What is Poikiloderma of Civatte

Poikiloderma of Civatte is a common, chronic benign (non-cancerous) skin condition in fair-skinned adults that mainly affects the skin on the sides of the neck, which is probably caused by long-term sun exposure. The term “poikiloderma” refers to a change in the skin where there is thinning, increased pigmentation and dilation of the fine blood vessels (telangiectasia). Poikiloderma of Civatte mainly affects women. Poikiloderma of Civatte shows a specific pattern of color change in the skin due to sun damage to the neck and sometimes the center of the chest. Poikiloderma of Civatte characteristically spares the shaded area under the chin. The skin in the affected skin is red-brown with prominent hair follicles. Poikiloderma of Civatte occurs more commonly in females than in males ¹.

Civatte was a French dermatologist who first described a common weathering change that affects the skin of the sides and front of the neck.

Poikiloderma of Civatte is a commonly acquired chronic and progressive condition affecting mostly middle-aged or elderly women fair-skinned individuals, however, poikiloderma of civatte has been seen in other age groups. Although oikiloderma of Civatte is benign, it may result in significant cosmetic disfigurement ². While the exact pathogenesis of this condition is still unknown, several causative factors have been hypothesized, including long-term ultraviolet (UV) exposure, hormonal changes of menopause, genetics, and contact hypersensitivity, most specifically to fragrances and cosmetics ³.

Poikiloderma of Civatte is primarily a cosmetic condition that does not require treatment, but see your doctor if you become concerned about its appearance.

Use sunscreens, wear sun-protective clothing, and avoid peak sun hours (between 10 AM and 3 PM) to help prevent poikiloderma of Civatte from occurring or worsening.

There are no oral or topical medications that can improve poikiloderma of Civatte, but your doctor will encourage you to use sun-protective measures as noted above to prevent it from getting worse.

Some types of laser therapy may improve the appearance of poikiloderma of Civatte.

Poikiloderma of Civatte causes

The exact cause of poikiloderma of civatte is unknown. Contributing factors are:

• Fair skin
• Accumulated sun exposure
• Photosensitizing components of cosmetics and toiletries, especially perfumes
• Hormonal factors

Long-term exposure to UV light appears to be a primary etiologic factor, which is supported by the finding that lesions occur on sun-exposed areas ⁴. 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, including fragrances used in aroma therapy ³. A 2014 article cited hypersensitivity to methylchloroisothiazolinione and methylisothiazolinone (MCI/MI) as a possible contributing etiology ³.

As poikiloderma of Civatte is seen most commonly in middle-aged and elderly women, hormonal changes related to menopause or low estrogen levels have been implicated.

Genetic predisposition may also 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 ⁵. The genetically determined predisposition may be expressed as an increased susceptibility of the skin to UV radiation.

A classification system has been suggested to help with the diagnosis and treatment of specific causes of poikiloderma ⁶.

Poikiloderma of Civatte symptoms

Poikiloderma of Civatte usually affects the front and sides of the neck. The center of the chest is also sometimes affected. You will notice darkened skin color (hyperpigmentation) and lightened skin color (hypopigmentation) as well as redness (erythema). Fine blood vessels (telangiectasia) in the skin are often seen 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 is classically spared.

Patients usually report a chronic reddish-brown discoloration on the lateral cheeks and neck. Lesions usually are asymptomatic, but occasionally, patients may report mild burning, itching, and/or hyperesthesia.

Poikiloderma of Civatte diagnosis

Poikiloderma of Civatte is diagnosed clinically. While typically not necessary, antinuclear and anti-Ro (SS-A) antibody levels may be ordered to exclude connective-tissue disease if suspected.

Katoulis et al ⁷ report that poikiloderma of Civatte has distinct histological and ultrastructural features, stating these features are characteristic but not pathognomonic and that poikiloderma of Civatte should be considered a separate entity.

The epidermis shows moderate thinning of the stratum malpighii, hydropic degeneration of the basal cells, and effacement of the rete ridges. In the upper dermis, a bandlike inflammatory infiltrate primarily is composed of lymphocytes with few histiocytes, in addition to pigment incontinence. In late stages, a thin flattened epidermis, edema in the upper dermis, and dilated blood vessels are demonstrated.

Poikiloderma of Civatte treatment

There is no specific medical treatment for poikiloderma of Civatte. Patient should be educated about avoiding sun exposure and the correct use of sunscreens. The results of treatment may be disappointing in many cases.

• Sun protection including daily broad spectrum SPF 50+ sunscreen
• Avoid all perfumes on or near the affected area, including those in soap
• Hydroquinone-containing preparations may help fade the pigmentation
• Exfoliants including long term use of alpha hydroxy-acids and/or tretinoin
• Pulsed dye laser (PDL) and intense pulsed light (IPL) treatments seem the best way to reduce the telangiectasia and pigmentation.

Poikiloderma of civatte prognosis

Poikiloderma of Civatte is a chronic and progressive skin condition and, although benign, may result in cosmetic disfigurement that can be quite concerning to some patients. Patients with the mild form typically do not seek medical advice.

References

1. Graham R. What is poikiloderma of Civatte?. Practitioner. 1989 Sep 22. 233(1475):1210.
2. Poikiloderma of Civatte.  https://emedicine.medscape.com/article/1120079-overview
3. Khunkhet S, Wattanakrai P. The possible role of contact sensitization to fragrances and preservatives in poikiloderma of civatte. Case Rep Dermatol. 2014 Sep. 6 (3):258-63.
4. Lautenschlager S, Itin PH. Reticulate, patchy and mottled pigmentation of the neck. Acquired forms. Dermatology. 1998. 197(3):291-6.
5. Katoulis AC, Stavrianeas NG, Georgala S, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis?. Clin Exp Dermatol. 1999 Sep. 24(5):385-7.
6. Nofal A, Salah E. Acquired poikiloderma: proposed classification and diagnostic approach. J Am Acad Dermatol. 2013 Sep. 69(3):e129-40.
7. Katoulis AC, Stavrianeas NG, Panayiotides JG, et al. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007. 214(2):177-82.