiloderma of Civatte?

The exact cause is unknown. Long-term sun exposure is considered to be a main contributing factor. Other factors are:

  • Fair skin (Fitzpatrick skin phototype I and II)
  • Photosensitising components of cosmetics and toiletries, especially perfumes
  • Hormonal changes related to menopause or low oestrogen levels
  • A genetic predisposition.

What are the clinical features of poikiloderma of Civatte?

Poikiloderma of Civatte is characterised by confluent reddish-brown patches with atrophy that symmetrically involve sun-exposed areas such as the sides of the neck and lateral aspect of the cheeks. Poikiloderma of Civatte usually spares the shaded area under the chin.

What are the complications of poikiloderma of Civatte?

Poikiloderma of Civatte is usually asymptomatic but some patients can feel mild burning, itching, episodic flushing and sensitive skin in the affected area. No systemic involvement or severe complications are associated with poikiloderma of Civatte.

How is poikiloderma of Civatte diagnosed?

The diagnosis of poikiloderma of Civatte is made clinically. A punch biopsy can show typical histology with hyperkeratosis, epidermal atrophy, pigmentary incontinence, telangiectasia, a variable superficial dermal lymphohistiocytic infiltrate, and solar elastosis.

What is the differential diagnosis for poikiloderma of Civatte?

The differential diagnosis for poikiloderma of Civatte includes Riehl melanosis, erythromelanosis follicularis faciei et colli, and:

What is the treatment for poikiloderma of Civatte?

Medical treatment for this condition remains challenging. The patient should be educated about avoiding sun exposure and the correct use of sunscreen. The results of the treatment may be disappointing.

What is the outcome for poikiloderma of Civatte?

Poikiloderma of Civatte is a chronic and irreversible condition. The hyperpigmentation of the skin can cause cosmetic disfigurement and responds poorly to available treatments.

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References

  • Goldman MP, Weiss RA. Treatment of poikiloderma of Civatte on the neck with an
    intense pulsed light source. Plast Reconstr Surg. 2001 May;107(6):1376-81. PubMed
    PMID: 11335804.
  • Raulin C, Greve B, Grema H. IPL technology: a review. Lasers Surg Med.
    2003;32(2):78-87. Review. PubMed PMID: 12561039.
  • Weiss RA, Goldman MP, Weiss MA. Treatment of poikiloderma of Civatte with anintense pulsed light source. Dermatol Surg. 2000 Sep;26(9):823-7; discussion 828. PubMed PMID: 10971554.
  • Wheeland RG, Applebaum J. Flashlamp-pumped pulsed dye laser therapy for poikiloderma of Civatte. J Dermatol Surg Oncol. 1990 Jan;16(1):12-6. PubMed PMID: 2299018.
  • Lautenschlager S, Itin PH. Reticulate, patchy and mottled pigmentation of the neck. Acquired forms. Dermatology. 1998;197(3):291-6. Review. PubMed PMID: 9812039.
  • Katoulis AC, Stavrianeas NG, Georgala S, Katsarou-Katsari A, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol. 1999 Sep;24(5):385-7. PubMed PMID: 10564328.
  • Katoulis AC, Stavrianeas NG, Panayiotides JG, Bozi E,et al. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007;214(2):177-82. PubMed PMID: 17341870.

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