Background

Poikiloderma of Civatte refers to erythema associated with a mottled pigmentation seen on the sides of the neck, more commonly in women. Civatte first described the condition in 1923.

Pathophysiology

Poikiloderma of Civatte is a rather common, benign condition affecting the skin. Many consider it to be a reaction pattern of the skin and not a disease. The term poikiloderma refers to the combination of atrophy, telangiectasia, and pigmentary changes (both hypopigmentation and hyperpigmentation). Poikilodermatous lesions may be seen in certain genodermatoses, in connective-tissue diseases, in parapsoriasis/mycosis fungoides, and in radiodermatitis.

Frequency

International

The incidence of poikiloderma of Civatte is unknown; many patients may have a mild form of the disease and may not seek medical attention.

Mortality/Morbidity

In most patients, the condition is of purely cosmetic concern. Patients with the mild form do not seek medical advice.

Race

Poikiloderma of Civatte occurs most commonly in fair-skinned individuals.

Sex

Poikiloderma of Civatte occurs more commonly in females than in males.

Age

Most commonly, individuals affected are middle-aged or elderly women; however, the disease has been seen in other age groups.

Clinical

History

• Patients usually complain of chronic reddish-brown discoloration on the lateral cheeks and neck.
• Lesions usually are asymptomatic, but occasionally, patients report mild burning, itching, and hyperesthesia.

Physical

Reddish-brown, reticulate pigmentation with atrophy and telangiectasia is usually present in symmetric patches on the lateral cheeks and sides of the neck.

• Lesions appear to run in line with the normal skin creases of the neck.
• The submental area shaded by the chin usually is spared. oikiloderma of Civatte over the neck. Notice sparing of the area under the chin.

Causes

• Chronic exposure to ultraviolet light appears to be a primary etiologic factor, which is supported by the finding that lesions occur on sun-exposed areas. In addition, solar elastosis is a frequent histopathologic finding.
• Photosensitizing chemicals in perfumes or cosmetics have been implicated in the pathogenesis of poikiloderma of Civatte.
• Possibly, hormonal changes related to menopause or low estrogen levels may be a factor. Most patients are middle-aged or elderly women.
• Genetic predisposition may exist. This is supported by the presence of the condition in successive generations, and in individuals of both sexes, consistent with an autosomal dominant inheritance with variable penetrance. The genetically determined predisposition may be expressed as an increased susceptibility of the skin to ultraviolet radiation.

Recommended Treatments:

Radio Frequency

Laser Genesis

Skin Peels

Limelight