This is mainly in response to Matilda. Yes, I do believe what you have is poikiloderma. I think the surefire way to tell for sure is when you raise your
neck upward, does it appear worse? You will not only have the little bumps (which are raised hair follicles) but you also have what appear to be lines, almost rows of raised skin, that run in a horizontal pattern. You may also have slightly indented areas in between the "rows" of skin. Basically, it is atrophy of the skin on the neck and chest and unfortunately, there is little you can do to correct it. You can prevent further damage by consistent use of high SPF physical sunscreen that is made of zinc oxide/titanium dioxide. Stay away from chemical sunscreens.
I would also stay away from any type of laser treatments. It is too risky in regards to side effects and the outcome could be disasterous if the settings are too high. As I had mentioned in my previous post, I had spot treatment done to remove some angiomas on my neck and chest (which healed fine) but the esthitician also treated some spots on my face and though I was fine initially, it did produce very bad results in my cheek area a few month down the road. I suffered all winter long with burning, tingling sensations and advanced rosacea where I never had it prior to IPL.
I am trying to now get that under control and then I will try again to work on the Poikiloderma, however, I will be doing it with topical treatments only. I found the so called "experts" (derms and esthiticians) really have little or no knowledge about the condition and how to go about treating it. All the things I have had done by them probably did more harm than good.
I think Retin A is your best bet for now. I did try it (Tretinoin) over the summer for a couple of weeks but it was too much for me at the time. I was still recovering from the IPL, plus I had a focal TCA peel to remove a keratosis on the front of my neck and it was all too much at once. I did fine initially on the Tretinoin but gave up when it produced too much irritation/redness. I did go through the flaky stage, which can be kind of a hassle because you get little flecks of skin falling off your neck onto your clothes, so be prepared to moisturize to combat that.
I am going to try the Retin A again and try to stick with it for the long haul. I understand it can take 6 months to see results and you do have to go through some side effects (redness, peeling, flaking, etc) before you see improvement.
As far as you thinking you are vain because you are concerned about the appearance of this condition, you are far from it and I know how it must make you feel. I know in my situation, it has caused me to be extremely self concious. I must have spent countless hours on the internet hoping there would be something I could do to fix it. I have spent more money than I really could afford in my attempt to improve the appearance, only to come out defeated. My face is pretty youthful looking and from a distance you would not know I have this condition but up close it looks horrible. It's such a contrast from my face to my neck and I am limited in so many ways in my wardrobe -T-shirts are out of the question because anything with a collar that rubs up on the front of my neck irritates it and makes it look worse. I cannot ever wear an open neck blouse that fully exposes my neck and chest. I basically stick to v-neck type shirts as it seems to draw attention away from it. I have to be careful what type of lighting I am in and I cringe when I have to talk to someone face to face in lighting that fully accentuates the awful texture. To me it is very distressing and what I would consider cosmetically disfiguring. I don't date and I rarely go out anymore because of it. I thought I was over-reacting but I during a consult with one of the esthticians, she was very honest with me and told me it was the worst case she has seen. She said the red flushing can be treated but the textural issues are almost impossible to improve. She told me chemical peels might offer some improvement but I would have to have several and there is always the risk of scarring, hyper and hypo pigmentation. She told me to just accept it and concentrate on my good features. I am trying to do that but it can be very difficult.
It would be great if there was some type of support group for this condition where we could all exchange ideas and information. So far, I have met a few people on different skin care forums who have this and have had some very limited success in treating it. One lady used 302 products with some degree of success but it took a very long time. Another lady had used a dermabrasion kit along with retin A to produce a peeling effect. She said it cured it temporarily but it sounds like it could be harsh form of treatment if used on sensitive skin. Of course, if you come across anyone else who has this and has some degree of success in treating it, let me know. Likewise, I will let you know if I come up with anything. Sorry you have to go through this but maybe your case isn't as bad as you think and it's good that you are looking into options now. Best of luck to you!