Poikiloderma of Civatte: A Histopathological and Ultrastructural Study

Abstract

Background: Poikiloderma of the face and neck (Civatte) has not been studied in depth for decades, especially as far as the histopathology is concerned. Material and Methods: We studied 50 consecutive patients with poikiloderma of Civatte (PC). Their evaluation included: history, physical examination, lesional skin biopsy and histological examination of sections stained with hematoxylin-eosin, PAS, Fontana-Masson, acid orcein Giemsa for elastic fibers and toluidine blue for mast cells. In 10 randomly selected subjects, a second skin biopsy was performed and specimens were examined under the electron microscope. Results: There were 34 females (68%) and 16 males. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. Histological examination revealed an atrophic (62%), flattened (84%) epidermis with hyperkeratosis (92%) and occasional follicular plugging (34%). In some cases, mild hydropic degeneration of the basal cell layer was evident (46%). Melanin was irregularly distributed in the lower epidermis (94%), and melanophages were often present in the dermis (92%). The most prominent and constant feature (100%) was solar elastosis of the papillary dermis. The blood vessels were almost invariably dilated (96%) with a mild perivascular lymphohistiocytic infiltrate (78%), sometimes with plasmacytes (56%). At the ultrastructural level, the epidermis showed only minor changes. The dermoepidermal junction was intact. The most constant findings were swelling and disruption of the collagen fibers as well as focal degeneration of the collagen bundles. Occasionally, several vacuolar spaces were found just under the basal lamina. Melanin-laden macrophages scattered in the dermis were also detected. Conclusions: PC shows distinct histological and ultrustructural features, supporting the theory that it represents a separate entity. The histology of PC is characteristic but not pathognomonic. On this basis, the differential diagnosis from Riehl’s melanosis, poikiloderma atrophicans et vasculare and other acquired poikilodermas can be made. Ultrastructural findings were consistent with the histological findings. Changes of the dermal connective tissue (solar elastosis) predominated, providing morphological evidence for the role of ultraviolet radiation in the pathogenesis of PC.

Pseudoxanthoma elasticum–like papillary dermal elastolysis: A large case series with clinicopathological correlation

“…12 Similar findings are seen in poikiloderma of Civatte. 13 We identified melanophages in the papillary dermis of PXE-like PDE in nearly all cases (88.2%). The exact cause of the universal presentation of melanophages in our series of PXE-like PDE lesions is not known.…”

The Possible Role of Contact Sensitization to Fragrances and Preservatives in Poikiloderma of Civatte

“…Moreover, PC also develops in younger women after iatrogenic premature menopause [3,6]. As low estrogen levels cause decreased synthesis of collagen and loss of skin elasticity [7], these changes in dermal connective tissue due to estrogen depletion may be responsible for the development of telangiectasia and cutaneous atrophy in PC patients.…”

Acquired hyperpigmentations

“…Histopathological examination shows solar elastosis in the papillary dermis, associated with vasodilation, perivascular edema, hyperkeratosis and epidermal atrophy with effacement of the rete ridges, hydropic degeneration of basal cells, presence of dermal melanophages and sparse lymphocytic infiltrate. 91 …”