Author: Dr Francisco Flores, Dr Maryam Ameen, and Dr Brittany Tsai, Ross University School of Medicine.
Reviewing dermatologist: Dr Ian Coulson (2024).
Edited by the DermNet content department
Background
A 45-year-old male presented with progressive discolouration on both sides of his face for one year. He reported no pain or itch. Of note, the patient worked as an automobile salesperson.
Physical examination shows reticulate red-brown hyperpigmentation with telangiectasia and atrophy on the lateral cheeks and sides of the neck.
This is poikiloderma of Civatte, which is typically seen on sun-exposed areas such as the lateral cheeks and sides of the neck, and spares the shaded area under the chin. This is a common and benign skin condition more frequently seen in post-menopausal women.
Poikiloderma is characterised by hyperpigmentation, telangiectasia, and atrophy within the same lesion. In some instances, photosensitising fragrance constituents in personal care products may be responsible.
Use a UVA- and UVB-blocking sunscreen, and avoid perfumed products on the affected area.
Hydroquinone and retinoid creams may help. Intense pulsed light or pulsed dye laser are both advocated to reduce both the telangiectasia and hyperpigmentation.
See: Poikiloderma of Civatte.
