Isomorphic Response Research Articles

Laser-Induced Koebner-Related Skin Reactions: A Clinical Overview.

The Koebner phenomenon (KP), also known as the isomorphic response, describes the process by which new lesions that are clinically and histologically identical to a patient's existing skin disease develop following trauma. Many skin diseases exhibit this characteristic, with variations that include possible, questionable, and pseudo-Koebner reactions, with the latter category occurring due to infectious agents seeding at a trauma site. Laser application, a type of controlled skin injury used for improving cutaneous lesions and skin rejuvenation, is also considered a form of trauma. This raises the question of whether controlled thermal injury can be regarded as a type of mechanical trauma capable of producing Koebner-related reactions. We conducted a literature review of cases or studies to identify laser-induced dermatoses that correspond to Koebner-related or pathergy reaction categories. As a whole, we identified nine case reports on true KPs, two cases on possible KPs, seventeen cases on laser-induced questionable KPs comprising cases of vasculitis, eczema or Meyerson reactions, and eruptive squamous atypia cases (ESA) as well as two pseudo-Koebner cases involving wart occurrences at laser application sites. Laser-induced Koebner reactions highlight several aspects of the KP. Firstly, the type of mechanical damage influences disease promotion, as different lasers are associated with different KPs. For example, hair removal lasers are linked with true and questionable KPs such as vasculitis while resurfacing lasers were found to be more connected with ESA occurrence. Secondly, the laser target is significant, with vascular laser application for port-wine stains tending to result in eczematous reactions, while hair follicle destruction can frequently lead to true KPs. Thirdly, the number of sessions matters; true KPs and eruptive squamous atypia questionable KPs typically appear after one to two sessions, whereas eczematous reactions require more sessions (at least four). Additionally, skin phototype is crucial, with darker phototypes showing a higher KP frequency as laser treatment for hypertrichosis relies on melanin absorption in the hair bulge or bulb for follicle destruction, as chromophore competes with the abundant melanin in the epidermis. Further research with larger-scale studies into trauma-specific Koebner reactions is vital for refining treatment protocols, minimizing post-laser adverse effects, and improving dermatological care outcomes.

In-depth study of Wood's lamp examination combined with reflective confocal laser scanning microscopy for the guidance of vitiligo staging and treatment.

Both Wood's lamp and reflective confidential laser scanning microcopy are helpful for the diagnosis and treatment of vitiligo. However, there is few research that contains large samples and consistent observations. To analyze the characteristics of Wood's lamp images and reflectance confocal microscopy (RCM) images of vitiligo lesions and to evaluate their significance in vitiligo staging. We analyzed the characteristics of RCM images, Wood's lamp images, the vitiligo disease activity (VIDA) score, and clinical features to guide vitiligo staging and treatment. The expert consensus based on the clinical features, VIDA score, Wood's lamp findings, and isomorphic response was consistent with the Wood's lamp findings (χ2 = 3.63, p > 0.05) and RCM findings (χ2 = 3.60, p > 0.05) in diagnosing vitiligo and assessing the disease stage. There was a correlation between the three lesion grades based on the Wood's lamp findings and the stage of vitiligo (p < 0.01). Lesions that appeared porcelain white under the Wood's lamp were in the slowly progressive stage; lesions that appeared gray-white or trichromatic under the Wood's lamp were in the rapidly progressive stage; lesions with clear borders under the Wood's lamp needed further analysis by RCM for the stage to be determined; lesions with blurred borders under the Wood's lamp were in the rapidly progressive stage; lesions that were visible under the naked eye and under the Wood's lamp were in the rapidly progressive stage. The study demonstrates a reliable correlation between the findings of RCM (a sophisticated expensive tool) and Wood's lamp examination (a simple, readily available, inexpensive tool) in the assessment of the disease activity of vitiligo lesions.

Varicella zoster infection showing Koebner phenomenon.

Koebner phenomenon or isomorphic response describes the appearance of new skin lesions on areas of previously unaffected skin secondary to trauma. It is very rarely described in chickenpox. Here we describe a case of primary varicella zoster infection showing Koebner phenomenon.

32053 Vitiligo koebnerising to varicose veins of the lower limbs

A 29-year-old woman with Fitzpatrick skin type II noticed new white patches on her lower limbs after reporting a sudden onset of pain behind her knees along with the sudden appearance of bilateral varicose veins extending from the thighs down to the calves and shins. Subsequently she developed symmetrically distributed white patches in the submammary and groin areas. Examination of the affected areas revealed depigmented macular patches without scale, atrophy or induration in keeping with vitiligo. Strikingly, the white patches on the legs were confined to the prominent varicosities, consistent with koebnerisation of vitiligo to the skin overlying the varicose veins. Investigation of the pain behind the knees was unremarkable, leading to a likely diagnosis of symptomatic varicose veins. Koebner phenomenon, also called the isomorphic response, describes the development of lesions at sites of traumatised previously uninvolved skin, and is well-known to occur in vitiligo. The pathogenesis of this is thought to be an integration of immunologic mechanisms, deficiency of melanocyte growth factors, defective melanocyte adhesion, and increased oxidative stress. To our knowledge, this is only the second case reported in the literature of vitiligo koebnerising to areas of varicosities.

25669 Abscess formation of nasal flap area four years after reconstruction, 4 months after new-onset hidradenitis suppurativa

Hidradenitis suppurativa (HS) is an inflammatory condition characterized by recurrent nodules, abscesses, and sinus tracts. This case involves a 54-year-old Caucasian male that had a basal cell carcinoma removed from the left nasal ala, requiring 3 stages of Mohs surgery with a paramedian forehead flap. His final reconstruction was completed in November 2016 with no ensuing issues. He later presented in April 2020, with complaints of a tender fluctuant area where the reconstruction was performed. Of note, he was recently diagnosed with hidradenitis suppurativa, with symptom onset in January 2020. His history is notable for diabetes mellitus and hypertension, with increased tobacco use in the 6 months prior. Examination demonstrated an erythematous, tender nodule on the left nasal dorsum, along with superficial ulcerations in the bilateral axilla. No sinus tracts or fistulas were appreciated. Incision of the nodule drained 2 mL of white pus, with immediate pain relief. Doxycycline was initiated, and follow-up visit 2 weeks later showed near-complete resolution of the nose and axilla lesions. The median age of onset of HS is 32 years, with a predominantly female 3:1 ratio, thus making this present case uncommon. While infection is the most common postoperative complication seen in paramedian forehead flap reconstruction surgery, abscess formation 4 years later is highly unusual. Prior literature demonstrates the potential for koebnerization of HS, or an isomorphic response at areas of traumatized, but previously uninvolved skin. This theory could explain this abscess formation, albeit in a uniquely delayed fashion, at the prior flap site.

Exacerbation of generalized plaque psoriasis after tuberculin test.

Koebner phenomenon, also known as isomorphic response, is the appearance of active skin lesions in sites of epidermal injury. This manifestation is characteristic of different dermatological diseases, such as lichen planus, vitiligo and psoriasis. We present the case of a psoriatic patient who experienced Koebner phenomenon after Mantoux test, followed by eruption of generalized plaque psoriasis.

Grzybowski's Generalized Eruptive Keratoacanthomas in a Patient with Terminal Kidney Disease-An Unmet Medical Need Equally Ameliorated by Topical Imiquimod Cream and Lapacho Tea Wraps: A Case Report.

IntroductionDevelopment of singular keratoacanthoma (KA) is generally considered a benign condition as it has a tendency to regress spontaneously in spite of histological similarity to squamous cell carcinoma. Most KAs undergo excision to rule out differential diagnoses. Several alternative treatment modalities (keratinolytic, ablative, immunomodulating, antiproliferative, or targeted therapy) have been described in the past with varying success, underlining the therapeutic challenges associated with large or multiple lesions. Isomorphic response (Koebner phenomenon) may limit the efficacy of ablative options, and comorbidity may limit the use of systemic treatments. Less aggressive topical immunomodulatory treatment options represent an alternative with varying therapeutic success.Case ReportHere, we describe the clinical course of a 51-year-old male patient with terminal kidney disease who suffered from the rare benign pruritic condition of Grzybowski’s generalized eruptive keratoacanthomas (GEKA) and experienced a significant reduction of lesions and symptoms upon topical therapy with imiquimod 5% cream and lapacho tea dressings alike.ConclusionsVery little is known about the potential antiinflammatory or antiproliferative effects on the epidermis of the popular phytotherapeutic agent lapacho tea. More studies are warranted considering both the etiology and treatment of GEKA and topical use of phytotherapeutics in dermatology in general. Management of large or multiple KAs remains challenging.

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review

Basal cell carcinoma (BCC) can be a component of a collision tumor in which the skin cancer is present at the same cutaneous site as either a benign tumor or a malignant neoplasm. However, BCC can also concurrently occur at the same skin location as a non-neoplastic cutaneous condition. These include autoimmune diseases (vitiligo), cutaneous disorders (Darier disease), dermal conditions (granuloma faciale), dermal depositions (amyloid, calcinosis cutis, cutaneous focal mucinosis, osteoma cutis, and tattoo), dermatitis, miscellaneous conditions (rhinophyma, sarcoidal reaction, and varicose veins), scars, surgical sites, systemic diseases (sarcoidosis), systemic infections (leischmaniasis, leprosy and lupus vulgaris), and ulcers. The relationship between the BCC and the coexisting non-neoplastic condition may be coincidental or possibly related to the development of the BCC; alternatively, the development of the BCC may be unrelated to the coexisting non-neoplastic conditions and secondary to either a Koebner isomorphic response or a Wolf isotopic response in an immunocompromised district of skin. This paper reviews several of the case reports and studies that describe the association of BCC with these non-neoplastic cutaneous conditions.

14937 Keratoacanthomas associated with anti–TGF-β immunotherapy

Keratoacanthomas (KAs) are rapid-growing skin tumors that resemble well differentiated cutaneous squamous cell carcinomas (SCCs) and typically present as solitary lesions on sun-exposed skin. KAs can arise in association with medications, including inhibitors of BRAF or transforming growth factor beta (TGF-β). A novel bifunctional fusion protein that blocks both programmed death ligand 1 (PD-L1) and TGF-β signaling has shown a manageable safety profile and clinical efficacy in patients with heavily pretreated solid tumors. In these patients, we have observed adverse events (AEs) that include both immune-related AEs and biopsy-proven KAs. In total, 18 of 93 treated patients (19%) developed at least 1 KA. These lesions appeared on chronically sun-damaged skin, typically months after starting therapy. KA-like papules were managed by observation with destructive therapy (cryotherapy or excision) used for symptomatic or clinically atypical lesions. Patients generally did not require treatment discontinuation. Whereas most patients had small numbers of treatment-emergent KAs, 3 patients developed numerous eruptive KAs. These patients’ presentations resembled Grzybowski-type eruptive KAs in that they also demonstrated generalized pruritus, macular erythema, and/or lesions in areas of prior instrumentation suggestive of an isomorphic response. Acitretin was helpful in controlling the eruptive KAs and associated AEs. The occurrence of isolated and eruptive KAs in this patient population adds to a growing body of evidence supporting an association between KA development and reduced TGF-β signaling. Ongoing studies are investigating the predisposing genetic and molecular factors required for TGF-β inhibitor–related KAs and exploring strategies to prevent these cutaneous neoplasms.

Reakcja izomorficzna u pacjenta z ostrą uogólnioną osutką krostkową wywołaną przez chinolon

Reakcja izomorficzna u pacjenta z ostrą uogólnioną osutką krostkową wywołaną przez chinolon

Koebner phenomenon caused by bloodletting and cupping therapy in a patient with psoriasis

The Koebner phenomenon refers to the appearance of isomorphic lesions on areas of cutaneous injury in otherwise healthy skin areas. This is a common skin reaction presented by the German dermatologist Heinrich Koebner (1838–1904) in 1872. In addition to the name Koebner phenomenon, it is also called the isomorphic response. We report a case of a 26-year-old man with a 10-year history of psoriasis vulgaris. The patient had been treated with bloodletting and cupping therapy for chronic back pain and developed psoriatic papules and plaques in the places of injuries. The presented case confirms the role of iatrogenic trauma as a trigger for the formation of psoriatic plaques in patients with clinically manifested disease.

A case of isomorphic response in vitiligo induced by inappropriate topical application of compound Kaliziran tincture

A case of isomorphic response in vitiligo induced by inappropriate topical application of compound Kaliziran tincture

Koebner Phenomenon in Juvenile Dermatomyositis

Koebner phenomenon is an isomorphic response seen in a variety of dermatoses such as psoriasis. Its key feature is the appearance of a new dermatosis in previously unaffected areas following trauma. An 8-year-old girl presented with several months history of a worsening rash on her hands and face, pruritus, and proximal muscle weakness. At age 4, a diagnosis of juvenile dermatomyositis was first established by the presence of heliotrope rash, …

Relationship between the severity of isomorphic response at the donor site and the therapeutic effect of cultured melanocyte transplantation in patients with vitiligo

Objective To investigate the value of the severity of isomorphic response at the donor site in evaluation of the therapeutic effect of cultured melanocyte transplantation. Methods A total of 172 vitiligo patients, who received cultured melanocyte transplantation or non-cultured epidermal suspension transplantation at the Department of Dermatology of Hangzhou Third Hospital from May 2008 to August 2016 and developed isomorphic response at the donor site, were enrolled into this study. According to the area of isomorphic response, these patients were divided into 2 groups: incomplete isomorphic response group whose area of isomorphic response was less than the suction area, and complete isomorphic response group whose area of isomorphic response was equal to the suction area. The correlation between therapeutic effects of melanocyte transplantation and isomorphic response was analyzed. Results Of the 172 patients, 83 had incomplete isomorphic response, and 89 had complete isomorphic response at the donor site. In the incomplete isomorphic response group, 21 (25.3%) patients were cured, and 17 (20.5%) were markedly improved, while 4 (4.5%) patients were cured, and 11 (12.4%) were improved in the complete isomorphic response group. Additionally, the response rate was significantly higher in the incomplete isomorphic response group than in the complete isomorphic response group (45.8% vs. 16.9%, χ2= 31.581, P < 0.001) . Furthermore, the duration of stable phase was also significantly longer in the incomplete isomorphic response group than in the complete isomorphic response group (18.5 ± 15.3 months vs. 10.2 ± 7.3 months, t= 4.581, P < 0.001) . Correlation analysis showed that the duration of stable phase, which was classified into 5 grades including 6-11 months, 12-23 months, 24-35 months, 36-47 months and ≥ 48 months, was negatively correlated with the severity (incomplete or complete) of isomorphic response (rs=-0.322, P < 0.001) , but positively correlated with repigmentation rates of the skin lesions (rs= 0.675, P < 0.001) . Conclusion The length of duration of stable phase is an important factor affecting the therapeutic effect of melanocyte transplantation in vitiligo patients with isomorphic response at the donor site, and the severity of isomorphic response can indicate the length of duration of stable phase and predict the therapeutic effect of melanocyte transplantation. Key words: Vitiligo; Melanocytes; Cell transplantation; Treatment outcome; Koebner phenomenon

Tattooing and psoriasis: a case series and review of the literature.

Koebner phenomenon (KP) affects from a quarter to a third of the patients with psoriasis and can occur on tattoos MATERIAL AND METHODS: We retrospectively reviewed a case series of seven tattooed patients with an isomorphic response on their tattoos or partial psoriasis patches on their tattoos. We collected the demographic data, the past history of psoriasis, the clinical presentation, and the outcomes. We also performed a review of the literature. We tried to classify the different clinical profile of KP/psoriasis on tattoos accordingly. Six men and one woman with a median age of 36 ± 6.4 years old were included. Five disclosed a KP in a recent tattoo within days to 1 month after its completion. Fifteen additional cases were collected from the literature (8 men, median age 22 ± 8.2 years old). The delay of psoriasis flare-up after tattooing was rather short, from a few weeks to several months. We found a high variability in the clinical presentation with five clinical subtypes/profiles of psoriasis on tattoos. A possible confusion between "genuine" KP on tattoos and the coincidental occurrence of psoriasis patches on tattoos is possible in some cases of the literature. Patients were mainly managed locally, rarely by systemic treatments or biologics. Koebner phenomenon on tattoos may occur in patients with psoriasis under various forms. The evolution is benign, and psoriasis is not a contraindication for tattooing, but patients need proper counseling before getting tattooed.

Therapeutic efficacy of autologous cultured melanocyte transplantation in the treatment of vitiligo among patients with isomorphic response at donor sites and its relevant factors

Objective To evaluate the therapeutic efficacy of transplantation of autologous cultured pure melanocytes (TACM) in the treatment of vitiligo among patients with isomorphic response at donor sites, and to analyze its relevant factors. Methods A total of 1 685 patients with vitiligo were subjected to TACM. After 6-month follow-up, correlations were evaluated between isomorphic response at donor sites and the therapeutic efficacy of TACM, and factors associated with the therapeutic efficacy were analyzed. Results Of the 1 685 patients subjected to TACM, 75 (4.5%) had isomorphic response at the donor site. Among 75 patients with isomorphic response, 13 (17.3%) achieved 90%-100% repigmentation, and 23 (30.7%) achieved 50%-90% repigmentation. However, among the 1 610 patients without isomorphic response, 865 (53.7%) achieved 90%-100% repigmentation, and 1 376 (85.5%) achieved 50%-90% repigmentation. Fisher's exact probability test showed that the recovery rate and response rate were both significantly lower in the patients with isomorphic response than those without (P 48 months than in those with the duration of stable phase being 12-48 months, in patients aged ≤ 12 years than in those aged ≥ 18 years, in patients with segmental vitiligo than in those with non-segmental vitiligo, in patients with the recipient site on the face and trunk than in those with the recipient site on the limb, as well as in patients with total area of depigmented lesions ≤ 100 cm2 than in those with total area of depigmented lesions > 100 cm2 (all P < 0.05) . Conclusion Patients with isomorphic response show poor response to TACM, which may be associated with the duration of stable phase, patients' age, types of vitiligo, recipient sites and total area of depigmented lesions. Key words: Vitiligo; Cell transplantation; Melanocytes; Koebner phenomenon

The isomorphic response in vancomycin-induced linear IgA bullous dermatosis

The isomorphic response in vancomycin-induced linear IgA bullous dermatosis

Categorization of and comments on isomorphic and isotopic skin reactions

Locus minoris resistentiae (lmr) can be defined as a site of the body that offers lesser resistance than the rest of the body to the onset of disease. The well-known Köbner phenomenon is itself a clear example of lmr in dermatology. The new term locus maioris resistentiae (LMR), a site of the body that offers greater resistance than the rest of the body to the onset of disease, defines the opposite condition. Renbök phenomenon (reverse Köbner’s isomorphic response) typically represents an example of LMR.

Wolf’s isotopic response: The first attempt to introduce the concept of vulnerable areas in dermatology

The term isotopic response was coined in 19951 to describe the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease. That publication paved the way to recognition of this phenomenon by the medical community worldwide with multiple reports describing it under a variety of conditions.The term isotopic response, however, turned out to be unsuitable for a Medline search, because it generated hundreds of references linked with radioactive isotopes. To facilitate Medline searches for this dermatologic phenomenon by avoiding unnecessarily time-consuming sifting through so many unrelated references, it was suggested that the name Wolf be added. The name Wolf’s isotopic response has since been generally accepted and even included in Stedman’s Illustrated Dictionary of Dermatology Eponyms.Although the concept of the isotopic response was conceived as being analogous to Köbner’s isomorphic response, and despite the similarities between the two terms, the similarities are only “skin deep,” and there is a major difference between the two. Isomorphic response means “the same morphology” (as that of the existing disease) and describes the appearance of the same disease at another location. The term isotopic response describes the appearance of an altogether different disease at the site of an already healed skin disease. We describe this entity and present representative clinical examples. Some problems in the definition of Wolf’s isotopic response are provided, with special emphasis on its overlapping with Köbner’s isomorphic response.The description of Wolf’s isotopic response, which is analogous but not identical to the isomorphic response described some 120 years ago by Köbner, illustrates the contribution of morphologic findings and original ideas in keeping up with the ongoing progress in the field of dermatology.

Vancomycin-induced linear IgA bullous dermatosis with isomorphic response

Linear IgA bullous dermatosis (LABD) is occasionally induced by certain drugs, of which vancomycin is the most common. We herein describe a case of vancomycin-induced LABD on the trunk and extremities. Our case was unique in which tense bulla was induced on the old operation scars. A 92-year-old man developed diffuse erythema and bullas on his trunk and extremities. Also, blister formation was observed on the operation scar on the abdomen. A biopsy specimen showed subepidermal split with neutrophilic and lymphocytic infiltration in the upper dermis. Direct immunofluorescence showed a linear IgA deposition at the basement membrane zone. His skin conditions were improved by stoppage of vancomycin and topical corticosteroids. We should know about the occurrence of LABD in patients under vancomycin treatment.