Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 19 February 2026
Poikiloderma of Civatte and chest pigmentation more broadly are recognised medical conditions, and more than one cause can look similar. This page is general information, not a diagnosis. Dr Garara will assess your skin and history in person. Some pigmented lesions on the chest can indicate skin cancer or other conditions and benefit from dermatological or GP review before aesthetic treatment.
Pigmentation on the chest is rarely a single colour or pattern. It usually combines hyperpigmentation (discrete age spots, dense freckling, and patchy darkening from cumulative UV), a vascular component (broken capillaries and chronic redness), and skin atrophy (thinning and crepiness of the décolletage skin).
When all three are present in a characteristic horseshoe pattern on the sides of the neck and central chest, the clinical name is Poikiloderma of Civatte.
Dr Bhavin Garara’s approach is to assess which components are present and treat each with the appropriate tool. The clinic does not use aggressive deep chemical peels in this area because of the chest’s scarring sensitivity.
A typical Poikiloderma of Civatte presentation shows:
A horseshoe-shaped area of involvement on the sides of the neck and central V of the chest.
A mix of red, brown, and pinker patches rather than uniform colour.
Visible broken capillaries close to the surface.
A thinned, crepey skin texture.
Often a sharp contrast at the jawline (skin under the chin that is shaded is spared).
The dominant cause. Years of unprotected exposure to the chest add up. The pattern often spares skin that is consistently shaded.
Some fragrances and cosmetics applied to the chest can interact with UV and worsen pigmentation. The chest is a common site for “perfume dermatitis.”
Hormonal pigmentation patterns occasionally appear on the chest, particularly in patients with melasma.
Lighter Fitzpatrick types show pigment and redness sooner; darker types tend to show post-inflammatory pigmentation in response to UV.
Cumulative damage shows over decades.
At the clinics in London, Dr Garara assesses which components are present (pigment, vascular, atrophic), the Fitzpatrick type, the presence of any suspicious lesions warranting review, and your daily SPF habits. The plan usually combines pigment-clearing laser, vascular-clearing laser, and regenerative support — often over several sessions with conservative settings to protect the chest from post-inflammatory pigmentation or scarring.
Prevention
Consistent daily habits are the foundation of any chest-pigmentation plan and prevent recurrence after treatment.
Prevention
Consistent daily habits are the foundation of any chest-pigmentation plan and prevent recurrence after treatment.
Features
Picosecond laser, vascular laser, regenerative skin treatments, non-ablative laser resurfacing, and a medical-grade topical regimen.
Treatment is layered — pigment-clearing laser, vascular-clearing laser, regenerative support, surface resurfacing, and a daily topical regimen — chosen by which components are present.
For discrete age spots and diffuse pigmentation on the chest, PicoSure Pro delivers very short pulses of light energy designed to break down melanin clusters with reduced thermal effect — important on the chest, which scars more readily than the face. Multiple sessions are typically needed.
For the redness component of Poikiloderma — broken capillaries and chronic diffuse redness — Derma V targets visible blood vessels. Often combined with picosecond laser in alternating sessions for combined pigment-plus-vascular presentations.
To address the atrophic component (thin, crepey chest skin), polynucleotides (Rejuran®), PDRN, multi-ingredient skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes support fibroblast activity and dermal density.
For diffuse dullness and superficial pigmentation, MultiFrax (a 1927nm non-ablative laser) refines the surface with a few days of mild flaking.
Niacinamide, vitamin C, tranexamic acid, and gentle retinoids on the chest skin support pigment control over months and reduce recurrence. Patience and consistency are key.
Treatment for higher Fitzpatrick skin types (IV–VI) requires careful device selection and conservative settings to reduce the risk of post-inflammatory hyperpigmentation or, in some cases, keloid scarring. Dr Garara has particular experience in aesthetic medicine for skin of colour and tailors device choice, energy levels, and treatment intervals accordingly.
For discrete age spots and diffuse pigmentation on the chest, PicoSure Pro delivers very short pulses of light energy designed to break down melanin clusters with reduced thermal effect — important on the chest, which scars more readily than the face. Multiple sessions are typically needed.
See full treatment page: PicoSure ProBook a consultation with Dr Bhavin Garara.
Book a Consultation| Treatment | Best suited for | Typical downtime | How long results last | What it does |
|---|---|---|---|---|
| Picosecond laser | Age spots and diffuse pigmentation | 1–5 days of darkening / flaking | Long-lasting with daily SPF | Breaks down melanin clusters |
| Vascular laser | Redness, broken capillaries, Poikiloderma | 1–3 days of mild redness or swelling | Long-lasting | Targets visible blood vessels |
| Regenerative skin treatments | Atrophy, thin chest skin | 1–2 days of mild bumps | Around 6–12 months with a course | Supports dermal density |
| Non-ablative laser resurfacing | Diffuse dullness and superficial pigment | A few days of flaking | Long-lasting; results continue developing for months | Resurfaces the top layer |
| Medical-grade topical regimen | Daily foundation, prevention of recurrence | None | Ongoing with consistent use | Manages pigment over months |
Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.
Pigment and vascular treatments are widely performed on the chest, but the décolletage scars more readily than facial skin. Conservative settings, careful test patches, longer intervals between sessions, and consistent SPF are essential. Post-inflammatory hyperpigmentation in skin of colour is a real risk and is managed by device choice and protocol tailoring.
We share this not to alarm you but because patients deserve full information. Dr Garara is happy to discuss specific risks at consultation. New, changing, or asymmetric lesions warrant GP or dermatological review before aesthetic treatment.
Common questions about treating chest pigmentation.
Chest pigmentation often appears alongside other concerns. You may also want to read about:
For an overview of all the facial concerns we treat, visit our Hands, neck and décolletage hub.
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This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.
