Poikiloderma of civatte - Mottled pigment and redness on the neck and chest.

Poikiloderma of Civatte (PC) is a common, benign condition that is seen on the neck and decolletage typically in a ‘v shape’. Pigmented lesions and redness are the dominating abnormalities in this condition. PC is chronic, progressive and a cosmetic concern for many women. A common treatment option for PC is with the use of light based therapies. Light based therapies use the theory of selective photothermolysis to target and destroy chromphores in the skin by heating them to a point of coagulation. In the case of PC both hemoglobin (blood) and melanin (pigment) need to be targeted. In this article we will discuss Intense Pulsed Light, also referred to as IPL. A description of the device and treatment for PC will be briefly explored, including risks and complications. Moreover, as IPL induces significant tissue trauma, there is the potential for risks and complications.

  Mottled pigment and redness on the neck and chest.

Mottled pigment and redness on the neck and chest.

Poikiloderma of Civatte presents with areas of linear telangiectasia (red vessels), hypopigmentation (loss of pigment), hyperpigmentation (darkened pigment). The area looks mottled brown and varying degrees of red. Diagnosis is higher in females, particularly those that are peri-menopausal, however it also occurs in males.
Most literature is in agreement that the cause of PC is due to chronic UV sun exposure and in some occurrences a photosensitising substance such as perfume has contributed.
As well as varying degrees of cosmetic disfigurement some individuals report symptoms of itchiness and burning.

In the case of PC, pigment may be located superficially or deep in the skin so multiple settings and treatments may be required. Immediately after the treatment the pigmented areas may appear darker or grey with redness around the pigment.
The vessels in the area will appear blanched (white/grey) which indicate vasoconstriction and collapsion of the vessel. Erythema (redness) may be an immediate or a delayed response.

Treatment protocols for PC vary between different devices and parameters also need to be altered to suit the individuals Fitzpatrick type (skin colour). After a thorough consultation and patch test, the skin is prepped by a clinical cleanse. Following on, a transparent gel is applied to the treatment area, this ensures cooling to the skin.

Clearance of PC is determined by the individuals healing mechanisms, level of disfigurement, compliance of home care and the selection of appropriate parameters. After treatment pain and erythema are expected responses that will last between 24 to 72 hours. Post treatment care can minimise discomfort associated with the pain after IPL and includes the use of cool packs.

Treatment of PC with IPL causes a superficial injury that triggers a sequence of events which is typical of the bodies natural wound healing responses.

The wound healing responses following treatment clear pigmented lesions and vessels by one of two conglomerated mechanisms; phagocytosis (pigmented being encapsulated by immune cells like a pac man) or desquamation (where cells move upwards and exfoliate off). Pigment that is still visable once theses processes are complete may require further treatments with IPL.

The risk of adverse effects following the treatment of PC with IPL align with the competency of the technician and the compliance of pre and post care by the patient. Risk factors with any light based treatment include transient and permanent effects. This includes: post inflammatory hyperpigmentation (darkening pigment), hypopigmentation (loss of pigment), purpura (bruising), blistering, infection and scarring. Persistent pain or erythema may indicate an infection to the treatment site.

Mild brusing is reported following IPL, resolution usually occurs between 3 to 5 days.

Blistering may occur due to over treating the area caused by excessive energy or by overlapping the IPL head on the skin. Blistering is typically reported in darker skin types. The risk of blistering can be minimised by ensuring precise placement of the treatment head and using a smaller filter head on difficult areas such as the clavicle bone and the curve of the sternocleidomastoid. It should also be noted that lowering the fluence whilst maintaining the safest parameters for the individual will minimise the risk of blistering. Antibiotic ointments should be applied in the occurrence of blistering. Transient hyperpigmentation after blistering may persist for months to years, in some cases hyper and hypo-pigmentary changes will be permanent. Avoidance of sun exposure will minimise the risk of post treatment hypopigmentation.

In conclusion PC is a benign, common dermatoses, affecting the neck and décolletage with varying degrees of vascular and pigmentary changes. Depending on the individuals disfigurement patients may seek treatment for aesthetic purposes. IPL has demonstrated to be a suitable option for the treatment of PC. Clinical practice report that the clearance rates mark a significant improvement within 3 treatments of IPL. Following treatment the events of wound repair are induced and remove treated chromophores by phagocytosis and desquamation. Patient compliance plays an equally important role in minimising transient and long term pigmentary changes.

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To find out more about the conditions that can be treated by an experienced Dermal Clinician Click Here for a link to the Australian Society of Dermal Clinicians.

Marnina Diprose holds a Bachelor Health Science in Dermal Therapies, and a Vocational Certificate of Laser and Light. Marnina has a strong passion in scar revision and holistic approaches to patient care. For media inquiries or if you have an interest in blog contribution please email info@arozedermaltherapies.com.au


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