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PhotoagingCommonICD-10 L57.3

Poikiloderma of Civatte

Civatte's poikiloderma · sun-damage neck poikiloderma

Poikiloderma of Civatte is a very common cosmetic and clinical photoaging change of the lateral neck and upper chest, sparing the shaded submental skin. It comprises three histological components — atrophy, mottled hyperpigmentation and telangiectasia — clinically producing reticulate reddish-brown discolouration. UV is the principal aetiology, with photo-contact reactions (perfumes, cosmetics) sometimes contributory (Berloque dermatitis component). Its skin-oncology relevance is twofold: (1) marker of substantial cumulative UV exposure / field cancerisation risk; (2) cosmetic differential for early stage IA/IB melanoma, lupus or cutaneous T-cell lymphoma erythematous patch.

CurrentLast reviewed 16 May 2026
Clinical image of Poikiloderma of Civatte
Poikiloderma of Civatte. Image sourced from DermNet New Zealand. Used under CC BY-NC-ND 4.0. No endorsement implied.

Pathogenesis

  • Chronic actinic damage to lateral neck, upper chest and flexor / extensor forearms.
  • Cumulative UV-A / UV-B → epidermal atrophy, basal cell pigment dropout, dermal solar elastosis, ectatic capillaries.
  • Co-factors:
    • Phototoxic / photoallergic reactions from perfumes (bergapten), cosmetics, photoactive drugs.
    • Hormonal influence (postmenopausal predominance suggests oestrogen role).
    • Fair skin (Fitzpatrick I-II), genetic predisposition.

Clinical features

  • Symmetric reticulate reddish-brown discolouration with mottled pigment, fine telangiectasia, and slight atrophy.
  • Sites: lateral neck and upper anterior chest, with characteristic sparing of submental skin (shaded from UV by the chin).
  • Slow, progressive course; symmetric, asymptomatic.
  • Patients describe long-standing "sun damage" appearance, often distressing for cosmetic reasons.

Differential diagnosis

  • Lupus erythematosus (subacute) — annular / psoriasiform photodistribution; ANA / Ro.
  • Photo-distributed CTCL / poikilodermatous mycosis fungoides — biopsy if atypical.
  • Erythema ab igne — heat exposure history; reticulate vascular pattern.
  • Dyschromatosis (rare).
  • Drug-induced hyperpigmentation, melasma, post-inflammatory hyperpigmentation.
  • Granuloma faciale, cutaneous lupus, polymorphous light eruption.

Management

  • Photoprotection: daily SPF 50 broad-spectrum sunscreen; high-SPF clothing collar; avoid peak UV.
  • Switch perfumes / cosmetics with photosensitisers to bland alternatives.
  • Topical: retinoids (tretinoin, adapalene) for texture; azelaic acid for pigmentation; vitamin C; tranexamic acid (oral / topical) for pigment.
  • Procedures:
    • Intense pulsed light (IPL) — first-line for telangiectasia and pigment; 3-6 sessions.
    • Pulsed dye laser (PDL) for telangiectasia.
    • Q-switched / picosecond laser for stubborn pigment.
    • Fractional non-ablative / ablative laser for textural component.
    • Chemical peels (TCA 15-25%) — caution for hyperpigmentation in Fitzpatrick III-IV.
  • Counsel about field cancerisation — examine for actinic keratoses, Bowen disease, lentigo maligna; mole-mapping if dysplastic naevi or family history.

References

  1. Katoulis AC et al. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007;214:177-182.
  2. Goldman MP, Weiss RA. Treatment of poikiloderma of Civatte on the neck with an intense pulsed light source. Plast Reconstr Surg. 2001;107:1376-1381.
  3. Rusciani A et al. Treatment of poikiloderma of Civatte using intense pulsed light source: 7 years of experience. Dermatol Surg. 2008;34:314-319.
  4. British Association of Dermatologists. Poikiloderma of Civatte — patient information leaflet. London: BAD; 2023.

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