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Discussion Poikiloderma of Civatte (PC) although rather common in countries with lighter skin population and a lot of sunshine (e.g. Greece) is a rare condition in moderate climates of East-European countries like Belarus. Hence, the clinical picture of pigment changes suggestive of PC should be differentiated from other poikiloderma conditions in largeplaque parapsoriasis, lupus erythematosus, dermatomyositis, chronic radiation dermatitis, dyskeratosis congenital and rare syndromes, e.g. Bloom syndrome and Rothmund-Thomson syndrome. PC is classified into erythemato-telangiectatic, pigmented and mixed type depending on predominating clinical feature [3]. In our case it was a mixed type with mottled pigmentary changes and a lot of telangiectasias sparing the submental region and the anterior neck which is highly characteristic of PC. The perimenopausal age of the patient was also typical for this condition. Treatment of PC remains challenging [4-10]. Ideally it should combine the elimination of vascular and pigment components simultaneously [3]. Various treatment modalities include lasers, depigmenting agents, topical retinoids and chemical peelings [1,3]. Laser therapy is considered to be the most succsessful, though costly and not consistntly effective [3]. Since treatment of PC remains a challenge all means of photoprotection are fundamentally important. Our patient was recommended to use sunscreen with SPF at least 50+ from March till October; to apply pigment-lightening creams: hydroquinone + tretinoin + hydrocortisone from October till March an to visit a gynecologist and an endocrinologist for corresponding examination. Recommendations to the patient: - To use sunscreen with SPF at least 50+ from March till October; - To apply pigment-lightening creams: hydroquinone + tretinoin + hydrocortisone from October till March - Examination by a gynecologist and an endocrinologist REFERENCES 1. Lautenschlager S, Itin PH: Reticulate, patchy and mottled pigmentation of the neck. Acquired forms. Dermatology. 1998;197:291-6. 2. Katoulis AC, Stavrianeas NG, Georgala S, Katsarou-Katsari A, Koumantaki-Mathioudaki E, Antoniou C, et al. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol. Sep 1999; 24 (5):385-7. 3. Katoulis AC, Stavrianeas NG, Panayiotides JG, Bozi E, Vamvasakis E, Kalogeromitros D, et al. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007;214:177-82. 4. Goldman MP, Weiss RA: Treatment of poikiloderma of Civatte on the neck with an intense pulsed light source. Plast Reconstr Surg. 2001;107:1376-81. 5. Weiss RA, Goldman MP, Weiss MA: Treatment of poikiloderma of Civatte with an intense pulsed light source. Dermatol Surg. 2000;26:823-7. 6. Rusciani A, Motta A, Fino P, Menichini G: Treatment of poikiloderma of Civatte using intense pulsed light source: 7 years of experience. Dermatol Surg. 2008;34:314-9. 7. Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Troiano M, Prignano F, et al. Intense pulsed light in the treatment of nonaesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. 2011;25:68-73. 8. Meijs MM, Blok FA, de Rie MA: Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of patients with severe depigmentation. J Eur Acad Dermatol Venereol. 2006;20:1248-51. 9. Batta K, Hindson C, Cotterill JA, Foulds IS: Treatment of poikiloderma of Civatte with the potassium titanyl phosphate (KTP) laser. Br J Dermatol. 1999;140:1191-2. 10. Behroozan DS, Goldberg LH, Glaich AS, Dai T, Friedman PM: Fractional photothermolysis for treatment of poikiloderma of Civatte. Dermatol Surg. 2006;32:298-301. . Copyright by Uladzimir P. Adaskevich, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. © Our Dermatol Online 2.2013 187
Comment to the article DOI: 10.7241/ourd.20132.43.1 POIKILODERMA OF CIVATTE by Uladzimir P. Adaskevich, Maryia A. Katina, Valeryia A. Miadzelets comment: Anca Chiriac MD, PhD Nicolina Medical Center, Department of Dermatology Iasi-Romania E-mail: ancachiriac@yahoo.com Prof. Caius Solovan University of Medicine, V Babes Timisoara, Romania Source of Support: Nil Competing Interests: None Our Dermatol Online. 2013; 4(2): 188 Date of submission: 22.03.2013 / acceptance: 28.03.2013 Cite this article: Anca Chiriac, Caius Solovan: comment: Poikiloderma of Civatte. Our Dermatol Online. 2013; 4(2): XX This clinical entity is not uncommon in Romania, especially in spring and summer,(but also during winter, for whose who are very fond of sky), most frequently diagnosed in fair-skin women over 40 years old, on a genetic background, after sun exposure (varying from minutes to hours), with a great cosmetic and physiological impact on social life. It is still a problem for dermatologists, not mainly for diagnosis but for therapy. It is an easy clinical diagnosis, although many other dyspigmentations must be ruled out (see classification). Classification of facial and neck melanosis [1]: * Melasma (chloasma) * Erythema dyschromicum perstans (Ashy dermatosis of Ramirez, erythema chronicum figuratum melanodermicum) * Lichen planus pigmentosus * Riehl’s melanosis (Pigmented cosmetic/ contact dermatitis) * Erythromelanosis peribuccale pigmentaire of Brocq * Poikilodermia Civatte * Erythromelanosis follicularis of face and neck * Nevus of Ota * Miscellaneous causes: Periorbital Melanosis Addison’s disease Exogenous ochronosis Post chikungunya pigmentation (reported in India, induced by alpha virus transmitted by Aedes aegypti and Aedes albopictus) Acanthosis nigricans In daily practice a skin biopsy is vary rare necessary for diagnosis, a through endocrinological examination is mandatory, sometimes an allergology test or a very attentive anamnesis are helpful (cosmetics involved). The mainstay of the treatment is photoprotection, which must be very clearly explained to the patients, the rules regarding the use of sunscreens have to be followed carefully and even so the avoidance of pick hours on sunlight (10 am-4pm) must be strictly accepted. There are no guidelines for the management of Poikilodermia Civatte so, different, and sometimes combined therapies, have been applied with success in treating this condition, aspect very well presented in the article. We prefer Hydroquinone and chemical peels (Azelaic acid and Kojic acid) along with laser therapy. We congratulate the authors for presenting the case, which turned to be an open door to an up-to date overview on Poikilodermia Civatte. REFERENCES 1. Khanna N, Rasool S: Facial melanoses: Indian perspective. Indian J Dermatol Venereol Leprol. 2011;77:552-64. 188 © Our Dermatol Online 2.2013 www.odermatol.com
Page 1 and 2: Volume 4, Number 2, April 2013 ISSN
Page 3: Editorial Board: Abdel-Naser Mohame
Page 6 and 7: CONTENTS E d i t o r i a l O r i g
Page 8 and 9: Original Article DOI: 10.7241/ourd.
Page 10 and 11: Figure 1. Survival time of HIV/TB-
Page 14 and 15: Figure 3. A. melanocytic naevus on
Page 18 and 19: 82% of the children belonged to the
Page 20 and 21: Comment to the article DOI: 10.7241
Page 22 and 23: The skin around body openings such
Page 24 and 25: Figure 1. Finger nail dystrophy in
Page 28 and 29: Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 34 and 35: 5. Brocard A, Quereux G, Moyse D, D
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
Page 60 and 61: Figure 1. a PAS positive accentuati
Page 62 and 63: The patient was put on melanocyl 0.
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Page 70 and 71: Surgery has been reported to be the
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Page 76 and 77: Discussion The breast location of t
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Page 82 and 83: Discussion SCACP is one of the cuta
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Page 90 and 91: Clasificación En base al epitelio
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Clinical Images DOI: 10.7241/ourd.2
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Figure 7. Fixed cutaneous sporotric
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Letter to the Editor DOI: 10.7241/o
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Historical Article DOI: 10.7241/our
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Figure 6. Henri Mondor (1885-1962).
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Figure 5. Alfred Guido Miescher (18
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Names of ''Lines'', in dermatology
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Figure 1. Erik Adolf von Willebrand
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THOMAS INMAN English physician, 182
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There are three type of tinea capit
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