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Poikiloderma of Civatte - Signs, Symptoms, and Treatment

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Poikiloderma of Civatte is a skin condition caused due to sun exposure and is characterized by net-like reddish or brown spots on the face and neck.

Medically reviewed by

Dr. V. Srikanth Reddy

Published At November 23, 2022
Reviewed AtApril 26, 2023

What Is Poikiloderma of Civatte?

Poikiloderma of Civatte is a chronic, non-cancerous skin condition commonly acquired on the cheeks and neck. It results in hypopigmentation or hyperpigmentation of the affected skin, raising only cosmetic concerns. The condition usually runs a benign course and is asymptomatic.

The term 'poikiloderma' refers to a cutaneous change in the affected skin exhibiting vasodilatation of the capillaries, epidermal atrophy, and reticulated hyperpigmentation or hypopigmentation changes. A French dermatologist named Civatte was the first to describe this benign condition in 1923.

The condition represents net-like mottled reddish-brown patches on the face and neck with telangiectasia. It most commonly occurs in fair-skinned individuals. It most commonly affects the areas of the skin that are exposed to the sun for a longer period.

It is, therefore, not a disease but a classic combination triad of -

  • Cutaneous atrophy (lax, wrinkled, and shiny skin).

  • Telangiectasia (a condition where there is dilatation of the fine blood vessels).

  • Hyperpigmentation or hypopigmentation.

What Are the Types of Poikiloderma of Civatte?

Poikiloderma of Civatte is usually recognized into three clinical subtypes based on its typical clinical manifestations. These three subtypes are -

  1. Erythematotelangiectatic type.

  2. Pigmented type.

  3. Mixed type.

What Are the Causes of Poikiloderma of Civatte?

The exact etiology of the disease is unknown. The disease can be either due to genetic or acquired causes. Some of the causes are as follows:

1. Long and chronic exposure to ultraviolet rays is considered the main causative factor for developing this cutaneous condition.

2. Other predisposing factors include:

  • Individuals who have white or fair skin.

  • Light-sensitive compounds in certain body deodorants, perfumes, toiletries, or make-up products can trigger autoimmune reactions leading to contact hypersensitivity.

  • Hormonal changes that occur during menopause in women may trigger this disorder.

  • If lower, estrogen levels can also trigger this disorder's etiopathogenesis.

What Is the Epidemiology of Poikiloderma of Civatte?

Female predilection is seen as compared to males. The disorder is more frequently present in females who are approaching menopause. The prevalence of this disease is not known. Not more than 100 to 150 individuals have been reported in medical history. Poikiloderma of Civatte occurs more commonly in white-skinned individuals.

What Are the Signs and Symptoms of Poikiloderma of Civatte?

The disease does not usually show any signs or symptoms in mild cases. However, few affected individuals may show stingy, pruritic, and itchy symptoms of the poikiloderma lesions. The main clinical symptoms of the disease include:

1. Mottled alternating spots that are either red or brownish-red in color. The pigmentation is due to the following factors:

  • Hemosiderin pigment released from the disintegrated red blood cells leads to brown staining of the skin lesions.

  • The blood is released from the tiny, broken blood capillaries.

  • Chronic sun exposure can lead to the deposition of melanin in the cutaneous layers.

2. Epidermal atrophy results in thinning of the cutaneous cellular layers making the skin look dry.

3. The characteristic lesions are typically present on the face and neck exposed areas. Usually, the neck area shaded by the chin is spared from developing any cutaneous lesions.

4. The classic lesions develop bilaterally (both sides) on the cheeks and neck and sometimes symmetrically in the upper chest region.

5. The changes are gradually exaggerated on the cutaneous surface with time.

How Is the Diagnosis of Poikiloderma of Civatte Made?

The diagnosis of Poikiloderma of Civatte is usually established based on extensive clinical examination.

  • Physical Examination: The classical triad of symptoms and the occurrence of symmetrical lesions on the cheeks and neck serve as an important diagnostic clinical feature to differentiate the disease from other skin lesions.

  • Other Tests: Clinical history and examination can be followed by blood tests and a lesional skin biopsy to confirm the diagnosis.

What Is the Differential Diagnosis of Poikiloderma Of Civatte?

These include:

  • Acute cutaneous lupus erythematosus (autoimmune inflammatory disease causing widespread organ damage).

  • Bloom’s syndrome (a genetic disorder characterized by retarded growth and a narrow face).

  • Rosacea (blushing on the face due to visible blood vessels).

  • Parapsoriasis (reddish, scaly patches that are treatment-resistant).

  • Pigmented contact dermatitis (allergic skin reaction due to cosmetic ingredients or fragrance).

  • Cutaneous type of T-cell lymphoma (cancer of the T-cells).

  • Eczema (dry, itchy, and rough skin).

What Is the Treatment and Management of Poikiloderma Of Civatte?

The disease cannot be cured, but the symptoms can be minimized by taking preventive measures.

1. Drug Therapy- The first and foremost is avoiding exposure to harmful ultraviolet rays. Preventing sun exposure prevents the appearance of new skin lesions from developing and improves the existing lesions.

  • Use mineral sunscreens with SPF (sun protection factor) 50 to protect the skin from ultraviolet (UV) rays damage.

  • The use of perfumes and cosmetic products that are found to be faulty should be stopped immediately.

  • Retinoids can be used topically at night to improve the effect of laser therapy and mitigate cosmetic disfigurement.

  • Skin-lightening corticosteroid creams can also be recommended to reduce hyperpigmentation. They should be applied twice a day for three to four months.

2. Laser Therapy- It is the mainstay of treatment for managing the patchy lesions of Poikiloderma of Civatte. Laser therapy aims to eliminate the pigmented and vascular areas and stimulate collagen fibers' resynthesis. The commonly used laser techniques include:

  • Pulsed Dye Lasers (PDL) Therapy - These are strong and sturdy lasers that are focused on targeting the underlying blood capillaries beneath the skin without causing any harm to the skin cells. They function at a single wavelength of light only. Therefore, this laser therapy aims to eliminate the erythema of the skin lesions that occur due to broken small blood capillaries underneath the skin. Pulsed dye lasers cause temporary edema, worsening the skin's redness before improving it. The patient requires several visits to treat the condition.
  • Intense Pulsed Light (IPL) Therapy- This treatment therapy operates at multiple different wavelengths. They target the melanin pigment and the blood capillaries simultaneously. They also induce the synthesis of collagen fibers, making the skin look more supple and plump. Intense pulse therapy is not as strong and sturdy as pulsed dye lasers. Hence, multiple patient visits are advised for the sessions to treat the condition significantly. This laser therapy improves the problem of skin discoloration.
  • Fractional Laser Therapy- This therapy targets the epithelium and the connective tissue, stimulating new collagen regrowth and remodeling collagen fibers. The results are achieved gradually. Numerous sessions with the patient are needed. It may take six to seven months to resolve the problem completely.

Conclusion:

Poikiloderma of Civatte is a long-lasting skin condition with no proper cure or treatment. The management of the symptoms mainly comprises eliminating both the hyper-pigmented and vascular components with the help of laser technology. Besides laser therapy, it is very important to prevent from sun exposure by using broad-spectrum sunscreens.

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Dr. V. Srikanth Reddy
Dr. V. Srikanth Reddy

Dermatology

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