Poikiloderma of Civatte Clinical Presentation

Updated: Apr 28, 2017
  • Author: Jeannette Rachel Jakus, MD, MBA; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

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.

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Physical Examination

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 is classically spared (note the image below).

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

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. [3, 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. [1, 5] A 2014 article cited hypersensitivity to methylchloroisothiazolinione and methylisothiazolinone (MCI/MI) as a possible contributing etiology. [1]

As this condition 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. [6] 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. [7]

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