Poikiloderma of Civatte Treatment & Management

Updated: Mar 16, 2022
  • Author: Jeannette Rachel Jakus, MD, MBA; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

No specific medical treatment exists for poikiloderma of Civatte. Educating the patient about avoiding sun exposure and the proper use of sunscreens is most important. Exposure to fragrances and cosmetics should also be avoided.


Surgical Care

Intense pulsed light systems have been used and found to be effective in the treatment of poikiloderma of Civatte. [10, 11, 12, 13, 14, 15] Intense pulsed light induced a more-homogeneous distribution of melanin and increased nonfragmented elastic fibers, collagen density, and intensity, but no significant changes in vessel numbers or diameters. [16] These are high-intensity light sources that emit polychromatic, noncoherent light and, thus, are different from lasers. They have a wavelength spectrum of 515-1200 nm. Several treatments may be required for complete clearing. [17] Intense pulsed light should only be used by those experienced in the modality because persistent pigment abnormalities have been reported. [18]

The erythema and telangiectasias in persons with poikiloderma of Civatte respond well to the flashlamp-pumped pulsed-dye laser (585 nm and 595 nm) [19, 20, 21] and to the potassium-titanyl-phosphate laser. [22, 23] Caution must be exercised because of the higher incidence of adverse effects, such as hypopigmentation and scarring, especially when treating the neck and chest. Persistent depigmentation as a late adverse event has been reported in a series of patients with poikiloderma of Civatte after treatment with pulsed-dye laser. [18] Patients must be informed about the possibility of temporary purpura after treatment. Several treatment sessions may be required.

Bernstein et al trialed a prototype pulsed-dye laser with an increased treatment beam size of 15 mm in 17 patients with poikiloderma of Civatte. The patients showed approximately 50% improvement in symptoms 8 weeks post-treatment. [24]

Use of fractional photothermolysis (laser technology that creates microthermal injury zones in skin) to treat poikiloderma of Civatte has also been described to improve both dyschromia and wrinkles but has not been shown to be effective in improving skin laxity of the neck. Several treatment sessions may be required. [25, 26, 27]

Attempts to correct the disorder using electrosurgery, cryotherapy, and argon laser have been unsuccessful.