Clinical Features of Poikiloderma of Civatte
Poikiloderma of Civatte is a benign, acquired condition presenting with the classic triad of cutaneous atrophy, telangiectasias, and mottled pigmentary changes (both hyper- and hypopigmentation) affecting the lateral neck and upper chest, characteristically sparing the submental area. 1, 2
Patient Demographics and Distribution
- Predominantly affects middle-aged to elderly women (67.86% female in dermoscopy studies), particularly those who are peri-menopausal 1, 3
- Fair-skinned individuals are most commonly affected 3
- Classic anatomic distribution: lateral neck, upper chest (V-area), and face, with characteristic sparing of the submental and submandibular regions (the shaded areas under the chin) 1, 4
Primary Clinical Features
Vascular Component
- Telangiectasias are a defining feature, appearing as dilated fine blood vessels on the affected skin 3, 2
- Dermoscopically, these manifest as converging curved vessels (64.3% of cases), linear irregular vessels (60.7%), and rhomboidal/polygonal vessels (53.6%) 1
- Combination of linear and dotted vessels observed in 28.6% of cases 1
Pigmentary Changes
- Mottled appearance with both hyperpigmentation and hypopigmentation occurring simultaneously 3, 2
- Brown macules present in 39.3% of cases on dermoscopy 1
- White macules observed in 82.1% of cases, representing areas of hypopigmentation 1
Atrophic Changes
- Cutaneous atrophy is the third component of the classic triad 5, 2
- Whitish follicular plugs may be visible on dermoscopic examination (21.4% of cases) 1
Dermoscopic Patterns
When examined with dermoscopy, Poikiloderma of Civatte demonstrates highly characteristic patterns that aid in diagnosis:
- Reticular pattern is most common (53.6% of cases) 1
- White dots appear in 35.7% of cases 1
- Non-specific patterns in 32.1% 1
- The dermoscopic picture corresponds well with both clinical presentation and histological findings 1
Key Distinguishing Features
The pathognomonic feature is the sharp demarcation with sparing of the shaded submental area, which helps differentiate this from other poikilodermas with more serious prognoses 1, 4. This sparing pattern strongly suggests chronic photodamage as the underlying mechanism, distinguishing it from systemic causes of poikiloderma.
Clinical Pitfall
Do not confuse Poikiloderma of Civatte with poikiloderma associated with genetic syndromes (such as Rothmund-Thomson syndrome or Bloom syndrome) or dermatomyositis, which have different distributions, age of onset (often infantile in genetic syndromes), and carry significantly different prognostic implications including malignancy risk 6, 7. The benign nature of Poikiloderma of Civatte, its characteristic anatomic distribution with submental sparing, and its onset in middle age clearly differentiate it from these conditions.