DOCSLIB.ORG

Reverse Koebner Phenomenon in Vasculitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Reverse Koebner Phenomenon in Vasculitis [Downloaded free from http://www.e-ijd.org on Monday, December 05, 2011, IP: 14.99.170.50] || Click here to download free Android application for this journal Correspondence Management of urticaria. Allergy 2006;61:321-31. 2. Hurst M, Spencer CM. Ebastine: An update of its use in allergic disorders. Drugs 2000;59:981-1006. 3. Sastre J. Ebastine in allergic rhinitis and chronic idiopathic urticaria. Allergy 2008;63:1-20. 4. Godse KV. Updosing of antihistamines to improve control of chronic urticaria. Indian J Dermatol Venereol Leprol 2010;76:61-2. 5. Frossard N, Benabdesselam O, Purohit A, Mounedji N, Pauli G. Activity of ebastine (10 and 20 mg) and cetirizine at 24 hours of a steady state treatment in the skin of healthy volunteers. Fundam Clin Pharmacol 2000;14:409-13. 6. Magerl M, Schmolke J, Metz M, Zuberbier T, Siebenhaar F, Maurer M. Prevention of signs and symptoms of dermographic urticaria by single-dose ebastine 20 mg. Clin Exp Dermatol Figure 1: Multiple purpuric lesions present all over the legs, barring the 2009l;34: E137-40. area over left upper leg which was covered by pressure bandage. Arrow points to the site of biopsy 7. Gillen MS, Miller B, Chaikin P, Morganroth J. Effects of supratherapeutic doses of ebastine and terfenadine on the QT interval. Br J Clin Pharmacol 2001;52:201-4. complain of arthralgia, abdominal pain, dyspnea or any other significant systemic symptom. On examination, multiple Access this article online palpable purpura were present over both legs extending up Quick Response Code: to the thighs. There was no ulceration, necrosis, vesiculation Website: www.e-ijd.org or livido reticularis. Systemic examination was normal. Complete hemogram, liver function tests, kidney function tests, serum electrolytes, urine routine examination, DOI: 10.4103/0019-5154.87168 stool for occult blood and chest X-ray did not reveal any abnormality. Anti-nuclear antibodies and rheumatoid factor were negative. Histopathological examination of a skin biopsy specimen taken from the purpuric lesion on left leg showed features consistent with leukocytoclastic vasculitis. Direct immunofluorescence of another skin biopsy specimen showed IgG immune complex and C3 REVERSE KOEBNER complement deposits in vessel walls. Patient returned for follow-up after 10 days. Till then, she had not opened the PHENOMENON IN pressure bandage applied at the biopsy site. After removal LEUKOCYTOCLASTIC VASCULITIS of the bandage, we observed that the vasculitic lesions in the bandage covered areas had disappeared [Figure 1]. S Yadav, D De, A J Kanwar There were many new lesions elsewhere over the limbs, barring the area which was covered by the bandage. From the Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, The exact etiopathogenesis of Koebner phenomenon and Chandigarh, India. E-mail: [email protected] reverse Koebner phenomenon are poorly understood. Koebner phenomenon has been recently reviewed by Weiss Indian J Dermatol 2011:56(5):598-9 et al.[5] Koebnerization can be induced by various modes Sir, of trauma. Chronic pressure leading to both epidermal Heinrich Koebner described Koebner phenomenon and dermal injury is known to elicit Koebner response.[6,7] for the first time in psoriasis patients.[1] Since then, it There are few reports of Koebner phenomenon occurring has been reported in various dermatoses. Contrary to in patients with vasculitis.[8,9] However, there is no previous Koebner phenomenon, reverse Koebner response is the report of reverse Koebner phenomenon in vasculitis. nonappearance or disappearance of the lesions of particular Reverse Koebner phenomenon is a rarely reported entity. dermatoses at the site of injury. It is a very rare condition It was first described in psoriasis patient[2] and subsequently with only few cases reported till date.[2-4] We present to the reported in vitiligo cases.[3] Our understanding of reverse best of our knowledge, the first case of reverse Koebner Koebner phenomenon is poor because of its scant phenomenon occurring in a patient of cutaneous small occurrence and limited research into its pathogenesis. vessel immune complex vasculitis. In our patient, purpuric lesions cleared and new lesions A 32-year-old female patient presented to our outpatient failed to appear at the pressure site, probably because department with recurrent crops of reddish palpable spots the mechanical pressure led to diminished blood flow in over both the lower limbs for last 6 months. She did not the small vessels of dermis and the immune complexes Indian Journal of Dermatology 2011; 56(5) 598 [Downloaded free from http://www.e-ijd.org on Monday, December 05, 2011, IP: 14.99.170.50] || Click here to download free Android application for this journal Correspondence failed to deposit in adequate concentration. Consequently, 2Department of Pathology, Kasturba Medical College, 3Derma- adequate immune response was not elicited, which is of care, Skin and Cosmetology Centre, Mangalore, India. E-mail: paramount importance for precipitation of clinical lesion. It [email protected] is difficult to explain the fast clearance of the old lesions Indian J Dermatol 2011:56(5):599-600 covered under the bandage. Sir, Reverse Koebner phenomenon has never been reported A 14-year-old girl presented with an exuberant warty before in vasculitis. Further research is needed to study the brownish growth on her right great toe. A history revealed pathogenesis of this phenomenon. that when she was 4 years old, she had a small similar lesion, a part of which was biopsied by a general surgeon References and was reported as angiokeratoma. 1. Kobner H. Zur aetologie der psoriasis. Vierteljahrsschr Dermatol Examination revealed a solitary hyperpigmented, Syphil 1877;8:559. hyperkeratoic plaque consisting of closely set warty 2. Grekin DA, Van Scott EJ. Dermal role and controls in psoriasis. Arch Dermatol 1973;108:425. papules measuring 3 cm × 3.5 cm involving the pulp space of the right great toe. Surface of the lesion was firm 3. Malakar S, Dhar S. Spontaneous repigmentation of vitiligo patches distant from the autologous skin graft sites: A remote and verrucous with no ulceration, bleeding or atrophy reverse Koebner’s phenomenon? Dermatology 1998;197:274. [Figure 1]. The lesion was non-compressible and diascopy 4. Martin JM, Conde A, Pinazo I, Garcia L, Sanchez AL, Pinazo J, was negative. Regional lymph nodes were not enlarged. et al. Reverse Koebnerization after radiotherapy in a woman Systemic examination was normal. Routine laboratory with a mastectomy for a breast carcinoma. J Am Acad Dermatol investigations and X-ray chest were also found to be 2006;55: S90-1. normal. 5. Weiss G, Shemer A, Trau H. The Koebner phenomenon: Review of the literature. J Eur Acad Dermatol Venereol 2002;16:241-8. The patient was then considered for surgery. A wide 6. Farber EM, Roth RJ, Aschheim E, Eddy DD, Epinette WW. Role local excision of the lesion was done and the defect was of trauma in isomorphic response in psoriasis. Arch Dermatol closed by an islanded plantar digital artery flap in a V-Y 1965;91:246-51. fashion adjacent and just prominal to the excision wound. 7. Bernstein EF, Kantor GR. Treatment-resistant psoriasis due to The excised specimen was sent for histopathological a mastectomy sleeve: An extensive Koebner response. Cutis examination. We considered a clinical diagnosis of 1992;50:65-7. tuberculosis verrucosa cutis and angiokeratoma. 8. De D, Dogra S, Kanwar AJ. Isomorphic response of Koebner in a patient with cutaneous small vessel vasculitis. J Eur Acad Hematoxylin and eosin stained section of the specimen Dermatol Venereol 2008;22:1125-6. showed marked hyperkeratosis, parakeratosis, 9. Chan LS, Cooper KD, Rasmussen JE. Koebnerization as a papillomatosis, and elongation of the rete ridges. To our cutaneous manifestation of immune complex-mediated vasculitis. surprise, it extended from the derma-epidermal junction J Am Acad Dermatol 1990;22:775-81. into the deeper dermis, where numerous small to large vascular channels were seen lined by flattened endothelial Access this article online cells and filled with blood. Intervening dermal fibrosis and Quick Response Code: chronic inflammatory infiltrate was also present [Figure 2]. Website: www.e-ijd.org This is not a finding of angiokeratoma as it involves only the papillary dermis without any extension to the deep dermis and the subcutaneous fat. DOI: 10.4103/0019-5154.87169 Based on this clear histopathological evidence, a correct diagnosis of verrcuous hemangioma was made which had earlier been interpreted as angiokeratoma on superficial biopsy. Verrucous hemangioma is a rare variety of angiomatous nevi usually involving the lower extremities.[1] Lesions are VERRUCOUS HEMANGIOMA OR mostly seen at birth or appear during childhood. Initially, they are soft, bluish-red vascular lesion, but with time they ANGIOKERATOMA? A MISSED enlarge and develop keratotic and verrucous features.[2] DIAGNOSIS Clinically verrucous hemangioma simulates angiokeratoma, but histopathologically they can be clearly differentiated as 1 2 3 S Pavithra, H Mallya , H Kini , G S Pai the former involves the dermis and subcutaneous fat and the latter involves only the papillary dermis.[1] From the Derma-care, Skin & Cosmetology Center, 1Departments of Obstetrics and Gynaecology, The K S Hegde Medical Academy, This differentiation is important for the management of 599 Indian Journal of Dermatology 2011; 56(5).
Load more

Recommended publications
  • Psoriasis, a Systemic Disease Beyond the Skin, As Evidenced by Psoriatic Arthritis and Many Comorbities
    1 Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many Comorbities – Clinical Remission with a Leishmania Amastigotes Vaccine, a Serendipity Finding J.A. O’Daly Astralis Ltd, Irvington, NJ USA 1. Introduction Psoriasis is a systemic chronic, relapsing inflammatory skin disorder, with worldwide distribution, affects 1–3% of the world population, prevalence varies according to race, geographic location, and environmental factors (Chandran & Raychaudhuri, 2010; Christophers & Mrowietz, 2003; Farber & Nall, 1974). In Germany, 33,981 from 1,344,071 continuously insured persons in 2005 were diagnosed with psoriasis; thus the one year prevalence was 2.53% in the study group. Up to the age of 80 years the prevalence rate (range: 3.99-4.18%) was increasing with increasing age and highest for the age groups from 50 to 79 years The total rate of psoriasis in children younger than 18 years was 0.71%. The prevalence rates increased in an approximately linear manner from 0.12% at the age of 1 year to 1.2% at the age of 18 years (Schäfer et al., 2011). In France, a case-control study in 6,887 persons, 356 cases were identified (5.16%), who declared having had psoriasis during the previous 12 months (Wolkenstein et al., 2009). The prevalence of psoriasis analyzed across Italy showed that 2.9% of Italians declared suffering from psoriasis (regional range: 0.8-4.5%) in a total of 4109 individuals (Saraceno et al., 2008). The overall rate of comorbidity in subjects with psoriasis aged less than 20 years was twice as high as in subjects without psoriasis.
    [Show full text]
  • A Resident's Guide to Pediatric Rheumatology
    A RESIDENT’S GUIDE TO PEDIATRIC RHEUMATOLOGY 4th Revised Edition - 2019 A RESIDENT’S GUIDE TO PEDIATRIC RHEUMATOLOGY This guide is intended to provide a brief introduction to basic topics in pediatric rheumatology. Each topic is accompanied by at least one up-to-date reference that will allow you to explore the topic in greater depth. In addition, a list of several excellent textbooks and other resources for you to use to expand your knowledge is found in the Appendix. We are interested in your feedback on the guide! If you have comments or questions, please feel free to contact us via email at [email protected]. Supervising Editors: Dr. Ronald M. Laxer, SickKids Hospital, University of Toronto Dr. Tania Cellucci, McMaster Children’s Hospital, McMaster University Dr. Evelyn Rozenblyum, St. Michael’s Hospital, University of Toronto Section Editors: Dr. Michelle Batthish, McMaster Children’s Hospital, McMaster University Dr. Roberta Berard, Children’s Hospital – London Health Sciences Centre, Western University Dr. Liane Heale, McMaster Children’s Hospital, McMaster University Dr. Clare Hutchinson, North York General Hospital, University of Toronto Dr. Mehul Jariwala, Royal University Hospital, University of Saskatchewan Dr. Lillian Lim, Stollery Children’s Hospital, University of Alberta Dr. Nadia Luca, Alberta Children’s Hospital, University of Calgary Dr. Dax Rumsey, Stollery Children’s Hospital, University of Alberta Dr. Gordon Soon, North York General Hospital and SickKids Hospital Northern Clinic in Sudbury, University
    [Show full text]
  • UC Davis Dermatology Online Journal
    UC Davis Dermatology Online Journal Title Proposed classification for koebner, wolf isotopic, renbok, koebner nonreaction, isotopic nonreaction & other related phenomen. Permalink https://escholarship.org/uc/item/96s656b4 Journal Dermatology Online Journal, 20(11) Authors Kannangara, Ajith P Yosipovitch, Gil Fleischer Jr., Alan B Publication Date 2014 DOI 10.5070/D32011024682 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 eScholarship.org Powered by the California Digital Library University of California Volume 20 Number 11 November 2014 Commentary Proposed classification for koebner, wolf isotopic, renbok, koebner nonreaction, isotopic nonreaction & other related phenomen. Ajith P. Kannangara MD1, Gil Yosipovitch MD PhD2, Alan B. Fleischer Jr MD3 Dermatology Online Journal 20 (11): 12 1Base Hospital Balapitiya, Ministry of Health, Sri Lanka 2Department of Dermatology, Temple University School of Medicine, Philadelphia, USA 3Department of Dermatology, Wake Forest University School of Medicine; Winston-Salem, North Carolina, USA Correspondence: Ajith P. Kannangara, M.D Base Hospital Balapitiya, Ministry of Health, Sri Lanka. E-mail: [email protected] Abstract Students of skin diseases have long noted a variety of disease responses and non-responses to trauma and the presence of structural abnormalities. This article will review the series of these responses including: Koebner phenomenon, Wolf isotopic response, Renbök response, Koebner nonreaction, isotopic nonreaction, and other related skin reactions. Because most of these reported phenomena have similar morphological features the diagnosis is often made on the basis of differences in the clinical presentation. Note that some of the cutaneous reactions of similar phenomena have been described using varied nomenclature, further adding to the confusion.
    [Show full text]
  • Koebner Phenomenon in Rheumatoid Arthritis
    ndrom Sy es tic & e G n e e n G e f T o Yamamoto and Ueki, J Genet Syndr Gene Ther 2013, 4:8 Journal of Genetic Syndromes h l e a r n a r p DOI: 10.4172/2157-7412.1000173 u y o J & Gene Therapy ISSN: 2157-7412 Review Article Open Access Koebner Phenomenon in Rheumatoid Arthritis Yamamoto T1* and Ueki H2 1Department of Dermatology, Fukushima Medical University, Japan 2Department of Dermatology, Kawasaki Medical School, Japan Abstract Koebner phenomenon indicates the newly appearance of isomorphic lesions at the sites of mechanically stimulated or injured skin. This phenomenon can be seen in various inflammatory, auto-immune, viral, fibrotic, and even tumoral disorders. Also, rheumatic diseases such as lupus erythematosus, dermatomyositis, and rheumatoid arthritis (RA) often present with cutaneous manifestations with isomorphic response of Koebner. RA presents with various skin conditions as extra-articular manifestations. Rheumatoid nodule is the representative specific skin lesion which frequently occurs on the hand, elbow, sole, sacrum, occipital area, and so on. These sites are susceptible to both outer and inner mechanical stress. Rheumatoid nodules involve not only skin but internal tissues such as spine, lung, heart valves, and gastrointestinal tract, which are also susceptible to mechanical stress. This isomorphic response may be induced at deeper levels than skin, and thus considered to be “deep” or “internal” Koebner phenomenon. Other than rheumatoid nodules, several specific skin conditions are associated with RA, such as palisaded neutrophilic granulomatous dermatitis and rheumatoid neutrophilic dermatitis, which can be seen on the fingers, elbows, knees and sole.
    [Show full text]
  • Martin Steinhoff Dirk Roosterman, Tobias Goerge, Stefan W
    Dirk Roosterman, Tobias Goerge, Stefan W. Schneider, Nigel W. Bunnett and Martin Steinhoff Physiol Rev 86:1309-1379, 2006. doi:10.1152/physrev.00026.2005 You might find this additional information useful... This article cites 963 articles, 265 of which you can access free at: http://physrev.physiology.org/cgi/content/full/86/4/1309#BIBL Medline items on this article's topics can be found at http://highwire.stanford.edu/lists/artbytopic.dtl on the following topics: Biochemistry .. Transient Receptor Potential Channel Biochemistry .. Endopeptidases Biochemistry .. Proteolytic Enzymes Oncology .. Inflammation Medicine .. Neurogenic Inflammation Physiology .. Nerves Updated information and services including high-resolution figures, can be found at: http://physrev.physiology.org/cgi/content/full/86/4/1309 Downloaded from Additional material and information about Physiological Reviews can be found at: http://www.the-aps.org/publications/prv This information is current as of February 8, 2008 . physrev.physiology.org on February 8, 2008 Physiological Reviews provides state of the art coverage of timely issues in the physiological and biomedical sciences. It is published quarterly in January, April, July, and October by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2005 by the American Physiological Society. ISSN: 0031-9333, ESSN: 1522-1210. Visit our website at http://www.the-aps.org/. Physiol Rev 86: 1309–1379, 2006; doi:10.1152/physrev.00026.2005. Neuronal Control of Skin Function: The Skin as a Neuroimmunoendocrine Organ DIRK ROOSTERMAN, TOBIAS GOERGE, STEFAN W. SCHNEIDER, NIGEL W. BUNNETT, AND MARTIN STEINHOFF Department of Dermatology, IZKF Mu¨nster, and Boltzmann Institute for Cell and Immunobiology of the Skin, University of Mu¨nster, Mu¨nster, Germany; and Departments of Surgery and Physiology, University of California, San Francisco, California I.
    [Show full text]
  • INFECTIOUS DISEASES of HAITI Free
    INFECTIOUS DISEASES OF HAITI Free. Promotional use only - not for resale. Infectious Diseases of Haiti - 2010 edition Infectious Diseases of Haiti - 2010 edition Copyright © 2010 by GIDEON Informatics, Inc. All rights reserved. Published by GIDEON Informatics, Inc, Los Angeles, California, USA. www.gideononline.com Cover design by GIDEON Informatics, Inc No part of this book may be reproduced or transmitted in any form or by any means without written permission from the publisher. Contact GIDEON Informatics at [email protected]. ISBN-13: 978-1-61755-090-4 ISBN-10: 1-61755-090-6 Visit http://www.gideononline.com/ebooks/ for the up to date list of GIDEON ebooks. DISCLAIMER: Publisher assumes no liability to patients with respect to the actions of physicians, health care facilities and other users, and is not responsible for any injury, death or damage resulting from the use, misuse or interpretation of information obtained through this book. Therapeutic options listed are limited to published studies and reviews. Therapy should not be undertaken without a thorough assessment of the indications, contraindications and side effects of any prospective drug or intervention. Furthermore, the data for the book are largely derived from incidence and prevalence statistics whose accuracy will vary widely for individual diseases and countries. Changes in endemicity, incidence, and drugs of choice may occur. The list of drugs, infectious diseases and even country names will vary with time. © 2010 GIDEON Informatics, Inc. www.gideononline.com All Rights Reserved. Page 2 of 314 Free. Promotional use only - not for resale. Infectious Diseases of Haiti - 2010 edition Introduction: The GIDEON e-book series Infectious Diseases of Haiti is one in a series of GIDEON ebooks which summarize the status of individual infectious diseases, in every country of the world.
    [Show full text]
  • Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A
    “Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B.
    [Show full text]
  • PDF Florida Society of Oral Surgeons 2018 Early Oral Cancers And
    10/25/2018 Conflicts of Interests FLORIDA SOCIETY OF ORAL & • Neither my immediate family nor I have any MAXILLOFACIAL SURGEONS financial interests that would create a conflict of interest or restrict our independent judgment 2018 ANNUAL MEETING with regard to the content of this course. EARLY ORAL CANCERS AND PRE-CANCERS & POTPOURRI OF ORAL PATHOLOGY DONALD M. COHEN DMD, MS, MBA PROFESSOR OF ORAL & MAXILOFACIAL PATHOLOGY ACTING CHAIR DEPARTMENT OF ORAL DIAGNOSTIC SCIENCS UNIVERSITY OF FLORIDA COLLEGE OF DENTISTRY GAINESVILLE, FLORIDA [email protected] 800-500-7585 Course Objectives • Upon completion of this course, participants should be able to: • Recognize and formulate a differential diagnosis, understand the etiology and management of various oral and maxillofacial conditions. • Better recognize early mailignacies, improve diagnostic skills for oral soft and hard tissue lesions through practice sessions utilizing the audience response devices. TWO WEEK FOLLOW UP!! 1 10/25/2018 IDIOPATHIC LEUKOPLAKIA NON-SMOKERS LEUKOPLAKIA • FEATURES TO WORRY ABOUT • 5-8 times INCREASED risk of oral cancer • Occurrence in non-smoker • More frequent on tongue/floor of mouth(64 vs. 11%) • Thickened often corrugated appearance • More dysplasia(38 vs. 5 %) • Associated erythema • High risk location-horseshoe shaped area • Younger patients • ??pain • Often very subtle lesions under tongue and on lingual frenum Multifocal or recurrent • • Likely high risk HPV related SEVERE KOILOCYTIC DYSPLASIA TONSILLAR CRYPT EPITHELIUM • Stratified squamous but
    [Show full text]
  • Koebner Phenomenon Leading to the Formation of New Psoriatic Lesions: Evidences and Mechanisms
    Bioscience Reports (2019) 39 BSR20193266 https://doi.org/10.1042/BSR20193266 Review Article Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms Yong-Zhi Ji and Shi-Rui Liu Department of Dermatology, Second Hospital of Jilin University, Changchun, China Correspondence: Shi-Rui Liu ([email protected]) Koebner phenomenon refers to the emergence of new psoriatic lesions in the healthy skin re- gions following an injury/trauma to psoriatic patients. The occurrence of psoriatic lesions at unusual areas of the body regions such as on penis, around eyes and on keloids suggest that the Koebner phenomenon may be responsible for these lesions. A number of agents/triggers have been reported to induce the development of new psoriatic lesions in healthy skin ar- eas and these include, tattooing skin, radiations, skin incision, viral infections and striae etc. The different mechanisms that contribute in inducing the development of new psoriatic lesions as Koebernization include the involvement of mast cell-derived inflammatory medi- ators such as tryptase, IL-6, IL-8, IL-17, and IL-36γ. Moreover, an increased expression of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) also contribute in Koebernization. Apart from these, there is a critical role of α 2 β1 integrins, S100A7 (psori- asin) and S100A15 (koebnerisin), change in the ratio of CD4+/CD8+ T cells, down-regulation of mechanosensitive polycystin 1 protein, decrease in inflammation controlling atypical chemokine receptor 2 (ACKR2), reduced expression of N-methyl-D-aspartate (NMDA) re- ceptors (NMDARs) on the keratinocytes and increase in levels of chemokines (CXCL8 and CCL20) in inducing formation of new psoriatic lesions.
    [Show full text]
  • The Koebner Phenomenon May Contribute to the Development of Calciphylaxis: a Case Series
    University of Massachusetts Medical School eScholarship@UMMS Open Access Publications by UMMS Authors 2021-04-28 The Koebner phenomenon may contribute to the development of calciphylaxis: A case series Colleen K. Gabel Massachusetts General Hospital Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/oapubs Part of the Dermatology Commons, Nutritional and Metabolic Diseases Commons, Pathological Conditions, Signs and Symptoms Commons, and the Skin and Connective Tissue Diseases Commons Repository Citation Gabel CK, Chakrala T, Dobry AS, Garza-Mayers AC, Ko LN, Nguyen ED, Shah R, St. John J, Nigwekar SU, Kroshinsky D. (2021). The Koebner phenomenon may contribute to the development of calciphylaxis: A case series. Open Access Publications by UMMS Authors. https://doi.org/10.1016/j.jdcr.2021.04.016. Retrieved from https://escholarship.umassmed.edu/oapubs/4692 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Publications by UMMS Authors by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. CASE SERIES The Koebner phenomenon may contribute to the development of calciphylaxis: A case series Colleen K. Gabel, BS,a Teja Chakrala, BS,a AllisonS.Dobry,MD,b Anna Cristina Garza-Mayers, MD, PhD,c Lauren N. Ko, MD, MEd,c Emily D. Nguyen, MD,a Radhika Shah, MD, PharmD,d Jessica St. John, MD, MBA, MPH,e Sagar U.
    [Show full text]
  • Koebner Phenomenon from Insulin Injection
    THE CLINICAL PICTURE Parvathy Madhavan, MBBS Lauren Hamann, RN, BSN, CDE Kamal Shoukri, MD Latha Dulipsingh, MD, FACP, FACE University of Connecticut Health Center, Saint Francis Hospital and Medical Center, Saint Francis Hospital Director, Diabetes and Endocrinology, Farmington, CT Hartford, CT and Medical Center, Hartford, CT Division of Endocrinology, Saint Francis Hospital and Medical Center, Hartford, CT Koebner phenomenon from insulin injection ■ KOEBNER PHENOMENON Koebner phenomenon was first described by Heinrich Koebner in 1876 as the appearance of new psoriatic skin lesions at previously unaffected sites due to cutaneous trauma such as bruises, tattoos, and horse bites.1,2 It has also been described in lichen planus and vitiligo.1–3 The pathogenesis of Koebner phenomenon is not well understood.1 Our case demonstrates an isomorphic response or Koebner phenomenon due to trauma in- Figure 1. Erythematous, scaly plaques 5 cm by 5 cm at subcutaneous insulin injection sites. duced by subcutaneous insulin injections in a patient with preexisting psoriasis. The condition can occur at 68-year-old man with psoriasis and type 2 diabetes sites not previously affected by psoriasis, such as the ab- A mellitus was seen as an outpatient for management of domen in our patient.2 The phenomenon can take from his diabetes. On examination of subcutaneous insulin injec- 3 days to 2 years to develop after trauma.2,3 tion sites, 2 large erythematous scaly plaques were noted on The differential diagnosis includes conditions such the abdomen (Figure 1). The patient said he noticed these as Wolf isotopic response, reverse Koebner phenomenon lesions shortly after he began injecting insulin in his abdo- (also called Renbök, which is Koebner spelled backwards men 5 years ago.
    [Show full text]
  • Erythematous, Scaly Rash After Sun Exposure RITA S
    Photo Quiz Erythematous, Scaly Rash After Sun Exposure RITA S. MATOS, MD, Unidade de Saúde Familiar São Bento – Agrupamento de Centros de Saúde de Gondomar, Portugal TIAGO TORRES, MD, PhD, Centro Hospitalar Universitário do Porto; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal The editors of AFP wel- come submissions for Photo Quiz. Guidelines for preparing and sub- mitting a Photo Quiz manuscript can be found in the Authors’ Guide at http://www.aafp.org/ afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto@ aafp.org. This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor. A collection of Photo Quiz published in AFP is avail- Figure 1. able at http://www.aafp. org/afp/photoquiz. Previously published Photo A 45-year-old woman presented with a Question Quizzes are now featured 10-day history of an erythematous, scaly rash Based on the patient’s history and physical in a mobile app. Get more information at http:// on her back that developed after a period of examination findings, which one of the fol- www.aafp.org/afp/apps. intense sun exposure. She did not have a fever lowing is the most likely diagnosis? or chills, and there was no discharge from the ❏ A. Herpes zoster. site. The patient was otherwise healthy. She ❏ B. Irritant contact dermatitis. had a history of small, erythematous, scaly ❏ C. Koebner phenomenon. lesions on both elbows during adolescence ❏ D. Pityriasis rosea. that spontaneously resolved. Her family his- ❏ E. Tinea corporis. tory was significant for maternal psoriasis.
    [Show full text]