Clinical Challenge: Hypopigmented Rash on Neck

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A 45-year-old man is referred for evaluation of a neck rash. He first noted the condition approximately 2 years ago. He works as a roofer, smokes cigarettes, and frequently experiences sunburns. He denies a history of systemic disease and is on no oral medications. Examination of his posterior and lateral neck reveals depigmented macules, hyperpigmentation, and prominent vasculature. The patient notes that the rash does not itch or burn.

Poikiloderma of Civatte is a chronic, benign skin disorder that is named after the French dermatologist Civatte who first described the disorder in 1923.1 The condition most commonly arises in middle-aged to older fair-skinned individuals with a history of significant sun...

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Poikiloderma of Civatte is a chronic, benign skin disorder that is named after the French dermatologist Civatte who first described the disorder in 1923.1 The condition most commonly arises in middle-aged to older fair-skinned individuals with a history of significant sun exposure.  Other contributing factors include hormonal changes in women related to menopause and Fitzpatrick skin type I and II.2

Clinical findings include hyperpigmented or hypopigmented macules with prominent vasculature and skin atrophy.3 Affected areas are reddish or brown in color. Adjacent areas that are shaded from the sun, such as skin underneath the chin, are often spared. Most cases are asymptomatic although some patients may experience pruritus or burning. Diagnosis is based on the characteristic appearance and location of the disorder and may be aided by dermoscopy.4

Treatment of poikiloderma is challenging. Patients should be educated as to the importance of sun protection and daily use of a broad-spectrum sunscreen. Hyperpigmentation may improve with hydroquinone and low-potency topical steroids may minimize burning. Pulsed dye laser is often used to reduce telangiectasia.5

Sara Mahmood, DPM, is a podiatrist who completed a joint dermatology/podiatry fellowship and is on staff at DermDox Dermatology Centers. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. Katoulis AC, Stavrianeas NG, Georgala S, et al. Poikiloderma of Civatte: a clinical and epidemiological studyJ Eur Acad Dermatol Venereol. 2005;19(4):444-448. doi:10.1111/j.1468-3083.2005.01213.x
  2. Katoulis AC, Stavrianeas NG, Katsarou A, et al. Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of CivatteBr J Dermatol. 2002;147(3):493-497. doi:10.1046/j.1365-2133.2002.04993.x
  3. Nofal A, Salah E. Acquired poikiloderma: proposed classification and diagnostic approachJ Am Acad Dermatol. 2013;69(3):e129-e140. doi:10.1016/j.jaad.2012.06.015
  4. Errichetti E, Stinco G. Dermoscopy in facilitating the recognition of poikiloderma of CivatteDermatol Surg. 2018;44(3):446-447. doi:10.1097/DSS.0000000000001222
  5. Bernstein EF, Schomacker K, Paranjape A, Jones CJ. Treatment of poikiloderma of Civatte using a redesigned pulsed dye laser with a 15 mm diameter treatment spotLasers Surg Med. 2019;51(1):54-58. doi:10.1002/lsm.23036