CONDITIONS ยท DANVILLE, CA

Redness of the Neck & Chest (Poikiloderma of Civatte) Treatment in Danville, CA

Red and Blotchy Neck and Chest, Treated in Danville, CA

Have you noticed redness in the skin of your neck and upper chest, perhaps more so as you age? This common condition has the rather intimidating name of Poikiloderma of Civatte. It is named for Achille Civatte, the French dermatologist who first described it in 1923. However, it is usually simply called "redness of the neck".

It is benign, it is long standing, and it is the visible record of years of sunlight on skin that most people never think to protect. It shows up as a mottled mix of red and brown on the sides of the neck and the upper chest, with fine visible vessels running through it, while the shaded strip directly under the chin stays pale.

Dr. Gallacher treats this condition with lasers, and she performs every laser treatment herself.

Have you noticed your neck and upper chest looking red, perhaps more so as you get older?

This is common. Its medical name sounds alarming: poikiloderma of Civatte. It is named after Achille Civatte, a French skin doctor who first wrote about it in 1923. Most people just call it redness of the neck.

It is harmless. It has usually been building for years. It is the visible record of sunlight on a part of the body almost nobody remembers to protect.

Dr. Gallacher treats this with lasers, and she does every laser treatment herself.

A dermatologist points to redness across a patient's neck and upper chest
AT A GLANCE

Redness of the Neck & Chest: the essentials

The short version

Medical name
Its medical name

Poikiloderma of Civatte, first described by Achille Civatte in 1923. Usually called simply "redness of the neck".

Typical appearance
What it looks like

Mottled red and brown discolouration, fine visible vessels, scattered paler patches and mild thinning of the skin, on the sides of the neck and the upper chest.

Blotchy red and brown colour, fine visible veins, some paler patches, and skin that has thinned a little. On the sides of the neck and the upper chest.

Common pattern
A telltale pattern

The shaded area of the throat below the chin is usually not affected.

The shaded skin under your chin is usually spared.

Main contributors
What causes it

Accumulated sun exposure, genetic predisposition, ageing, hormonal changes, and photosensitising ingredients in cosmetics and perfumes.

Years of sun. Your genes. Getting older. Hormones. And perfumes or cosmetics that make skin more sun sensitive.

Treatment
Treatment

The VBeam pulsed dye laser for the redness and the vessels, and the Erbium laser for texture and surface photodamage, selected and combined according to what your skin actually shows.

The VBeam laser for the redness and the veins. The Erbium laser for rough texture and sun damage. Which one, and in what combination, depends on what your skin actually shows.

Downtime
Time off afterwards

Varies by device; vascular treatment can cause temporary redness/swelling and sometimes bruising.

Depends on the machine. Vascular treatment usually causes redness and swelling for a while, and sometimes a bruise.

Who holds the handpiece
Who does it

Dr. Gallacher. She does not delegate laser treatment.

Dr. Gallacher, herself. She does not hand laser treatment to anyone else.

Number of sessions
How many sessions

Most patients require several treatments for optimal results. The number is set after assessment, not promised in advance.

Most people need several to get the best result. The number is decided after she has looked at your skin, not before.

What is poikiloderma of Civatte, and where does the name come from?

What is it, and where does the name come from?

This common condition has the rather intimidating name of Poikiloderma of Civatte. It is named for Achille Civatte, the French dermatologist who first described it in 1923. However, it is usually simply called "redness of the neck".

"Poikiloderma" is a descriptive term. It refers to skin showing three changes together: increased pigment, visible small blood vessels, and thinning of the skin surface. That combination is exactly what makes this condition look mottled rather than uniformly red or uniformly brown, and it is also why a single treatment aimed at one of those three changes rarely clears the whole picture.

The condition is chronic and benign. It does not turn into skin cancer. It is treated for appearance, not for safety.

The medical name sounds worse than the condition. Poikiloderma of Civatte is named after Achille Civatte, a French skin doctor who first described it in 1923. Almost everyone just calls it redness of the neck.

"Poikiloderma" simply describes skin that is doing three things at once: making extra brown pigment, showing small blood vessels through the surface, and thinning slightly.

Those three things together are why it looks blotchy rather than evenly red or evenly brown. It is also why one treatment aimed at one of the three rarely fixes the whole thing.

It is long standing and harmless. It does not turn into skin cancer. It is treated because of how it looks, not because it is a danger.

What causes redness on the neck and upper chest?

What causes redness on the neck and chest?

A common cause is poikiloderma of Civatte, a benign chronic form of photodamage in which pigmentation, fine dilated vessels and subtle skin thinning occur together.

Usually poikiloderma of Civatte: a harmless, long standing form of sun damage, in which brown colour, fine widened blood vessels and slight thinning of the skin all happen together.

What does poikiloderma of Civatte look like?

What does it look like?

Symptoms include darkening or reddening of the skin, patches of lighter skin, visible or prominent blood vessels and thinning of the skin of the neck and chest. Rarely, patients report a mild burning or itching sensation. The shadowed area of the throat below the chin is usually not affected.

In practice the pattern is easy to recognise once it is pointed out:

You may notice darker or redder skin, patches of paler skin, visible blood vessels, and skin that has thinned on the neck and chest. Some people get mild burning or itching, but that is unusual. The shaded skin under the chin is usually fine.

Once someone points the pattern out, it is easy to spot:

Diagram showing typical poikiloderma of Civatte pattern with sparing under the chin

Diagram showing typical poikiloderma of Civatte pattern with sparing under the chin

A diagram showing the typical pattern, with the shaded skin under the chin spared.

Why does poikiloderma of Civatte develop?

Why does it happen?

The exact cause of redness of the neck is not clear, but contributing factors may include:

Nobody can point to one single cause. Several things seem to contribute:

Two of these matter most for what you do next. Sun is the one you can still do something about. And perfume or cosmetics sprayed straight onto the neck is the one almost nobody has been warned about.

Two of these matter more than the rest for what you do next. Cumulative sunlight is the one you can still act on, and photosensitising products applied directly to the neck are the one most people have never been warned about.

Can redness of the neck and chest be prevented from worsening?

Can I stop it getting worse?

As with many things in life, prevention is more effective than treatment. To prevent this condition, or to avoid worsening it, try to:

As with many things in life, it is easier to prevent this than to treat it. To stop it starting, or stop it getting worse:

Sun protection also protects the money you spend on treatment. Laser can clear a lot of the redness and colour. Nothing stops it coming back if the sun exposure carries on.

Photoprotection also protects your investment. Laser treatment can clear a great deal of the redness and the pigment, but nothing stops the skin building the same picture again if the sun exposure continues.

How is redness of the neck and chest treated?

How is it treated?

There are no miracle oral supplements or topical ointments to rid you of this benign condition. However, if you wish to seek treatment for cosmetic reasons, the best option for improving the appearance of your skin is laser treatment.

There is no miracle pill and no miracle cream for this. It is harmless, so treating it is a choice, not a necessity. If you do want to improve how it looks, laser is the best option.

ConcernPossible approach
Persistent redness / vesselsVBeam pulsed-dye laser can selectively target superficial vascular redness and telangiectasias.
Mixed pigment / photodamagePigment-directed or fractional resurfacing may be considered depending on skin tone and diagnosis.
Texture / photodamageErbium or other resurfacing may be used selectively when texture and surface photodamage are important.
Prevention / maintenanceDaily sunscreen and avoidance of avoidable photosensitizing irritation remain essential.

Lasting redness and visible veins A vascular laser such as VBeam can target them selectively.
Mixed brown colour and sun damage A pigment laser or fractional resurfacing may suit, depending on your skin tone and the diagnosis.
Texture and sun damage Erbium or another resurfacing treatment, used selectively when the texture matters.
Keeping it away Daily sunscreen, and avoiding anything that makes the skin more sun sensitive.

Dr. Gallacher uses two lasers: the VBeam pulsed dye laser and the Erbium laser. They send a strong but gentle beam of light into the skin. That destroys the targeted blood vessels and makes the skin produce more collagen, which improves the texture.

She uses two because they do different jobs:

  • The VBeam is soaked up by the red colour inside the small blood vessels. The vessel heats up, closes, and your body clears it away. This is the one for redness and fine visible veins.
  • The Erbium works on the surface and just underneath. It removes sun damaged skin in a controlled way, and prompts the skin to make new collagen. This is the one for uneven texture, thin skin and a crepey look, which light alone will not fix.

Which one leads, and whether you need both, depends on what your skin is actually showing. Most people need several sessions to get the best result.

Dr. Gallacher uses the VBeam pulsed dye laser and the Erbium laser to improve the appearance of your skin. They work by sending an intense yet gentle beam of light into the affected area. This destroys the targeted vessels and stimulates the skin to produce more collagen, improving its texture.

The two lasers do different jobs, which is why she uses both:

  • The VBeam pulsed dye laser is absorbed by the red pigment inside the small blood vessels. The vessel wall heats and closes, and the body clears it. This is the tool for the redness and the fine visible capillaries.
  • The Erbium laser works on the surface and just below it, removing sun damaged skin in a controlled way and prompting the skin to lay down new collagen. This is the tool for uneven texture, thinning and the crepey quality that light alone will not fix.

Which of the two leads, and whether both are used, depends on which component is dominant in your skin. Most patients require several treatments for optimal results.

Who performs your treatment

Who does the treatment

Dr. Gallacher performs every laser treatment personally. Laser treatment at this practice is not delegated to a technician, a nurse or an assistant.

This matters more on the neck and chest than almost anywhere else on the body. Skin below the jawline has fewer of the structures that drive healing after resurfacing, so it recovers more slowly than facial skin and is less forgiving of aggressive settings. The margin between an excellent result and a visible line of pigment change is a matter of judgement about energy, spot size, overlap and where to stop. That judgement is made at the handpiece, in real time, by the physician who made the diagnosis.

She also selects the device to the indication rather than fitting the indication to whatever device is in the room. For this condition that means a pulsed dye laser for the vascular component and an Erbium laser for the surface component, chosen because those are the right tools for those targets, not because they are the ones available.

Dr. Gallacher does every laser treatment herself. She does not hand it to a technician, a nurse or an assistant.

That matters more here than in most places. Skin below the jaw heals more slowly than skin on the face and copes less well with strong settings. The difference between an excellent result and a visible line where the colour has changed comes down to judgement: how much energy, how big a spot, how much overlap, and when to stop. That judgement gets made at the handpiece, as it happens, by the doctor who made the diagnosis.

She also picks the machine to suit the problem, rather than fitting the problem to whatever machine is in the room. For this condition that means a pulsed dye laser for the redness and an Erbium laser for the surface, because those are the right tools for those jobs.

Who may be a good candidate for laser treatment?

Who is suitable for the laser?

You are likely to be a suitable candidate if the diagnosis has been confirmed as benign, the colour or texture genuinely bothers you, and your skin can safely tolerate the device proposed.

Assessment comes first, and it can change the plan:

This is likely to suit you if the diagnosis has been confirmed as harmless, the colour or texture really bothers you, and your skin can safely handle the machine being proposed.

She assesses you first, and what she finds can change the plan:

What treatment is like on the day

What treatment is like on the day

Treatment is performed in the office and does not require general anaesthesia. The area is cleaned, eye protection is fitted for you and for the team, and the settings are tested on a small area before the full treatment area is covered.

VBeam pulses are brief. Patients commonly describe the sensation as a snap with a flick of heat, made more tolerable by the device's cooling spray, which fires immediately before each pulse. Erbium resurfacing is more involved and topical anaesthetic is used.

A treatment of the neck and upper chest usually takes under an hour, including preparation. You are given written aftercare instructions before you leave, along with a direct route back to the practice if anything concerns you afterwards.

Treatment happens in the office. You are awake. You do not need a general anaesthetic.

She cleans the area, everyone puts on eye protection, and she tests the settings on a small patch before treating the whole area.

The VBeam fires very short pulses. Most people describe it as a snap with a flick of heat. The machine sprays a burst of coolant just before each pulse, which makes it much easier to tolerate. Erbium resurfacing is a bigger procedure, so numbing cream is used.

Treating the neck and upper chest usually takes under an hour, including getting ready. You go home with written aftercare instructions and a direct way to contact the practice if anything worries you.

Diagram showing vascular laser treatment of fine blood vessels on the neck and chest

Diagram showing vascular laser treatment of fine blood vessels on the neck and chest

A diagram showing laser treatment of the fine blood vessels on the neck and chest.

What is recovery like?

What is the recovery like?

Recovery depends on which laser is used.

How long you need depends on which laser is used.

First 1 to 2 days
The first day or two

Warmth, redness and swelling are common after vascular treatment.

Warmth, redness and swelling are usual after the vascular laser.

Several days
The next few days

Bruising after vascular treatment or flaking after resurfacing may be visible.

A bruise after the vascular laser, or flaking after resurfacing.

Following weeks
Over the following weeks

Color and texture improve gradually; several sessions may be recommended.

The colour and the texture improve gradually. You may be advised to have several sessions.

After the VBeam on its own. In Dr. Gallacher's practice, this is not a big recovery. Expect warmth, mild redness and some swelling for a day or two. Whether you bruise depends on the settings. Some settings are meant to cause a temporary bruise, because it gives a stronger result on the veins. If that is the plan, she tells you before treatment so you can pick your timing. Most people go back to normal the same day.

After Erbium resurfacing. This one has a real recovery. Expect redness, dryness, and flaking or crusting for several days while the surface heals. Then pinkness that fades gradually. Skin on the neck and chest heals slower than the face, so she uses careful settings and plans the recovery around your diary rather than squeezing it in.

For both. Staying out of the sun and using sunscreen afterwards is not optional. Freshly treated skin changes colour easily. Protecting it is what makes the result last.

After VBeam alone. In Dr. Gallacher's practice, discomfort and downtime after vascular laser treatment for this condition are minimal. Expect warmth, mild redness and some swelling for one to two days. Whether bruising occurs depends on the settings selected. Some settings deliberately produce temporary bruising for a stronger vascular effect, and where that is planned she will tell you before treatment so you can choose your timing. Most patients return to normal activity the same day.

After Erbium resurfacing. This is a resurfacing procedure and the recovery is real. Expect redness, dryness and flaking or crusting for several days while the surface heals, followed by pinkness that settles gradually. Skin on the neck and chest heals more slowly than facial skin, so settings are chosen conservatively and the recovery is planned around your calendar rather than squeezed into it.

For both. Sun avoidance and sunscreen afterwards are not optional. Treated skin is temporarily more vulnerable to pigment change, and continued protection is what makes the improvement last.

What are the benefits, risks and alternatives?

What are the benefits, risks and alternatives?

TopicKey points
Potential benefitsLess mottled redness, fewer visible vessels, more even colour and smoother looking skin across the neck and upper chest.
Expected temporary effectsWarmth, redness, swelling and tenderness. Bruising after some vascular settings. Flaking or crusting after resurfacing.
Less common risksBlistering, temporary or lasting change in skin colour, redness that persists longer than expected, infection, and rarely scarring. Risk of pigment change is higher in deeper skin tones and higher on the neck than on the face.
What treatment does not doIt does not make the skin immune to further sun damage, and it does not stop new vessels forming. This is a benign condition that is improved, not cured.
AlternativesSun protection alone, camouflage cosmetics, topical care for part of the pigment, or choosing no procedure at all, which is entirely reasonable because the condition is harmless.
What you can gainLess blotchy redness, fewer visible veins, more even colour, and smoother looking skin on the neck and upper chest.
What is normal afterwardsWarmth, redness, swelling and tenderness. A bruise, with some vascular settings. Flaking or crusting after resurfacing.
Less common risksBlisters. A change in skin colour, which is usually temporary but can last. Redness that drags on. Infection. Rarely, a scar. The risk of colour change is higher in darker skin, and higher on the neck than on the face.
What it will not doIt does not protect you from future sun damage, and it does not stop new veins appearing. This is improved, not cured.
Other optionsSun protection on its own. Camouflage make up. Creams for some of the brown colour. Or nothing at all, which is a perfectly sensible choice, because the condition is harmless.

Results, and keeping them

Results, and keeping them

Most patients require several treatments for optimal results. Improvement builds between sessions rather than appearing all at once, because the treated vessels clear over a period of weeks and new collagen forms over a period of months.

Results are not permanent in the sense of being immune to what caused the condition. New sun exposure produces new vessels and new pigment. Patients who maintain daily sun protection, keep the neck and chest covered in strong sun, and return for occasional maintenance treatment hold their improvement far longer than those who do not.

Most people need several sessions for the best result. The improvement builds up between sessions rather than arriving all at once. The treated veins clear over a few weeks, and new collagen forms over a few months.

The result is not permanent, in the sense that the cause has not gone away. More sun means new veins and new brown colour. People who use sunscreen daily, keep the neck and chest covered in strong sun, and come back for the occasional top up keep their result far longer than people who do not.

Why Dr. Gallacher

Why Dr. Gallacher

Dr. Gallacher, the founder of the Dermatology and Laser Centre, is a Board Certified Dermatologist and uniquely qualified as one of the few true experts in the use of cosmetic lasers.

She is fellowship trained, and she has served as faculty at Stanford University and UC Davis. Only a small number of board certified dermatologists in the United States combine fellowship training with faculty experience at both institutions.

For a condition like this one, that background shows up in three practical ways. The diagnosis is made by a dermatologist, so a benign poikiloderma is distinguished from the things that can imitate it. The device is matched to the target rather than the target squeezed to fit an available device. And the treatment itself is performed by Dr. Gallacher, not delegated.

Dr. Gallacher founded the Dermatology and Laser Centre. She is a board certified dermatologist, and she is one of the few genuine experts in cosmetic lasers.

She is fellowship trained, and she has taught as faculty at both Stanford University and UC Davis. Very few board certified dermatologists in the United States have all of that.

For a condition like this, that background shows up in three practical ways. A dermatologist makes the diagnosis, so harmless poikiloderma is told apart from the conditions that look like it. The machine is chosen to suit the problem, not the other way round. And Dr. Gallacher does the treatment herself.

OUR APPROACH
Poikiloderma is usually a mixed problem: red vessels, pigment and sun related texture change. I prefer to identify which component is dominant and treat that target rather than using one setting for everything." Dr. Gergana Gallacher
This is usually a mixed problem: red vessels, brown colour, and sun damaged texture, all at once. I would rather work out which part is doing the most and treat that, than use one setting on everything." Dr. Gergana Gallacher
WHAT TREATMENT CAN LOOK LIKE

Illustrative result

What a result can look like

Before and after laser treatment for poikiloderma of Civatte on the neck and chest

Illustration, not a patient photograph. Before and after laser treatment for poikiloderma of Civatte on the neck and chest. It shows the kind of change this treatment is intended to produce. Individual results vary, and no outcome is guaranteed. Photographs of real patients are published only with written consent.

This is a drawing, not a photo of a patient. It shows a before and after for laser treatment of the neck and chest, to give you an idea of the kind of change it aims at. Results are different for everyone, and nothing is guaranteed. We only publish photos of real patients with their written permission.

COMMON QUESTIONS

Questions patients ask

Is redness of the neck and chest dangerous?

Is this dangerous?

No. Poikiloderma of Civatte is benign. It does not become skin cancer. However, the same skin has had a great deal of sun, and any separate new, changing, bleeding or unusual lesion in the area should be examined medically rather than treated cosmetically.

No. It is harmless and it does not turn into skin cancer. But this skin has had a lot of sun. If there is a separate spot that is new, changing, bleeding or odd, get it looked at properly rather than treated cosmetically.

Why is the skin under my chin less affected?

Why is the skin under my chin unaffected?

Because your chin shades it. That single detail is one of the most useful diagnostic signs in dermatology, and it is also the clearest evidence that sunlight is the main driver.

Your chin shades it. That one detail is one of the most useful clues in skin medicine, and it is the clearest proof that sunlight is the main cause.

Can creams or supplements get rid of it?

Can creams get rid of it?

There are no miracle oral supplements or topical ointments to rid you of this benign condition. Sun protection and good topical skin care can improve part of the pigment and stop the condition progressing, which is genuinely worth doing. The visible vessels and the thinning of the skin, however, respond to laser rather than to creams.

No. There is no miracle pill and no miracle ointment for this. Sun protection and good skin care can improve some of the brown colour and stop it getting worse, which is worth doing. But the visible veins and the thinned skin need a laser, not a cream.

How many treatments will I need?

How many treatments will I need?

Most patients require several treatments for optimal results. The exact number depends on how much redness and how much pigment is present, which device is chosen, and how your skin responds. Dr. Gallacher will give you a plan after assessing your skin, and she will not promise a number before then.

Most people need several for the best result. How many depends on how much redness and how much brown colour you have, which machine is used, and how your skin responds. Dr. Gallacher gives you a plan after looking at your skin. She will not promise a number before that.

Will the redness come back?

Will it come back?

The condition itself does not switch off. New sun exposure produces new vessels and new pigment over time. Long term sun protection and occasional maintenance treatment are what preserve the improvement.

The condition does not switch itself off. More sun means new veins and new colour over time. Long term sun protection and the occasional top up treatment are what keep the result.

Can the VBeam and the Erbium be combined?

Can the two treatments be combined?

Yes, and for mixed poikiloderma this is common. They may be staged or combined depending on how much redness and how much photodamage there is, and the interval between them is decided for you individually rather than by a fixed protocol.

Yes, and for mixed cases that is common. She may do them together or in stages, depending on how much redness and how much sun damage there is. The gap between them is worked out for you, not set by a fixed rule.

Which lasers does Dr. Gallacher use for this?

Which lasers does Dr. Gallacher use?

The VBeam pulsed dye laser and the Erbium laser. The VBeam addresses the redness and the visible vessels. The Erbium addresses texture and surface photodamage. Which leads depends on your skin.

The VBeam pulsed dye laser and the Erbium laser. The VBeam deals with the redness and the visible veins. The Erbium deals with rough texture and sun damage. Which one leads depends on your skin.

Does Dr. Gallacher perform the laser herself?

Does Dr. Gallacher do the laser herself?

Yes. Every laser treatment is performed by Dr. Gallacher. It is not delegated to a technician, a nurse or an assistant.

Yes. She does every laser treatment. It is not passed to a technician, a nurse or an assistant.

Does it hurt?

Does it hurt?

VBeam pulses are brief and the device sprays coolant immediately before each pulse, which most patients find makes the treatment comfortable. Erbium resurfacing is more involved and topical anaesthetic is used.

The VBeam fires very short pulses and sprays coolant just before each one, which most people find makes it comfortable. Erbium resurfacing is a bigger procedure, so numbing cream is used.

Can I have this treated in summer?

Can I have this done in summer?

It is possible, but it is not ideal. Treated skin is temporarily more prone to pigment change, and this is an area that is difficult to keep out of the sun in warm weather. Autumn and winter are usually the better time to start.

You can, but it is not the best timing. Treated skin changes colour easily for a while, and this is a hard area to keep covered in warm weather. Autumn and winter are usually a better time to start.

DERMATOLOGY AND LASER CENTRE ยท DANVILLE, CA

Talk it through with a physician first.

Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.

This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.

  • American Board of Dermatology
  • American Society for Dermatologic Surgery
  • American Society for Laser Medicine and Surgery
  • American Academy of Dermatology
  • Stanford Medicine
  • University of California, Davis
  • University of California, San Francisco
  • Castle Connolly Top Doctors since 2018