Poikiloderma of Civatte laser treatment: an update and literature review

Background: Poikiloderma of Civatte is a chronic acquired dermatosis of the lateral neck, upper chest, and less commonly the cheeks, characterized by variable combinations of erythema, telangiectasia, reticulate hyperpigmentation, and epidermal atrophy. Because the condition contains both vascular and pigmentary components on anatomically delicate skin, treatment remains technically challenging. Laser- and light-based devices are widely used in practice, yet the contemporary evidence base is scattered across direct clinical studies, device reviews, photoaging literature, and expert guidance. Methods: A review of studies published from 2019 to 2026 was performed using MEDLINE, PubMed, and Ovid. 37 articles relevant to Poikiloderma of Civatte laser treatment or closely related therapeutic domains were included. Studies were narratively synthesized and classified using the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: The current literature is dominated by low-level evidence. Direct evidence for Poikiloderma of Civatte treatment remains limited to a small number of clinical studies, principally involving pulsed dye laser, 577 nm pro-yellow laser, and a newer 532 nm long-pulse device. These reports generally demonstrate meaningful improvement in erythema and telangiectasia, with variable effects on dyspigmentation and acceptable short-term tolerability. However, most publications from 2019 to 2026 are narrative reviews, procedural chapters, educational articles, or broader discussions of neck rejuvenation, vascular lesions, photoaging, and intense pulsed light technology. Collectively, they support the biologic rationale for device-based treatment and highlight the importance of wavelength selection, pulse structure, epidermal protection, skin phototype, and treatment of mixed vascular-pigmentary disease. Persistent gaps include limited randomized data, inconsistent outcome measures, short follow-up, and poor standardization of treatment protocols. Conclusion: This literature review supports laser- and light-based therapy as the therapeutic cornerstone for Poikiloderma of Civatte, but the strongest evidence remains narrow and device-specific. Current practice is guided less by robust comparative trials than by extrapolation from vascular laser science, photoaging treatment principles, and clinician experience. Future work should prioritize standardized severity scales, split-site comparative trials, longer follow-up, and stratification by clinical subtype and skin phototype.