Poikiloderma of Civatte

A 44-year-old woman was being seen regularly for skin manifestations of systemic lupus erythematosus (SLE). During a routine visit, blotchy erythema and hyperpigmentation were noted on the normally exposed areas of her neck and upper chest; the submental area was spared. Close examination revealed fine telangiectases and poorly marginated hyperpigmented and hypopigmented macule.

This constellation of skin findings is known as poikiloderma of Civatte, a localized photodermatosis most commonly found in middle-aged women. It mainly affects the neck but may also be seen on the lateral cheeks and the photoexposed regions of the upper chest.

The term “poikiloderma” refers to the combination of hyperpigmentation, hypopigmentation, telangiectases, and atrophy, all of which may be associated with this condition. The suspected cause is chronic exposure to sunlight combined with photodynamic substances found in cosmetics and/or an unidentified endocrine factor. The presence of SLE in this patient probably contributed to this skin condition by increasing her intrinsic photosensitivity.