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What The Heck Is Poikiloderma of Civatte & Who Can Get It?

Image courtesy of regionalderm.com

It sure is a mouthful to say… but besides being a tongue twister, what exactly is poikiloderma of Civatte? Do you need to be cautious of this skin condition? Read on for all the answers!

Okay, start with the basics. What is poikiloderma of Civatte?

To put it super simply, poikiloderma of Civatte, or POC, is a benign skin condition (that means noncancerous!) that’s more commonly referred to as sun aging.. probably because the official name is a bit hard to remember!

This type of dermatitis is somewhat common, and not at all dangerous. That said, it doesn’t look great and it does have the potential to hide truly dangerous skin cancers. But if you’re wondering about what those pinkish-reddish-brownish patches on your face or neck might be, read on and find out what you can do!

Image courtesy of dermquest.com.

What’s with the name poikiloderma of Civatte?

Let’s clear this one up: This condition is named after the French dermatologist who first described it in 1923. It’s also referred to as reticulated pigmented poikiloderma or Berkshire neck, or just plain poikiloderma.

How does POC affect my skin?

Poikiloderma of Civatte shows up as a pigmented area on the skin of your face, any part of your neck, or on the upper chest.

But what’s really going on under the surface?

When you’ve got poikiloderma, your skin thins, shows increased pigmentation, and tends to display dilation — that’s the redness that can result from lots of fine blood vessels making themselves known your skin. Not all of this will happen at once though! POC has a slow, gradual onset that’s usually pretty mild.  

The condition does have other symptoms, which can include flushed skin, superficial atrophy, spider vein-like patterns (telangiectasia), and more prominent hair follicles in the affected area. Some patients may experience mild burning, irritation, and sensitivity, but generally, that’s about it. Most of the time, there are no symptoms other than the actual rash.

Image courtesy of dermquest.com

What causes Poikiloderma of Civatte?

Unlike a lot of skin conditions, dermatologists have confidence in the cause of poikiloderma of Civatte: the sun. Accumulated ultraviolet rays (what you probably know as UV rays) have a direct effect on POC. So, that’s exactly why the condition is located in areas that are most commonly exposed to the sun and isn’t typically found in areas that aren’t exposed to UV rays — like under the chin.

There are some other contributing factors, too. Chemicals in cosmetics and perfumes may exacerbate POC and make the damage worse. There may also be a genetic component, as poikiloderma of Civatte has appeared sporadically in families. Low estrogen levels have also been linked to the onset of poikiloderma.

Image courtesy of doctorv.ca

Who ends up getting POC?

For the most part, poikiloderma of Civatte affects middle-aged women with fair skin who are menopausal.

It looks very similar to hyperpigmentation and melasma — both of which can be caused by UV rays but are also affected by hormone imbalances and fluctuations. That doesn’t mean men don’t get it, though. Teenagers who spent a lot of time soaking up the sun (whether they’re sunbathing or playing sports) may also start showing signs of sun aging.

In fact, the incidence of POC in men (and people in general) is likely underreported. The reality is, most people don’t head to their derm if they have POC, so it’s hard to know how many people it really affects.

If I do go to a doctor, how can they diagnose my POC?

Poikiloderma of Civatte is often diagnosed by doctors by the dominant clinical features of the condition — fancy words for the obvious, presenting symptoms. There are two main types of POC: erythemato-telangiectatic (we know, it’s another mouthful) and pigmented. The former usually means the skin is reddish, flushed, and has some visible blood vessels, while the pigmented type is mostly classified based on the color of the lesion. A mixed type is, you guessed it, a mixture of both flushed skin and pigmented areas.

Image courtesy of doctorv.ca

Okay, I definitely have POC! Now what?!

For starters, don’t freak out. Poikiloderma of Civatte is chronic but rarely leads to anything worse. That said, it isn’t the prettiest, and it’s irreversible, meaning you can’t really fix it. Plus, it will get worse over time. We’d highly suggest you see a doctor in order to rule out the possibility that what you think is POC is actually something more serious: Any skin or connective tissue diseases or skin cancer, such as squamous and basal cell carcinomas, which are at increased risk from chronic sun exposure.

Your doctor will do a differential diagnosis, possibly with a biopsy. That said, POC is typically very distinguishable, so it shouldn’t be mistaken for conditions like eczema or rosacea.

If you have sun aging (or even if you don’t!), it’s super important for you to protect your affected skin from further damage. That means sunscreen, sunscreen, sunscreen.

The best way to do that? Avoid direct sunlight! Of course, that’s not possible all day every day, so you should slather on SPF, wear protective clothing and a hat, and do try to stay indoors or in the shade as much as you can, especially during hours with the strongest sunlight. Did we mention use sunblock, always?! So that you never forget to head out the door without sunscreen on, try adding a moisturizer with SPF to your routine. Avoid documented allergens, and test occasionally for further damage.

How can I get rid of my poikiloderma of Civatte?

Though POC isn’t the prettiest, treatment of this condition is often not necessary, at least not from a medical standpoint. If you hate the way it looks, though, topical remedies can help.

Retinoids, hydroquinone-containing preparations, and exfoliants with alpha hydroxy acids or tretinoin may reduce the look of PC if used long term. Even if you choose not to actively treat your POC, the consistent use of a strong sunscreen can still help — and will certainly prevent further sun damage.

Unfortunately, dermatologists do find getting rid of POC to be challenging. Many of the traditional therapies used for skin issues have proven ineffective, or time-consuming. Or, these solutions may treat one symptom but not others. Even fractional non-ablative laser treatment — which are often the method of choice because they heat our skin and promote collagen production — isn’t consistently effective. Frustrating, we know.

Intense pulse light systems (IPL lasers) and pulsed dye laser treatments do show promise in evenly resurfacing skin that’s affected by poikiloderma of Civatte. We know, lots of confusing words. In a nutshell, these devices release energy onto the surface of your skin to heat and cause damage to pigmented cells. This then encourages those cells to die and reproduce as healthy unpigmented skin.

In short, ask your doctor for recommendations…but don’t expect miracles. Ultimately, poikiloderma of Civatte is a condition where prevention remains key.

Dr. Betty Yan, a dermatology resident at Southern Illinois University School of Medicine (SIU), helped contribute to the accuracy of this story.

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