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Poikiloderma of Civatte (PC) is a common, acquired, chronic, benign skin condition that affects the neck and face. It often affects fair-skinned, middle-aged, and elderly people. The condition effects more females than males. Poikiloderma refers to a skin condition consisting of redness (telangiectasia), textural changes to the skin and white and brown patches (hypo- and hyperpigmentation). It usually presents symmetrically involving the sides and V-shaped area of the neck as well as the outer parts of the face whilst sparing the middle of the neck [1].
PC tends to have a gradual onset. People can experience abnormal sensations in the skin of the neck such as itchiness, burning & flushing. Because of the variations in clinical appearance, a consultation with a qualified professional to determine the type is needed to administer the right treatment for the patient. The different types are classified into erythemato-telangiectatic type (predominantly red), pigmented type (predominantly brown) and mixed type [2].
Causes: There are many contributing factors to the cause of PC. These tend to be peri menopausal women, chronic exposure to UV radiation causing sun damage and contact sensitivity to fragrances, metals and commonly used preservatives [1;2].
Hormones: With estrogen depletion in menopause, it affects how the skin looks and feels. The decrease in collagen due to the reduction of estrogen contributes to the skins texture and the ageing seen in poikiloderma [2].
UV radiation: With sun exposure comes cellular damage and as this occurs it affects the way the skin presents as we age. Redness and pigmentation are regularly seen in patients that have been exposed to the sun in their early years without sun protection. The accumulative sun exposure is what contributes to the appearance of PC [2].
Contact sensitivity: Contact sensitivity is one thing I speak to patients about in clinic with PC. Avoiding spraying perfumes on the neck area is discussed due to the sensitising aspects this action can have on the skin of the neck. Contact sensitisation to fragrances, commonly used preservatives and metals from necklaces can cause contact dermatitis. Methylchloroisothiazolinone and methylisothiazolinone, also known as Kathon CG as well documented in research to be the main culprits to the sensitisation that occurs with this condition [2].
Genetic predisposition: Genetic links to this condition have been documented, with some research describing PC as an auto dominant condition.
Treatment: Treatment for this condition involves several modalities depending on its appearance. While the vascular alterations of PC can be effectively treated with lasers such as IPL or Excel V + lasers which target the redness and pigmentation, the textural change of the skin requires another approach like non-ablative fractional laser, skin needling and Laser Genesis to help with the remodelling of the collagen fibers in the skin tissue [3;4].
Brooke Worthy
Dermal Clinician
BHSc (Dermal Sciences)
References:
[1] 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
[2] Khunkhet. S & Wattanakrai. P, 2014. The Possible Role of Contact Sensitization to Fragrances and Preservatives in Poikiloderma of Civatte. Case Rep Dermatol. 6 (3) 258–263. https://doi.org/10.1159/000369489
[3] Bernstein, E. F., Schomacker, K., Paranjape, A., & Jones, C. J. (2019). Treatment of poikiloderma of Civatte using a redesigned pulsed dye laser with a 15 mm diameter treatment spot. Lasers in surgery and medicine, 51(1), 54–58. https://doi.org/10.1002/lsm.23036
[4] Bencini, P. L., Tourlaki, A., Galimberti, M., & Pellacani, G. (2015). Non-ablative fractionated laser skin resurfacing for the treatment of aged neck skin. Journal of Dermatological Treatment, 26(3), 252–256. https://doi.org/10.3109/09546634.2014.933765
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