On both sides of the neck, more or less symmetrically, a reddish-brown discoloration of the skin is observed, often with an irregular border. It may extend along the jawline to the cheeks. The redness appears precisely between the openings of the hair follicles, which are sometimes slightly raised and skin-colored. In a later stage, small white spots may also develop in the affected area. The redness can be blanched with pressure, often revealing a slight brownish discoloration. The skin centrally under the chin is usually unaffected because it is not exposed to sunlight.
What is Erythromelanosis interfollicularis?
Erythromelanosis (synonym: poikiloderma of Civatte) is a reddish-brown discoloration on both sides of the neck. It typically occurs after the age of 30. The discoloration can extend to the chest and cheeks. Only individuals with fair skin are affected.
What is the cause?
Poikiloderma is caused by sun exposure. The skin on the neck is very thin and, therefore, sensitive to UV rays from the sun or tanning beds. UV rays damage the elasticity of connective tissue, causing blood vessels to lose elasticity, dilate, and turn the skin red. The skin around the hair follicles remains normal, creating a “goosebumps” effect. Additionally, the skin develops a persistent brown discoloration.
What does it look like?
On both sides of the neck, more or less symmetrically, a reddish-brown discoloration of the skin is visible, often with an irregular border. The discoloration may extend to the jawline and the back of the cheeks. The redness occurs between the hair follicle openings, which may appear slightly raised and skin-colored. The redness can be blanched with pressure, usually revealing a slight brownish discoloration. In more advanced stages, small white spots may appear in the affected area. There is no scaling. The skin centrally under the chin is usually unaffected, as it is not exposed to sunlight.
Erythrosis is easy to identify, and additional testing is generally not required.
What is the treatment?
In recent years, it has become possible to treat erythrosis with lasers, which significantly improve the condition. However, due to the brown discoloration, a lightly discolored spot may remain after treatment, which can be further treated with a pigment laser.
To prevent worsening or recurrence, it is advised to avoid sun exposure or protect the skin with clothing or sunscreen with a high SPF (20 or higher).
Suitable lasers and light sources for treatment:
- Pulsed dye laser (e.g., V-beam® pulsed dye laser)
- KTP laser
- IPL (intense pulsed light)
These treatments are generally expensive and are not usually covered by health insurance. Your dermatologist or general practitioner can advise on choosing a suitable laser treatment center. Always check whether the laser clinic employs dermatologists, as this indicates reliability.
Alternative treatment:
If laser treatment is not possible or residual discoloration remains, camouflage treatment with a certified skin therapist may be considered. The therapist can apply a waterproof, color-matched cream to make the spots barely or not visible.
