Practice Essentials
Poikiloderma of Civatte is an acquired poikiloderma of the lateral face and neck first described by the French dermatologist Achille Civatte in 1923.
Pathophysiology
Poikiloderma of Civatte is a commonly acquired chronic and progressive condition affecting mostly older fair-skinned individuals, and, although benign, it may result in significant cosmetic disfigurement. While the exact pathogenesis of this condition is still unknown, several causative factors have been hypothesized, including long-term ultraviolet (UV) exposure, hormonal changes of menopause, genetics, and contact hypersensitivity, most specifically to fragrances and cosmetics. [1]
Prognosis
Poikiloderma of Civatte is a chronic and progressive skin condition and, although benign, may result in cosmetic disfigurement that can be quite concerning to some patients. Patients with the mild form typically do not seek medical advice.
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.
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. [2, 3] In addition, solar elastosis is a frequent histopathologic finding.
Diagnostics
While typically not necessary, antinuclear and anti-Ro (SS-A) antibody levels may be ordered to exclude connective tissue disease if suspected.
Treatment
No specific medical treatment exists for poikiloderma of Civatte, but pulsed light therapies at wavelengths of 515-1200 nm have proved useful. Also, there is a single report of a combination of photodynamic therapy (PDT) and topical aminolevulinic acid producing good clinical results after 2 PDT sessions. [4]
Prevention and patient education
Patients should be instructed to minimize UV exposure and to apply a broadband sunscreen of SPF 30 or more every day to all exposed areas of the face and neck. It is important to also remind patients to reapply their sunscreen every 1.5-2 hours or sooner if after exercise or water exposure.
Patients should also be instructed to avoid the application of fragrances or cosmetics to the affected areas.
Epidemiology
The incidence of poikiloderma of Civatte is unknown; many patients may have a mild form of the disease and may not seek medical attention. Poikiloderma of Civatte occurs most commonly in fair-skinned individuals. Poikiloderma of Civatte occurs more commonly in females than in males. [5] Most commonly, individuals affected are middle-aged or elderly women; however, the disease has been seen in other age groups.
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Poikiloderma of Civatte over the neck. Notice sparing of the area under the chin. Courtesy of Dr. Shukrallah Zaynoun.
