Which Treatment is Best for a Young, Caucasian Male with Poikiloderma?

I am a 20 year old Caucasian with poikiloderma on my neck and upper chest. It is not THAT bad typically but gets very noticeable when I am active or feel hot. I am looking to get it treated but am worried about the success of the treatments. The majority of doctors have suggested IPL, while others have suggested pulsed dye lasers and Q-Switched YAG. Also there has been a huge gap in between cost. I have seen a range from $200 per treatment to $750. Any information would be great.

Doctor Answers 3

A combination of IPL plus fractional laser can be very effective for poikiloderma of civatte on the neck.

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Poikiloderma of civatte is often seen in fair-complected folks on the neck and V of the chest due to longterm sun exposure. Very often the area directly under the chin is spared. As this is usually not only an issue of discoloration (red and brown), but also very often a textural change as well (bumps like chicken skin)-- a combination approach is often required for more effective treatments.  IPL is my preferred treatment to minimize the red as well as pigment, and I stagger those treatments with fractional lasers (both non-ablative and ablative--depending on "downtime" preferences of patients). The fractional lasers can help improve the texture and some studies show that the "columns" of treatment can help with transepidermal elimination of pigment for some dermatologic conditions (reference is B. Hantash). Three treatments of each can often yield pretty substancial improvments, but patients need to be absolutely diligent about sunscreen, sunprotection (UPF shirts covering this area for hiking, biking, golfing as well as swimming etc.) as well as topical application of a retin A derivative to help remodel the skin before, between, and after the above light and laser treatments.

Greenwood Village Dermatologic Surgeon

Poikiloderma and IPL or pulsed dye laser

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Poikiloderma of Civatte is caused by sun damage so the first step in treatment is strict sun protection.  Redness can be treated with IPL or pulsed dye laser, the cost is usually the same.  If there is brown pigment as well as redness, fading creams or Fraxel Re:store laser can help.  Usually maintenance treatments are required because of past sun damage resurfacing.  The skin on the neck and chest is quite sensitive, so you should receive treatment with a board certified dermatologist or plastic surgeon to avoid scarring.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Poikiloderma of the chest and neck

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you are describing a vasodilatation effect in being red at times from the existing superficial numerous capillary blood vessels engorgin with blood. The Nd yag or Alex laser would be less important than the V-beam 595nm. pulsed dye laser or IPL lightsource treatments. The IPL may handle both pigment and blood vessels but so can the V-Beam Perfecta, although there might be more risk on the chest than with IPL. No treatment will offer cure as your skin is prone to this and you may need maintenance treatments in the future. Make sure you use a good sunscreen every day.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.