Koebner Phenomenon in Vitiligo: Not Always an Indication of Surgical Failure

Vitiligo on tribal mark: A demostration of Wolf’s isotopic response

“…The presence of the vitiligo on the scar of both cheeks also diminished the possibility of an association with herpes zoster which is likely to be dermatomal and unilateral. The healed scars of varicella, herpes simplex, scrofuloderma and striae distense have also been associated with wolf's isotopic response [4,8]. Our patient does present differently with the healed scar of a tribal mark.…”

“…Opinion varies on whether koebner phenomenon could impede the surgical management of vitiligo, since the associated surgical injury at the donor site can initiate new vitiligo lesion. However in the stable state it is believed such injury may not induce new lesions [4]. While inflicting injury could results in the development of new lesions, it can also lead to the clearance or healing of an existing skin lesion.…”

Surgical Treatment of Vitiligo

“…However, it should be remembered that the Koebner phenomenon is fluctuating: people who have not observed such tendencies before may become Koebner-positive during their lifetime [78]. For this reason, Koebnerization is often precluding the possibility of surgical treatment in patients with vitiligo [81]. Another factor that should be taken into account in those who are considering surgery is the medications that the patient is taking.…”

Stability: Concept, relevance, inducing and maintaining it

“…In spite of clinical stability, Koebnerization at the donor site was seen in 15 of 261 patients treated with noncultured epidermal suspension during 3 years at the National Center for Vitiligo and Psoriasis. Even among these 15 cases, 12 of them showed repigmentation at the recipient areas in spite of koebnerization at the donor site 23 …”

“…However, the observations described in the literature also contain many uncertainties and discrepancies. For example, when we look at surgical outcomes in patients reporting KP, it is reported that the presence of KP at the donor site resulting in its depigmentation does not necessarily portend a poor prognosis for regimentation in the recipient area 23 …”