Poikiloderma of Civatte

Question 1

Clinical features?

Answer 1

Erythemato-telangiectatic &
pigment discolouration
Location: V shaped of chest, neck size and face
Chronic inflammatory skin condition

Question 2

Cause?

Answer 2

UV radiation
Genetics
Hormones: oestrogen levels changes
photosensitising produces (perfume)

Question 3

Why does it happen? (Pathophysiology)

Answer 3

photodamage skin
Pigment: accumulation of pigment due to chronic UV exposure
Blood vessels: UV exposure damage vessel walls = leads to be fragile and persistent erythema

Repeated sun exposure = chronic cumulative photodamage skin

Question 4

Treatment plan?

Answer 4

Skin care
- Panthenol, hyaluronic acid (reduce TEWL)
- Topical tyrosinase inhibitor: kojic acid, liquorice, vitamin c

Lasers
- Pulse dye laser (532nm): telangiectasia, redness (small vessels: shorter pulse, large vessels longer pulse)
- Long pulse Intense pulse light source (IPLS)(500-900nm): treat vascular and pigment lesions (gradually heat both melanin (brown) and hemoglobin (red) without excessive epidermal damage)
- Long pulse 1064nm nd:YAG: deep and persistent telanigectasia (gradually heat up preventing vessel ruptures)
KTP 532m, laser

Combination therapies
-AHA’s Chemical peels: Glycolic acid: increase cell turnover, desquamation and dispersion of melanin.
-Mandelic acid: inhibits production and tyrosinase activity