eMedicine Specialties > Dermatology > Photo-Related Diseases

Poikiloderma of Civatte

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
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
Contributor Information and Disclosures

Updated: May 15, 2009

Introduction

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 (Rothmund-Thomson syndrome, Bloom syndrome, dyskeratosis congenita), in connective-tissue diseases (dermatomyositis, lupus erythematosus), 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.1

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.
Poikiloderma of Civatte over the neck. Notice spa...

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

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Poikiloderma of Civatte over the neck. Notice spa...

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


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.

More on Poikiloderma of Civatte

Overview: Poikiloderma of Civatte
Differential Diagnoses & Workup: Poikiloderma of Civatte
Treatment & Medication: Poikiloderma of Civatte
Follow-up: Poikiloderma of Civatte
Multimedia: Poikiloderma of Civatte
References
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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. 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].

  13. 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].

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

  15. 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].

  16. 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].

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

  18. 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].

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Further Reading

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Keywords

poikiloderma of Civatte, Berkshire neck, mottled pigmentation on the neck, poikilodermatous lesions

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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.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
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; Merck Consulting fee Independent contractor; Tronox Consulting fee Independent contractor; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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