Poikiloderma

Poikiloderma causes the following changes to appear in a reticular, or net-like, pattern on your skin:

• reddish-brown discoloration
• telangiectasia, which are obvious small, visible blood vessels that look like they are broken
• thinning of your skin known as atrophy

You can identify poikiloderma of Civatte by its characteristic features. In this condition, skin changes occur on your neck, chest, and cheeks. Additionally, these changes:

• are symmetrical, appearing equally on both sides of your face and neck
• occur on the sides of your cheeks and neck and in the V of your chest formed by the sides of your neck and the bottom of your breastbone
• almost never affect the area on your neck that is shaded from the sun by your chin

You may feel minor burning and itching in the affected areas, but most people with poikiloderma don’t have these symptoms. Your skin changes will gradually increase over time.

Because it’s a combination of symptoms rather than a disease, poikiloderma can be caused by or associated with many diseases and conditions, such as:

• inherited diseases
• infections like Lyme disease
• connective tissue diseases like lupus and dermatomyositis
• metabolic diseases like amyloidosis
• immunologic diseases such as when the body rejects a bone marrow transplant
• medications like steroids or radiation treatment for cancer
• some uncommon cancers
• environmental exposures like ultraviolet light from the sun

The cause of poikiloderma of Civatte is unknown, but sun exposure is almost certainly a major contributor. Other possible factors include:

• genetics
• changes in your hormones, especially among women who have lower estrogen due to menopause or ovary removal surgery
• a reaction to contact with chemicals like those in perfume or makeup

Doctors think long-term exposure to ultraviolet light from the sun is a major cause of poikiloderma of Civatte because the sun is known to damage your skin, and the damage is cumulative. The more time your skin is exposed to the sun, the more damaged it becomes. Indications that the sun is a major cause of poikiloderma of Civatte are:

• You’re more likely to get it if you have fair skin.
• Skin that tends to be shaded from the sun, such as your neck under your chin, is not affected when the sun-exposed skin around it is.
• Protecting affected skin from the sun will slow the progression of your skin changes and may even improve it.

You’re are more likely to get poikiloderma if it runs in your family or if you get one of the acquired diseases that are associated with it.

You’re more likely to develop poikiloderma of Civatte if you’re:

• middle-aged
• a woman, especially if you’re in menopause or had your ovaries removed
• fair-skinned
• living where there’s a lot of sunshine
• a person who has or has had a lot of sun exposure
• from a family with a history of the condition
• a person whose skin is sensitive to chemicals, especially those in perfumes and makeup

Make an appointment with your doctor when you notice any concerning skin changes. Your doctor can examine your skin and rule out any serious conditions.

If you have poikiloderma of Civatte, your doctor can usually diagnose it just by asking you questions and examining you. If your poikiloderma is due to another inherited or acquired condition, your doctor will probably order blood tests, X-rays, or other tests based on your other symptoms.

Poikiloderma can’t be completely cured, but your skin changes may improve and the progression of your condition may slow down with treatment.

Treating the underlying cause of poikiloderma is important and should be done first. Then your skin can be treated to try to improve the discoloration and make it less noticeable.

Pulse dye lasers and intense pulse light therapy are expensive, but they’re the main treatments currently used to improve the telangiectasia and discoloration of your skin. However, the discoloration can’t be completely fixed, and the treatments make your skin look worse before it looks better.

According to the Australasian College of Dermatologists, medications that skin doctors use to bleach or lighten skin can improve the brown discoloration of your skin. After that treatment, lasers can improve the redness. Light therapy can improve both brown and red discoloration.

Because options for improving your skin are limited, preventing further damage by protecting your skin from the sun is the most important part of treating poikiloderma of Civatte. This includes:

• applying sunscreen with an SPF of 30 or more (some doctors recommend 50 or more) that covers both UVA and UAB light frequently whenever you are exposed to the sun in the summer and winter
• staying out of the sun during the hottest time of the day, usually two hours before and two hours after noon
• wearing clothing that blocks the sun from reaching your skin
• wearing wide-brimmed hats that shade your face, neck, and chest
• wearing scarves or high-neck shirts

While it can be irritating or bothersome, poikiloderma isn’t dangerous or life-threatening. It isn’t curable, but you can minimize your skin discoloration with treatment and prevent further damage by protecting your skin from the sun.