Will Active FX permanently clear poikiloderma?

Poikiloderma by definition involves skin atrophy, hyperpigmentation, hypopigmentaiton and redness, most commonly on the neck, due to prior sun damage. This is one of the most difficult skin blemish to treatment. In the past, treatment with IPL or photofacial has been disappointing. While fractional CO2 laser can be helpful, one should not expect permanent clearing and if performed by a phyisician who may be too aggressive and not familiar with skin physiology and wound care of the neck, you may end up with a worse cosmetic outcome.

Saying poikiloderma is difficult to treatment is an understatement.  Because of the extensive sun damage pigmentation is only part of the problem.  Fractional CO2 treatment can help to rebuild collagen but it must be done slowly.  In my experience the best treatment for the pigmentation is long-term use of retinoids and superficial to medium depth Chemical peels.  Remember that even though the damage is done, daily use of sun protection can help prevent worsening of the problem.