Clinical Challenge: A Growing Rash on a Man With a History of Sun Exposure - MPR

Clinical Challenge: A Growing Rash on a Man With a History of Sun Exposure

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A 48-year-old man presents with a rash involving his neck and upper chest. He states that the condition was first noted approximately 18 months earlier, and the rash has been spreading gradually. The man is fair-skinned and relates a history of ample sun exposure. The condition is asymptomatic and has not responded to topical steroid therapy. Examination of the affected area reveals dilated blood vessels, brownish hyperpigmentation, and thinning of the epidermis.

Poikiloderma of Civatte is a benign condition that occurs predominantly in fair-skinned individuals and represents a cutaneous reaction to chronic sun exposure. The disorder was first described by the French dermatologist Achille Civatte in 1923.1Classic involvement is of the lateral...

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Poikiloderma of Civatte is a benign condition that occurs predominantly in fair-skinned individuals and represents a cutaneous reaction to chronic sun exposure. The disorder was first described by the French dermatologist Achille Civatte in 1923.1

Classic involvement is of the lateral neck and upper chest, with sparing of the submental area. The disorder is characterized by reticulated hyperpigmentation, telangiectasias, and atrophy, and use of items such as cosmetics and colognes that contain photosensitizers may contribute to pathogenesis or worsening of the disorder.2 An autosomal-dominant transmission pattern with variable penetrance has been reported.3

The condition is asymptomatic, and therefore, the concern is primarily cosmetic in nature. Medical treatments to date have been ineffectual, and the condition worsens gradually over time.4 Limitation of sun exposure and use of a broad-spectrum sunscreen is recommended. Therapy with pulsed-dye laser, intense pulsed light, or ablative fractional thermolysis may improve the appearance.5,6

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania. 

References:

1. Civatte A. Poïkilodermie réticulée pigmentaire du visage et du cou. Ann Dermatol Syphilior. 1923;6:605-620.

2. Khunkhet S, Wattanakrai P. The possible role of contact sensitization to fragrances and preservatives in poikiloderma of Civatte. Case Rep Dermatol. 2014;6:258-263.

3. Katoulis AC, Stavrianeas NG, Georgala S, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol. 1999;24:385-387.

4. Nofal A, Salah E. Acquired poikiloderma: proposed classification and diagnostic approach. J Am Acad Dermatol. 2013;69:e129-e140.

5. Tierney EP, Hanke CW. Treatment of poikiloderma of Civatte with ablative fractional laser resurfacing: prospective study and review of the literature. J Drugs Dermatol. 2009;8:527-534.

6. Meijs MM, Blok FA, de Rie MA. Treatment of poikiloderma of Civatte with pulsed dye laser: a series of patients with severe depigmentation. J Eur Acad Dermatol Venereol. 2006;20:1248-1251.