Poikiloderma of Civatte: Neck and Chest Redness Treatment in Toronto

By Basil Russo, Founder, Bar Beauty Medical, 46 Fort York Blvd, CityPlace Toronto. Clinically reviewed by Jasmine Saggu, RN, Lead Injector.

Most people who come to us about this have never heard the name. They describe it as “the red V on my chest”, or “my neck looks twenty years older than my face”, or they point at the mottled brown and red patch that shows above every scoop neck they own. The clinical name is poikiloderma of Civatte, described back in 1923, and it is one of the most common things we see on necks and chests in Toronto.

It is also one of the easiest conditions to make worse with the wrong laser, which is most of what this page is about.

The sign that confirms it: the shaded triangle under your chin

Look in a mirror and tilt your chin up. In poikiloderma of Civatte, the redness and mottling covers the sides of the neck and the upper chest in a broad V, but there is almost always a pale, spared patch directly under the chin, roughly triangular, where the jaw casts a permanent shadow.

That spared shadow zone is the whole diagnosis in one glance. It tells you the driver is cumulative ultraviolet exposure, because the only skin that escaped is the skin the sun could never reach. Nothing else produces that pattern.

The affected skin usually shows three things mixed together:

• Redness from dilated superficial vessels, which is the vascular component
• Brown mottling from scattered pigment, which is the pigmentary component
• A fine crepey thinning of the skin surface, which is atrophy

That mixture is exactly why single approach treatments disappoint. A device that only chases pigment leaves the red behind. A device that only chases red leaves the brown behind. You need something that addresses both, or you need to accept a partial result.

Why it is not just sun, and why perfume is on the list

Ultraviolet exposure over decades is the main driver, and this is a condition of accumulation rather than of any single burn. But two other factors come up often enough to be worth naming.

Photosensitising fragrance. Certain fragrance compounds, historically bergamot oil in particular, react with sunlight to produce pigmentation. If you have spent years spraying perfume or cologne directly onto the sides of your neck and then walking out into daylight, that has contributed. The pattern is often subtly asymmetric on the side of your dominant hand for exactly this reason. It is not the only cause, but changing where you spray is free and worth doing.

Hormonal change. It appears more often in women around and after menopause, and the timing is common enough that people frequently notice it “arriving” in their late forties even though it accumulated over decades.

Why the neck is not just a bigger face

This is the part that most matters for your safety, and the part most clinics gloss over.

Neck and chest skin is structurally different from facial skin. It is thinner. It has substantially fewer pilosebaceous units, the hair follicles and oil glands that skin uses as reservoirs of cells to heal from. When facial skin is injured it repairs from those structures. The neck has far fewer of them, so it heals more slowly and it is meaningfully more prone to scarring and to hypopigmentation when treated aggressively.

This is why you hear horror stories about lasered necks and rarely about lasered faces. Aggressive ablative and high energy resurfacing on the neck has a genuine history of causing permanent problems, particularly a mottled white appearance that cannot be reversed.

The Neo Elite is a 1064nm Nd:YAG delivering energy in 650 microsecond pulses. Two things follow from that specification and both matter here. The 1064nm wavelength passes through the epidermis rather than being strongly absorbed by surface melanin, which is what makes it usable across all Fitzpatrick types including darker skin. The extremely short pulse means energy is delivered and gone before heat spreads into surrounding tissue. On a neck, that combination is the point.

We would rather run more sessions at a gentle setting than fewer sessions at a setting that risks a permanent problem on skin that does not forgive.

What results actually look like

Being straight with you about the ceiling here matters more than selling you a series.

The redness responds best. The vascular component is what the Neo Elite is genuinely strong at, and diffuse neck and chest redness is one of the more satisfying things we treat.

The brown mottling responds reasonably. Slower than the red, usually needing more sessions, and rarely to complete clearance.

The crepey texture responds least. Some improvement in skin quality is typical, but atrophy that has been decades in the making is not going to be reversed. If someone promises you that, walk out.

Realistically, the goal is a neck and chest that no longer announce themselves. Not a neck that matches the face of a twenty year old.

And it will come back if you do not change one thing

Poikiloderma of Civatte is driven by ultraviolet exposure, so it is progressive and it will re accumulate if the exposure continues. Treating it and then not protecting it is paying to reset a clock you immediately restart.

The single highest value thing you can do, before and after any treatment, is apply sunscreen to your neck and chest daily and actually reapply it. Most people apply diligently to the face and stop at the jawline. That habit is the reason this condition exists in the first place.

When we will not put a laser on your neck

We will not treat skin that is actively sunburned or freshly tanned, and we will ask you to stay out of deliberate sun exposure between sessions. We will not treat over a mole or a lesion that has not been assessed, and if anything in the area looks like it needs a physician’s eyes rather than ours, we will say so and send you. We do not treat during pregnancy.

If you have recently used isotretinoin, or you are on a photosensitising medication, tell us at consultation because it changes the plan.

How a neck and chest session runs

Sessions run roughly twenty to forty minutes depending on whether we are treating neck alone or neck and chest together. There is no gel, no contact and no cooling attachment. Most people describe a warm snapping sensation that is very manageable without numbing. You can go straight back to your day, and mild redness for a few hours is normal.

What neck and chest treatment costs

Most people need a series of three to six sessions spaced two to four weeks apart, putting a realistic course somewhere between roughly $1,050 and $2,700 for neck and chest work. We price per session and we do not lock you into a package before we have seen how your skin responds to the first one. Consultations are free. Our full price list has everything.

What else it could be, and how we tell

Several things show up on necks and chests and get lumped together as “sun damage”. They are treated differently, so it is worth separating them.

• Melasma on the neck. Melasma produces symmetrical brown patches with a soft border and no redness component. Poikiloderma has red in it, and it has the spared shadow triangle. Melasma is also hormonally driven and notoriously prone to rebound, so the treatment approach is more cautious. We cover it on our melasma page.
• Rosacea extending onto the neck. Rosacea centres on the face and only occasionally spills below the jaw. If the cheeks and nose are the main event and the neck is secondary, that points to rosacea.
• Actinic keratoses. These are rough, gritty, sometimes tender spots rather than a diffuse mottled patch. They are precancerous and they belong with a physician, not with us. If we see them, we will tell you.
• Post inflammatory pigment. Follows a specific insult, such as a burn or a reaction, and matches the shape of whatever caused it rather than following a sun exposure pattern.

If a patch is asymmetric, changing, raised, bleeding or new, that is a dermatology question and not a laser question. We will send you rather than treat you.

Why we use Nd:YAG here rather than IPL

Intense pulsed light is the device most commonly used for poikiloderma, and it is genuinely effective, particularly for the pigmentary component. It is worth explaining why we approach it differently.

IPL is broadband light. It covers a wide range of wavelengths, which is what makes it versatile across red and brown at once, but it also means a meaningful proportion of that energy is absorbed by melanin in the epidermis on its way through. On fair skin with little background pigment that is manageable. On medium and darker skin, and on skin that is even slightly tanned, that absorption is where complications come from, and on a neck the consequences of a complication are more lasting than on a face.

The 1064nm Nd:YAG sits at a wavelength where melanin absorption is comparatively low. It reaches vascular targets while passing relatively harmlessly through the pigmented layer above them. The trade off is honest: it is generally less dramatic on pigment per session than IPL, so brown mottling takes more sessions. What you get in exchange is a much wider safety margin on exactly the tissue that punishes mistakes.

For a fair skinned patient in winter with mostly brown mottling, IPL is a reasonable choice and we will say so. For anyone with medium to deep skin, anyone with any tan, or anyone whose main complaint is the redness, we think the Nd:YAG is the better tool. Our Aerolase versus IPL comparison goes into this further.

What we actually see in the clinic

Three patterns come through the door repeatedly.

The one who noticed it in a photograph. Usually mid forties, usually a woman, describes catching sight of her chest in a holiday photo and being startled. The mottling has been building for twenty years and became visible all at once because of an angle and a flash. This group tends to do well, because the vascular component is often the dominant one and that is what responds fastest.

The one who has been treating the wrong thing. Has been using brightening serums on the neck for two years, has flattened some of the brown, and cannot understand why it still looks red. Nobody told them there were two separate problems. Explaining the vascular component is often the most useful thing that happens in the consultation.

The one who was treated too aggressively somewhere else. The hardest group. Has pale patches or texture change from a previous high energy treatment on the neck. We are very careful here, we set expectations low, and sometimes the honest answer is that we should leave it alone. Hypopigmentation from over treatment is not something a laser fixes.

Aftercare, specific to the neck

Neck aftercare is stricter than face aftercare, for the structural reasons above.

• Expect mild redness and a warm feeling for a few hours, occasionally into the next day
• Nothing hot for twenty four hours. No sauna, no steam room, no hot yoga, no long hot showers directed at the area
• No retinoids, acids or exfoliants on the neck for about five days
• Daily sunscreen on neck and chest, without exception, and reapplied. This is not optional advice for this condition, it is the treatment
• Collars and scarves that rub can irritate freshly treated skin. Loose necklines for a day or two
• No deliberate sun exposure or self tanner between sessions

Neck and chest redness, questions we get

Is poikiloderma of Civatte dangerous?

It is a benign cosmetic condition, not a cancer and not precancerous. That said, it is a visible marker of significant accumulated sun exposure, which is worth discussing with your physician in the context of general skin checks.

Will it go away on its own?

No. It is progressive and it does not resolve without treatment.

Can I fix it with skincare alone?

Skincare can improve the pigmentary component modestly and daily sunscreen will stop it worsening, which is genuinely valuable. Topicals do very little for the vascular redness.

Why do I have it when my friends who sunbathed more do not?

Susceptibility varies with skin type and with hormonal factors. Fairer skin types tend to show it more readily. It is not purely a measure of how much sun you had.

Is it safe on darker skin?

The 1064nm wavelength is the one most commonly used across darker Fitzpatrick types precisely because it is not strongly absorbed by surface melanin. We treat all skin types, and we assess individually rather than by rule of thumb. Our page on Aerolase for darker skin tones covers this properly.

How many sessions before I see anything?

Most people see the redness starting to settle by the second or third session. Pigment is slower.

Can I combine it with other treatments?

Often yes, and a neck series pairs sensibly with facial work so the two areas match. We plan that at consultation rather than stacking things by default.

Does it affect men?

Yes, though we see it more often in women. In men it frequently shows on the back of the neck and the upper back instead, reflecting different exposure patterns.

Will the treatment leave me with white patches?

That risk is exactly why we work conservatively on necks. Hypopigmentation is a real and largely permanent complication of over aggressive treatment on this area, which is why we would rather add a session than raise the energy.

Can I have this done in summer?

We would rather treat you in autumn or winter, and we will not treat tanned skin. If you are booked for a sun holiday, finish the series first or wait until you are back and your tan has fully faded.

Does it come back?

The condition is driven by accumulated ultraviolet exposure, so yes, it re accumulates if the exposure continues. Daily sunscreen on the neck and chest is what protects the result.

Can I treat just the worst patch?

You can, and single spot work starts at $50, but the result often looks obvious because the treated patch no longer matches the skin around it. On a diffuse condition we usually recommend treating the whole affected area.

Where are you?

46 Fort York Blvd, CityPlace, downtown Toronto. Free consultation, book online whenever suits you.

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Treating the face too? Neck and chest work is usually planned alongside facial treatment so the two do not end up mismatched. See Aerolase for melasma and Aerolase for hyperpigmentation.