Poikiloderma is that red, sun-damaged skin you see on the necks and upper chests of fairskinned people who have loved the sun. It’s easy to improve!

Poikiloderma, or more correctly Poikiloderma of Civatte, is an odd and exotic-sounding name for a skin condition so common in Australia that we all assume it to be pretty normal.

That is, if you are “red neck”

Because this is the medical term for a red, chronically sundamaged neck and decolletage.

People of Celtic background who grow up in Australia spending a lot of time in the sun will often manifest a definite patch of red skin on the sides of their necks, generally on the anterior surface of the sternomastoid muscle bilaterally. There will often be a similar patch on the top of the sternum if that person had been in the habit of wearing an open-necked shirt or blouse.

In the 19th century, many impoverished and uneducated people from Scotland and Ireland migrated to mid-west America to work on the farms. These white-skinned folk, toiling outdoors on farms, without modern sunscreens, obviously developed a lot of poikiloderma whilst maintaining themselves in poverty and failing to get an education. Hence the term “red-neck”, with all its shades of meaning.

Poikiloderma is straightforward to improve, impossible (at present) to perfectly cure. Its brightness and colour can be substantially reduced with IPL treatments. Several are needed, with each treatment paring back the redness a little more, although even one will lead to an improvement. The often sharp border between the poikiloderma and the surrounding skin is softened, and the affected skin looks more even and normally tanned with each treatment. However, we cannot make the skin white again, nor make it perfectly match the unaffected skin often directly adjacent to it. One must celebrate that the previously dry glass is suddenly half full, rather than lament that the glass is still half empty.

Because small areas are typically affected, treatments are fairly brief and thus inexpensive. The affected areas, almost by definition, are commonly on display, and so treatment is very worthwhile.