What is Poikiloderma of Civatte?
On the Rosacea Forum, "Ghost" asked me a question about Poikiloderma of Civatte. Ghost was interested in what causes Poikiloderma of Civatte and what could be done about it. I realized that this is a good Ask Dr. Bailey question and I wanted to share my answer with my readers here. As with so many medical conditions and treatments, this one immortalizes Civatte, a physician who described the condition in the 1920s.
What is Poikiloderma of Civatte?
It's a mottled discoloration on the sides of the neck, typically sparing the area under the chin. There is usually a brawny redness to the skin that looks like a staining, and it sort of is. There are also little telangiectasias ("broken" capillaries that are not really broken just prominent and visible). The discoloration is triggered by chronic sun exposure, which is why it spares skin under the chin. Fair-skinned people are more prone to it, as with most sun damage conditions, although I've seen it on all skin types.
In Poikiloderma of Civatte, the discoloration is due to:
- "Broken" capillaries and the blood in these visible and prominent capillaries
- Brown staining of the skin from iron that comes from red blood cells (hemosiderin)
- Melanin deposited in the skin from sun damage
What is the treatment for Poikiloderma of Civatte?
Treatment needs to target all three of these things, plus sun protection. The brown color is sort of like a tattoo with staining by the melanin and hemosiderin, which is why creams don't work to really get rid of the discoloration. Skin care products are an important part of treatment though.
My skin care regimen to treat Poikiloderma of Civatte includes:
1. Broad spectrum sun protection: I recommend mineral zinc oxide sunscreen every day. I also recommend using clothing, hats, and scarves to protect the skin that is so prone to this stubborn condition. Click here to see the sunscreens that I trust for my patients.
2. Pigment-lightening products, such as prescription tretinoin, glycolic acid, and possibly even prescription hydroquinone: Neck skin is sensitive and can usually only tolerate glycolic acid or tretinoin twice a week, but it still helps. The sides of the neck are more tolerant of these products than the central mid-neck area, which is good since that is where Poikiloderma of Civatte causes the discolored skin. Click here to see the true professional-strength glycolic acid products that I use and trust for my patients.
3. Antioxidant skin care products for all sun damage treatments: These products employ vitamin C (which also can lighten pigment by its own unique mechanism) and/or Replenix CF or Green Tea Antioxidant Skin Therapy Cream. Click here to see these professional strength antioxidant products that I use in my dermatology practice.
A typical daily skin care routine would look like:
PM: Apply Replenix CF followed by Glycolic Acid Anti-Wrinkle Face Cream
My Anti-Aging Antioxidant Kit - Glycolic Acid Anti-Wrinkle Face Cream for Normal Skin includes all of these, plus it adds Replenix Exfoliation Scrub, which helps to brighten the skin so that it looks better, and also allows products to penetrate better, enhancing results.
Procedures that I use to treat Poikiloderma of Civatte in my dermatology office:
Skin care is important for preventing and treating Poikiloderma of Civatte, but to really reverse the color we often have to do laser treatments. The best for this problem is Intense Pulsed Light "laser" treatments (called BBL in my office because I have the Sciton BBL machine) or other types of laser treatments like the V-beam which treats skin capillaries. Click here to see the laser services we offer in my Sonoma County Dermatology Office.
Whenever I see a mottled brawny redness on the sides of the neck, I also look for some of the other conditions that occur there, that can lead to more redness and discoloration, and that I would want to treat too. These conditions include the presence of demodex mites (yes really), pityrosporum folliculitis (a yeasty acne), rosacea (occurs off the face too), and dandruff (yes, really too). That little triangle of the neck under the ear is a busy place! I have information on my blog about these conditions. Use the search bar or Topic Category drop-down function and click "Acne" or "Rosacea" to find most of the information on these topics.
This was a great question Ghost. Poikiloderma of Civatte is such a common skin problem and I wanted to share my answer with all of my readers.
Cynthia Bailey MD, Dermatologist