Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms

Ji, Yong-Zhi; Liu, Shi-Rui

doi:10.1042/bsr20193266

Cited by 63 publications

(63 citation statements)

References 104 publications

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“…Additionally, there were significantly higher H‐score mean values between psoriasis lesion and perilesional epidermis when compared to control groups. Our results agreed with previous studies which found that perilesional psoriatic skin is prone to develop psoriasis lesions which may explain koebnerization 24 …”

Section: Discussionsupporting

confidence: 93%

Smad7 in psoriasis vulgaris patients: A clinical and immunohistochemical study

Hemida

Hammam

Salman

et al. 2020

J of Cosmetic Dermatology

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Background Psoriasis is an inflammatory disease that is mostly immune‐derived. It causes proliferation of skin cells, forming plaques. Psoriasis etiology is unknown. It might be multifactorial. Aims This work aimed to study Smad7 expression in psoriasis vulgaris patients in comparison with normal skin. Patients/Methods Thirty patients with psoriasis vulgaris in comparison with 20 age‐ and sex‐matched seemingly healthy individuals were selected. We used psoriasis area and severity index (PASI) to evaluate psoriasis severity. Skin biopsies were prepared from skin lesions (30), perilesions (30) and control (20) groups for histopathological and immunostaining evaluation of Smad7. Results Smad7 was progressively upregulated in proliferating keratinocytes from controls (58.18 ± 30.93) to perilesional (106 ± 38.93) and lesional (156.33 ± 62.01) skin (P < .001). Also, dermal inflammatory cells showed upregulation of Smad7 expression from control skin (40 ± 28.28) to skin lesions (137.33 ± 73.86) (P < .010). Smad7 expression showed a positive significant correlation with psoriasis severity (r = .452; P < .012). Conclusion Smad7 may be involved in increased keratinocyte proliferation as well as skin inflammation in psoriasis vulgaris patients.

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Section: Discussionsupporting

confidence: 93%

Smad7 in psoriasis vulgaris patients: A clinical and immunohistochemical study

Hemida

Hammam

Salman

et al. 2020

J of Cosmetic Dermatology

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“…The Köebner phenomenon after breast surgery is uncommon and generally associated with the occurrence of psoriatic lesions 2,7 ; however, there are descriptions of the phenomenon after radical mastectomy 8 , bilateral prophylactic mastectomy and reconstruction with prostheses 7 , and after skin-sparing mastectomy with immediate reconstruction, using prosthesis and latissimus dorsi muscle f lap 9 . To our knowledge, the cases reported in the current study are the first descriptions of this phenomenon after breast oncoplastic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology underlying the Köebner phenomenon remains inconclusive, despite the frequent observation of epidermal cell damage associated with the inflammatory dermal reaction 2,7 , but experimental studies involving its induction have shown divergent results when it comes to the clinical manifestations of the lesions 2 . Thus, physical, biochemical, and immunological factors can also be associated with the occurrence of the Köebner phenomenon and contribute to the diversity of clinical presentations seen in the literature 2,4,10 .…”

Section: Discussionmentioning

confidence: 99%

“…Vitiligo is characterized as an acquired disorder that progresses with chronic changes in the pigmentation of the skin and fanera, due to the functional loss of melanocytes 3 . The etiology of vitiligo is still not completely elucidated, although there are autoimmune and genetic components capable of activating the disease, as well as epigenetic features capable of triggering the disease by means of environmental factors 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Although the Köebner phenomenon is relatively common in the surgical field, reports of its occurrence after breast surgery are scarce in the literature. In addition, it is usually associated with the occurrence of psoriatic lesions, which makes its presentation in the form of vitiligo even more unusual 4,7 . Thus, the objective of this study was to describe two cases of vitiligo as an initial manifestation of the Köebner phenomenon after breast oncoplastic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Vitiligo as a Köebner phenomenon after oncoplastic breast surgery

Paulinelli¹,

Soares

Seba

2020

Mastology

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The Köebner phenomenon is characterized by the appearance of several types of dermatological lesions after traumatic stimulation. The triggering of this phenomenon after breast surgery is uncommon and usually associated with psoriatic lesions. The aim of this study was to describe two cases of vitiligo as the initial manifestation of Köebner phenomenon after breast oncoplastic surgery. Case 1: female, 41 years old, no history of dermatological pathologies, presenting with tubular carcinoma in the right breast. Quadrantectomy and sentinel lymph node biopsy were performed, followed by reconstruction with mammoplasty. Later, the patient started on tamoxifen and underwent radiotherapy, without complications. Thirty days after treatment, the patient presented progressive depigmentation of the areola-papillary complex. Topical treatment was started with dermatological ointment tacrolimus monohydrate and, after one year, the condition was completely resolved. Case 2: 52-yearold woman with previous history of vitiligo on the face, with complete clinical response after dermatological treatment. She was diagnosed with ductal carcinoma in situ on the left breast and underwent quadrantectomy, by means of mammoplasty using the round block technique. Afterwards, she underwent radiotherapy and started tamoxifen. Four years after the surgery, she developed dyschromia in the ipsilateral periareolar region and was diagnosed with vitiligo. Local dermopigmentation was offered, but the patient opted for an expectant conduct and clinical follow-up. To our knowledge, this is the first description of Köebner phenomenon after breast oncoplastic surgery. In these cases, the therapeutic approach must be multidisciplinary and count on the assessment of multiple clinical and individual parameters.

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Colostomy Bag–Induced Koebner Phenomenon

2020

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A man in his 60s presented with a 2-month history of an asymptomatic peristomal rash. A colostomy had been performed 1 year previously on the left side of the abdomen in the setting of adenocarcinoma of the colon. He had a known history of mild plaque psoriasis for several years, controlled with topical corticosteroids. A skin examination revealed sharply demarcated erythematous plaques of different sizes, with silvery scale, distributed concentrically around the stoma (Figure ), beneath and beyond the adhesive tape used to affix the colostomy bag. Psoriatic lesions were present on his elbows and legs. The patient had previously been treated with moisturizers and topical antifungal creams by his enterostomal nurse without any improvement. A clinical diagnosis of peristomal koebnerization of psoriasis was made. The patient was treated with 0.005% calcipotriol/0.05% betamethasone dipropionate gel, with complete healing of all lesions.Koebner phenomenon, also known as isomorphic response, is characterized by the appearance of lesions on healthy skin as a consequence of cutaneous trauma. 1 Patients with a cutaneous disease who are stressed by different types of stimuli may develop lesions of the same kind as their preexisting skin disorder (isomorphic). The interval between injury and the development of lesions can be days to months in duration. 1 The pathogenesis of this phenomenon is not well understood. The release of inflammatory mediators following epidermal and dermal injury, in combination with a genetic predisposition, may trigger this reaction. 2 True koebnerization is mainly seen in patients with psoriasis, lichen planus, and vitiligo. Almost 25% of patients with psoriasis experience Koebner phenomenon. 1 In the present case, repeated trauma related to the colostomy bag likely elicited this response.Koebner phenomenon should be distinguished from other cutaneous phenomena. It is different from pathergy, which describes a disproportionate cutaneous injury at a site of minimal trauma, as can be seen in pyoderma gangrenosum or Behçet disease. 1 The phenomenon of a new, unrelated dermatosis appearing in the same location as a previously healed cutaneous disorder, usually herpes zoster, is referred to as the Wolf isotopic response. 3 Peristomal skin complications are common and include a wide variety of etiologic factors such as infectious and inflammatory dis-orders and even malignant tumors. 4 An important differential diagnosis for peristomal complications induced by trauma is pyoderma gangrenosum, particularly in the setting of painful papules progressing rapidly toward ulceration. However, the most frequent origin of peristomal rash is irritant contact dermatitis. If persistent, patch tests should be performed to rule out allergic contact dermatitis, which accounts for a smaller percentage of cases. 4 Koebner phenomenon is a rather frequent cutaneous complication. To avoid a delayed diagnosis, one must consider the possibility of koebnerization in patients with a preexisting skin condition.

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Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms

Cited by 63 publications

References 104 publications

Smad7 in psoriasis vulgaris patients: A clinical and immunohistochemical study

Smad7 in psoriasis vulgaris patients: A clinical and immunohistochemical study

Vitiligo as a Köebner phenomenon after oncoplastic breast surgery

Colostomy Bag–Induced Koebner Phenomenon

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