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Introduction
Poikiloderma of Civatte (Poikilodermia vascularis et pigmentosa Civatte) is a chronic skin condition which refers to the group of melanodermas. The term „poikiloderma” means a skin change with atrophy (thinning), pigmentary changes (either hyperpigmentation or hypopigmentation) and telangiectasia formation (dilatation of fine blood vessels) [1-3]. Poikiloderma of Civatte (PC) is characterized by erythema associated with atrophy and pigmentation changes of the skin usually seen on the sun exposed areas such as cheeks and sides of the neck. The condition was first described by a French dermatologist Civatte in 1923 [1,2]. PC occurs in females more frequently than in males. Female individuals are most commonly affected in the menopausal period [3]. The incidence of PC is unknown; many patients may have a mild form of the disease and may not ask for medical attention. Fair-skinned people are more prone to the disease, although it may be seen in all skin types [1,3]. Some reports point out to clinical and pathomorophological similarity of poikiloderma of Civatte and Riehl’s melanosis. But in the latter case the skin atrophy is less intensive and teleangiectasias are not typical [1,2]. Chronic exposure to ultraviolet light is considered to be an important etiologic factor which is confirmed by the fact that lesions occur on sun-exposed areas. In addition, solar elastosis is a frequent histopathologic finding. Photosensitizing chemicals in perfumes or cosmetics have been implicated in the pathogenesis of poikiloderma of Civatte. Hormonal changes related to menopause or low estrogen levels may also be seen as a possible causative factor. There are some reports suggesting genetic background. The genetically determined predisposition may be expressed in an increased susceptibility of the skin to ultraviolet radiation [1-4]. UV-induced changes of the dermal connective tissue are the predominant histological feature of PC, leading to telangiectasia due to the loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume or cosmetic ingredients. The lesions are usually asymptomatic, but some patients may feel mild burning, itching and increased sensitivity in the affected area. The...