Poikiloderma of Civatte is a chronic skin condition characterized by erythema associated with atrophy and pigmentation changes usually seen on sun exposed areas like cheeks and sides of the neck. It occurs most commonly in fair skinned females. Usually middle aged or old women are affected, but can also be seen on other age groups.
It is a non cancerous skin condition which is usually due to reaction pattern of skin caused by sun exposure or aging and not due to any disease. Common skin changes are skin atrophy (thinning), pigmentary changes ( either hyperpigmentation or hypopigmentation ) and telangiectasia ( dilation of fine blood vessels).
The lesion are usually asymptomatic, some patients may have mild burning, itching and increase sensitivity to the affected area. You may notice reddish-brown discoloration patches often in symmetrical pattern more commonly on lateral cheeks and and sides of neck, less commonly on center chest.
The exact cause of Poikiloderma of Civatte is unknown, some contributing factors that have been identified are:
- Chronic sun exposure to ultravoilet lights is thought to be main contributing factor as it most commonly occurs on sun exposed areas.
- Photosensitizing agents in perfumes and cosmetics.
- Hormonal changes associated with low estrogen level or menopause have been suspected as it usually occurs in mid-age or old age groups women.
- Some research have also suggested genetic inheritance .
Although your physician will diagnose based on clinical findings but Antinuclear and anti-Ro antibody test may be carried out to exclude other connective tissue disease. Sometime for rare confusing cases, biopsy of the lesion might be done to exclude other pathological disease.
Poikiloderma of Civatte Treatment
There are no specific treatment with 100% results and results may be disappointing. The first and most important steps in the management of Poikiloderma is to avoid sun exposure. You may apply broad spectrum sunscreen with SPF atleast 30+ . Beside that avoid all other cosmetics and perfumes on affected areas. Long term use of exfoliants including alfa hydroxy acids and topical retinoids may help.
Recently, Pulsed Dye Lasers and Intense Pulse Light therapy have been used widely with successive results. Several treatment sessions may be required for complete clearing of lesion. Some study have also described fractional photothermosis as a good options with some promising results, but again repeated session may be required for desired results. Even cryotherapy, electrosurgery and other few have been tried without successful results.