Piokiderma 1_1112 Derm Dx
Piokiderma 2_1112 Derm Dx
A 58-year-old man complains that his friends and family have started teasing him that he is a “redneck,” because he has red patches on his neck. He estimates that the problem has developed over the past 15 years.
The red patches do not come and go, but remain fixed and are not itchy or painful. The patient has a history of basal cell carcinoma, which was excised from his right temple two years earlier. He takes hydrochlorothiazide for hypertension. What’s your diagnosis?
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Poikiloderma of Civatte is characterized by reddish to brownish patches with telangiectasias appearing on the lateral aspects of the neck. Typical patients with this condition have a fair complexion and report significant sun exposure. The lower anterior neck and “V” area of the superior chest may also be affected.
Characteristically, the skin of the central neck immediately below the chin, known as the submental skin, is spared because it is relatively protected from sunlight by the natural shadow created by the chin. This submental sparing is seen dramatically in the photographs presented in this case.1,2
In addition to Poikiderma of Civatte, there are many other signs of photoaging. Solar elastosis is the term that refers to the thickening of the skin associated with increased skin wrinkling and a yellowish discoloration, seen most frequently on the sun exposed areas of the face.
Cutis rhomboidalis nuchae, also called sailor’s neck, farmer’s neck and leatherneck, refers to thickened and leathery skin on the posterior neck with exaggerated skin markings that form a crisscross pattern.
Colloid millium refers to translucent yellowish papules occurring on sun-exposed areas of the face, neck and back of the hands. Favre-Racouchot syndrome refers to large open comedones on the inferior orbital and malar skin.
Solar purpura refers to easy bruising caused by solar damage to the connective tissues of the skin. This is commonly seen as purplish bruising on the forearms and dorsal hands that subsequently fades to a brownish discoloration.
Solar lentigines, also called liver spots, are irregular brown macules on sun-exposed areas, especially the dorsal arms, forearms, V-area of the chest and face.1,2
Poikiderma of Civatte diagnosis is based on the clinical appearance of mottled erythema and telangiectasias on the lateral neck and “V” area of the chest with submental sparing.
Other signs of photoaging are frequently present. Biopsy is rarely necessary but will show epidermal atrophy, irregular basal layer pigmentation and telangiectasias.1,2
Poikiloderma of Civatte may be treated with intense-pulsed light or pulsed-dye lasers. Sun-tanned skin is at greater risk for damage by the laser therapy, therefore patients should avoid the sun for four weeks prior to treatment.3
Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.
- Bolognia J, Jorizzo JL, Rapini RP.”Chapter 86: Photodermatoses.” Dermatology. St. Louis, Mo.: Mosby/Elsevier, 2008.
- James WD, Berger TG, Elston DM et al. “Chapter 3: Dermatoses Resulting from Physical Factors.” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunder Elsevier, 2006.
- Robinson JK. “Chapter 34: Laser and Light Treatment of Acquired and Congenital Vascular Lesions.” Surgery of the Skin. Edinburgh: Elsevier Mosby, 2005.