John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Poikiloderma of Civatte (P.C.)

Patient Information Sheet

Poikiloderma of Civatte is a peculiar mottled looking pattern of dilated red blood vessels on the sides of the neck. There may be areas of darkening and areas of lighter color. There is a large dense, reticulated network of small blood vessels giving an overall red color with mottled brown pigment. In my experience, it is this vascular network that is the hallmark of P.C. A reticulated vascular network means that the distribution is like a lace doily pattern. These interlacing red blood vessels are interspersed by uniformly distributed tiny white dots of hair follicles.

Oddly, the area on the midline of the neck under the chin and around the Adam's apple is spared. This has caused speculation that P.C. is due to sun exposure. For years, P.C. has been thought of as an adverse interaction of estrogen and sunlight. That is, the estrogen sensitizes the skin to sunlight to produce P.C.

Katoulis et al did biopsies of P.C. in 50 patients. The common feature was sun damage to the upper dermis (skin). Blood vessels were dilated in 96% of biopsies, and many of these had lymphocytic inflammation around those blood vessels.

Poikiloderma of Civatte or P.C.

Poikiloderma of Civatte - Photo from DermNet NZ

Treatment Options

I did thorough computerized literature searches in 2012 and 2018. There are no clearly superior treatments of P.C. The literature is skimpy, probably because P.C. is not a sign of anything bad.

  1. Sunscreen
    Katoulis's biopsies, hyperpigmentation in sun exposed areas of the neck, and sparing of the shaded area under chin suggest that protection from ultraviolet light could be helpful. I recommend using a non-irritating sunscreen such as Neutrogena Dry Touch UltraSheer SPF 100+.
  2. Mild Topical Cortisone Cream
    The lymphocytic infiltrate around the dilated small blood vessels might respond to a mild topical cortisone cream such as hydrocortisone valerate. I have used this approach for many years with mostly good results (Tkach, JR. Finding and inventing alternative therapies, Dermatology Clinics 1989 Jan.; 7(1): 1-18). It takes 2-4 months of applications twice a day to see an improvement. In my opinion, this is a good starting point for treatment of P.C.
  3. Hydroquinone (4%)
    This is a bleaching cream that takes about 4 months to work. It is helpful for the brown discoloration. Some authors suggest a combined mixture of Retin A, a cortisone cream, and hydroquinone.
  4. Retin A Micro:
    Sun damage to the collagen of the upper dermis suggests to me that the simple cream Retin A could be beneficial if used for about a year. Retin A might also smooth out the irregular pigment. I have had some success with Retin A Micro 0.4%. It takes 2-4 months to see an improvement.
  5. Intense Pulsed Light (IPL)
    This is the currently favored treatment. It uses an intense light that is wavelength controlled by means of special filters. There is one model manufactured in Bozeman. A topical anesthetic is applied for 20 minutes to reduce pain. A gel matching the index of refraction allows conduction of the light source to the skin. The hand held light source is rubbed over the area to be treated. IPL seems to work by coagulating the unwanted dilated vessels. Treatments occur monthly for five months at a total cost of about $1,500.
  6. Laser Treatments
    Laser requires fewer treatments and is a stronger form of treatment. The red color of hemoglobin in blood allows absorption of monochromatic laser light generated by a variety of laser types. This coagulates the blood vessels treated and destroys them. The risk of laser treatment is scarring.

Limitations of Treatments of P.C.

The cause of P.C. remains unknown. These treatments act on the results of the disease process and not the cause. The underling pathophysiologic process is still going on, so eventually there is a risk of the condition recurring in 2-3 years.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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