Poikiloderma of Civatte (POC) is a condition that is attributable to chronic sun exposure of the neck and the chest. The severity of findings is dependent on the duration and intensity of sun exposure, constitutive skin color (Fitzpatrick skin type), and the capacity to tan.
Age: most frequently observed in persons older than 40 years
Sex: slight female predominance
Race: most common in fair-skinned individuals (skin phototypes I and II); rarely seen in darker-skinned individuals (skin phototypes IV–VI)
Precipitating factors: chronic sun exposure including intentional sun exposure since youth and occupational exposure; trauma; chronological aging
Ultraviolet B (UVB) is the most damaging UV radiation, with high dose ultraviolet A (UVA) contributing to the noted changes. In addition, visible and infrared radiations have been shown to augment the action of UVB.
Telangiectases, mild atrophy, reticulated hyperpigmentation, and hypopigmentation affecting the lateral and posterior aspect of the neck, anterior chest, and jawline. Submental neck is spared. Perifollicular sparing noted (Figs. 12.1 and 12.2).
Poikiloderma of Civatte. Reticulated pigmentation, erythema, and atrophy can be seen with characteristic sparing of the submental area. The erythematous component is more prominent in this patient. (Courtesy of Richard A. Johnson, MD.)
Poikiloderma of Civatte—the pigmented component is more prominent in this patient.
Epidermal acanthosis with flattening of the dermal–epidermal junction. Focal increase in epidermal basal cell melanocytes; irregular basal cell hyperpigmentation. Dermal collagen breakdown with formation of amorphous masses and increase in glycosaminoglycans. Telangiectasia noted.
Rothmund–Thomson syndrome; radiation dermatitis; Kindler syndrome; Bloom’s syndrome; Ataxiatelangiectasia.
Chronic progressive course with continued sun exposure.
KEY CONSULTATIVE QUESTIONS
Past and current sun exposure history
Underlying medical conditions
H/o radiation therapy
Past treatments and response
Prevention: strict sun avoidance.
Topical therapy: daily sunscreen application with UVB/UVA coverage.
Laser therapy: great caution must be followed with any laser treatment administered to minimize the risk of scar formation, dyspigmentation, “finger-printing” or treatment skip areas, and textural changes. The neck is particularly prone to scarring given fewer pilosebaceous units. A test site is recommended. Multiple sessions are generally required.
Laser fluences should be lowered by approximately 25% to 30% of facial parameters to avoid adverse effects.