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What are the rust-colored patches on the sides of this 51 year old man's neck?

What is your diagnosis?


A 51-year-old man presents for the treatment of rust-colored patches on the sides of neck. The patient reports this discoloration has been increasing over the past five years. It seems to affect the lateral sides of his neck and spare the area on the anterior neck under the chin. What is your diagnosis?


Poikiloderma of Civatte

Poikiloderma of Civatte is a reticulated red to brown patch that usually occurs on the sides of the neck and the lower anterior neck as a result of chronic sun exposure. The mid to upper anterior neck is spared due to the shielding effect the chin from the sun. Close inspection reveals hyperpigmentation and telangiectasia. The brown and red color together produce the characteristic dark orange to rust color. Generally, the condition is asymptomatic; however, it can be a considerable cosmetic concern to many patients. It is also a cutaneous sign of chronic sun exposure, so regular skin examinations for other skin associated change or skin cancers should be considered. Mild atrophy may also accompany this condition.


Meticulous sun protection combined with phototherapy interventions, most notably the advanced fluorescence technology intense light treatment at 585 nm, has been very successful. Most patients undergo two treatments a month for two to three months. Significant improvement is seen in approximately 75% of patients with significance of improvement being judged at anywhere from a 50 to 90 plus percent improvement.


Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology


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