DISCUSSION
This particular pattern of mottled hyper- and hypopigmented skin is a result of overexposure to UV light. The name for this common problem—seen far more commonly in women than in men—is poikiloderma of Civatte (PC). This case is typical in that the changes manifested and progressed so slowly that the patient didn’t notice.
PC can manifest with combinations of red, brown, and yellow discoloration around the neck. In this case, the dominant color was red. The oval area of spared skin was created by the shade of the patient’s chin.
Similar changes can be seen with other conditions, such as poikiloderma vasculare atrophicans, a manifestation of small plaque parapsoriasis. However, this typically affects areas below the waist and does not have areas of sparing.
Treatment has been attempted with lasers and peels, yielding mixed success. Because of her condition’s benignancy, this patient did not opt for treatment.
TAKE-HOME LEARNING POINTS
- Poikiloderma of Civatte (PC) is a permanent skin change caused by overexposure to the sun or another UV source; it is more common in women than men.
- PC manifests with mottled hyper- or hypopigmented patches of skin on the anterior neck and upper chest, which develop gradually over the course of decades. Many patients also have sheets of telangiectasias covering the affected area.
- A distinct area of sparing (usually oval) is typically seen on the upper anterior neck, due to the chin’s shading of this area.
- Laser treatment has been somewhat successful in lightening the affected skin.