Dermatological conditions are a frequent reason for consultation in primary care. Poikiloderma of Civatte (PC) is an underrecognized cutaneous disorder characterized by chronic hyper- and hypopigmentation, telangiectasias, and superficial atrophy. Awareness of this entity is important for early recognition and appropriate management.A 70-year-old woman with fair skin phototype and medical history of hypertension, dyslipidemia, and osteoporosis presented to primary care with one-year history of hyperpigmented macules on the anterior and posterior infracervical regions and both forearms. She denied pruritus or other associated symptoms. Physical examination confirmed reticulated hyperpigmented lesions in the neck and décolletage area, without involvement elsewhere. Laboratory and endoscopic studies ruled out secondary causes of hyperpigmentation. She was referred to dermatology, where the main differential diagnoses were lichen planus pigmentosus or post-inflammatory pigmentation due to photosensitivity. Daily topical clobetasol and strict photoprotection were prescribed. Subsequent follow-up allowed confirmation of the diagnosis of Poikiloderma of Civatte.This case highlights an uncommon but clinically relevant dermatological entity in primary care, often misdiagnosed due to its subtle presentation and similarity to other hyperpigmentation disorders. While PC is benign, its cosmetic impact can be significant and progression is typically irreversible.Early recognition of PC allows appropriate counseling on photoprotection and management, avoiding unnecessary investigations. Clinicians should consider PC in postmenopausal women presenting with reticulated pigmentation in sun-exposed areas, especially the neck and chest.PC predominantly affects sun-exposed regions in fair-skinned individuals over 40 years, with higher prevalence in postmenopausal women. Etiology is multifactorial, including ultraviolet radiation, hormonal changes, contact sensitization from perfumes or cosmetics, and intrinsic aging. Diagnosis is primarily clinical, supported by histology which is characteristic but not pathognomonic.Poikiloderma of Civatte is a common, acquired, benign skin disorder with progressive course. Awareness in primary care is essential to provide early management, reduce cosmetic concerns, and prevent misdiagnosis.