Poikiloderma of Civatte Clinical Presentation

  • Author: Lana H Hawayek, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

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.

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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 (note the image below).

Poikiloderma of Civatte over the neck. Notice sparPoikiloderma of Civatte over the neck. Notice sparing of the area under the chin. Courtesy of Dr. Shukrallah Zaynoun.
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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.[2, 3] 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.[4] The genetically determined predisposition may be expressed as an increased susceptibility of the skin to ultraviolet radiation.

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Contributor Information and Disclosures
Author

Lana H Hawayek, MD  Assistant Professor of Dermatology, Cosmetic Dermatologic Surgery and Laser Specialist, University of Cincinnati, Veterans Affairs Medical Center; Consulting Staff, University Dermatology Consultants

Lana H Hawayek, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nelly Rubeiz, MD  Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon

Nelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Graham R. What is poikiloderma of Civatte?. Practitioner. Sep 22 1989;233(1475):1210. [Medline].

  2. Goldberg LH, Altman A. Benign skin changes associated with chronic sunlight exposure. Cutis. Jul 1984;34(1):33-8, 40. [Medline].

  3. Lautenschlager S, Itin PH. Reticulate, patchy and mottled pigmentation of the neck. Acquired forms. Dermatology. 1998;197(3):291-6. [Medline].

  4. Katoulis AC, Stavrianeas NG, Georgala S, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis?. Clin Exp Dermatol. Sep 1999;24(5):385-7. [Medline].

  5. Zaynoun ST, Aftimos BA, Tenekjian KK, Kurban AK. Berloque dermatitis - a continuing cosmetic problem. Contact Dermatitis. Mar 1981;7(2):111-6. [Medline].

  6. Katoulis AC, Stavrianeas NG, Panayiotides JG, et al. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007;214(2):177-82. [Medline].

  7. Goldman MP, Weiss RA. Treatment of poikiloderma of Civatte on the neck with an intense pulsed light source. Plast Reconstr Surg. May 2001;107(6):1376-81. [Medline].

  8. Raulin C, Greve B, Grema H. IPL technology: a review. Lasers Surg Med. 2003;32(2):78-87. [Medline].

  9. Weiss RA, Goldman MP, Weiss MA. Treatment of poikiloderma of Civatte with an intense pulsed light source. Dermatol Surg. Sep 2000;26(9):823-7; discussion 828. [Medline].

  10. Wheeland RG, Applebaum J. Flashlamp-pumped pulsed dye laser therapy for poikiloderma of Civatte. J Dermatol Surg Oncol. Jan 1990;16(1):12-6. [Medline].

  11. Rusciani A, Motta A, Fino P, Menichini G. Treatment of poikiloderma of Civatte using intense pulsed light source: 7 years of experience. Dermatol Surg. Mar 2008;34(3):314-9; discussion 319. [Medline].

  12. Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Troiano M, Prignano F, et al. Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. Jan 2011;25(1):68-73. [Medline].

  13. Meijs MM, Blok FA, de Rie MA. Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of patients with severe depigmentation. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1248-51. [Medline].

  14. Clark RE, Jimenez-Acosta F. Poikiloderma of Civatte. Resolution after treatment with the pulsed dye laser. N C Med J. Jun 1994;55(6):234-5. [Medline].

  15. Geronemus R. Poikiloderma of civatte. Arch Dermatol. Apr 1990;126(4):547-8. [Medline].

  16. Haywood RM, Monk BE. Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of seven cases. J Cutan Laser Ther. Jan 1999;1(1):45-8. [Medline].

  17. Batta K, Hindson C, Cotterill JA, Foulds IS. Treatment of poikiloderma of Civatte with the potassium titanyl phosphate (KTP) laser. Br J Dermatol. Jun 1999;140(6):1191-2. [Medline].

  18. Ross BS, Levine VJ, Ashinoff R. Laser treatment of acquired vascular lesions. Dermatol Clin. Jul 1997;15(3):385-96. [Medline].

  19. Behroozan DS, Goldberg LH, Glaich AS, Dai T, Friedman PM. Fractional photothermolysis for treatment of poikiloderma of civatte. Dermatol Surg. Feb 2006;32(2):298-301. [Medline].

  20. Tierney EP, Hanke CW. Review of the literature: Treatment of dyspigmentation with fractionated resurfacing. Dermatol Surg. Oct 2010;36(10):1499-508. [Medline].

 
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Poikiloderma of Civatte over the neck. Notice sparing of the area under the chin. Courtesy of Dr. Shukrallah Zaynoun.
 
 
 
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