Koebner Research Articles

Effects of individualized homoeopathic medicaments in Psoriasis: A single blind, simple randomized, placebo controlled study

Psoriasis is a non-contagious, chronic skin condition that produces plaques of thickened, scaling skin. It is considered as an incurable, long-term (chronic) inflammatory skin condition. Psoriasis is estimated to affect 2–4% of the population of the western world. Commonly appears for the first time between the ages of 15 and 25 years. In India the prevalence varies from 0.44 to 2.8%.Specific medical signs used for diagnosis are Auspitz's sign, Koebner phenomenon, Candle grease sign with itching, pain localized to papules and plaques. As it was understood to be a chronic, intractable & incurable disease, hence it was felt imperative to carry out a systematic constitutional treatment to validate the observations of earlier Homoeopaths and the subtle homoeopathic philosophy.Research Objectives: Primary objectives were to observe the change in disease severity and change in quality of life of the people. Secondary objective was to ascertain the effect on frequency of relapse and recurrence interval.Methodology: The study was simple randomized and single blind method. The sample size was fixed at 90.Test group 60 i.e. Group – I(Centesimal -30), Group – II(50 Millesimal -30) & Group – III( Control) 30. Duration of study was for two years. It was carried out at International Study & Research Centre on Homoeopathy, Bhubaneswar. There were inclusion & exclusion criteria, treatment plan, follow up with Psoriasis Area Severity Index (PASI), Psoriasis Disability Index (PDI), Relapse and Recurrence Interval (RRI).Results: Were documented on following points. Psoriasis Area Severity Index (PASI)/Psoriasis Disability Index (PDI)/ Relapse & Recurrence Interval (RRI). Statistical Analysis: By Kruskul Wallis Test, H0 was rejected. In paired ‘t’ test for PASI, Group – I and II results (P

Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences

Background Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals. Aim To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities' coexistence in patients with psoriasis at a tertiary care centre. Study Design A cross-sectional study. Methods A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was conducted by the dermatology departmentat Sri Krishna hospital, Karamsad, India following acceptance of the study proposal by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences (SPSS). Result Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the well established risk factors for developing psoriasis (14.2%). Our study's most commonly found nail changes were pitting (35.49%) and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used. Conclusion The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic syndromes in psoriasis patients due to its predilection with systemic comorbidities.

Tattoos Dermatological Complications: Analysis of 53 Cases from Northern Poland

Background: The frequency of tattoos varies from 10% to 30% across the population worldwide. The growing popularity of tattooing increases the number of cutaneous reactions connected with this procedure. As we have not found any previous studies in the literature concerning tattoo complications in Poland and other Eastern European countries, we believe this to be the first study of this kind. Objective: The primary objective of this study was to evaluate the clinical spectrum of complications associated with the procedure of permanent tattooing among patients from Northern Poland. Methods: Medical data of 53 patients who developed tattoo-related cutaneous conditions were analyzed. All of the patients were consulted in the Dermatology, Venereology and Allergology Clinic in Gdańsk in the years 2018–2021. Medical history, dermatological assessment, and photographic documentation of skin lesions were performed in each case. Dermoscopic examination was carried out in 16 cases and 20 skin biopsies of the tattoo reactions were performed. Results: Twenty-one patients (40%) presented tattoo ink hypersensitivity reactions, out of which 18 were triggered by the red ink. In 11 cases (21%), contact dermatitis has developed after tattooing, while 9 of the patients (17%) presented tattoo infectious complications, including local bacterial infections, common warts, molluscum contagiosum, and demodicosis. We collected 8 cases (15%) of papulonodular reactions in black tattoos, and in 6 of them, histology showed granuloma formation. In 2 cases (4%), symptoms of anaphylaxis were observed after the tattooing procedure, and in another 2 cases (4%), Koebner phenomenon in the tattoo was diagnosed. Dermoscopy was the clue to the diagnosis in 4 cases. Conclusions: This is the first report presenting multiple cases of tattoo complications from Eastern Europe. The results of the study are consistent with other researches, showing a similar distribution of tattoo complications and that across the different pigments used, the red ink is most frequently responsible for tattoo reactions. We emphasize the usefulness of dermoscopic examination in the diagnosis of tattoo-related infections and draw the reader’s attention to the rare, yet hazardous complications connected with peri-tattooing anaphylaxis.

A pruritic psoriatic plaque develops at the donor site of an autologous skin graft: Koebner phenomenon

A 64-year-old man attended our dermatology clinic with a rectangular-shaped pruritic rash on the upper part of his right thigh and oval pink plaques on his right forearm. The patient said that the lesions had developed gradually over the previous few weeks. 3 months earlier, he had developed necrotising fasciitis of his right forearm after a fishing trip; tissue cultures had grown Vibrio vulnificus and an emergency fasciotomy had been done by plastic surgery colleagues. To repair the wound on his arm, a split-thickness rectangular patch of skin had been harvested from the upper part of the patient's right thigh and grafted onto the lesion on his right forearm.

Psoriatic dactylitis: Koebner phenomenon of the pulleys-comment on "Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA?"

Psoriatic dactylitis: Koebner phenomenon of the pulleys—comment on “Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA?”

Assessment of the Tissue Resident Memory Cells in Lesional Skin of Patients with Psoriasis and in Healthy Skin of Healthy Volunteers.

Background: In the course of plaque psoriasis, tissue resident memory cells (TRM) are responsible for the phenomenon of “immune memory” of lesions, i.e., the appearance of recurrences of lesions in the same location, as well as Koebner phenomenon. We present results determining the location and amount of TRM in psoriatic lesions in patients suffering from plaque psoriasis, as well as an analysis of the relationship between TRM markers expression and the duration and severity of the disease. Methods: TRM markers (CD4, CD8, CD103, CD69, CD49, CXCR6) and tissue expression of cytokines (IL-17, IL-22) in the lesional psoriatic skin of 32 patients compared with 10 healthy skin samples were evaluated by immunohistochemistry. Results: The presence of TRM markers in both the epidermis and skin with psoriatic eruptions was demonstrated in much higher amounts compared with the skin of healthy volunteers. A significant positive relationship was demonstrated between the expression of TRM markers in patients with plaque psoriasis and the duration of skin lesions. There was no relationship between the amount of TRM and the severity of plaque psoriasis. Conclusions: A thorough understanding of the mechanisms responsible for the development and relapse of plaque psoriasis may contribute to the implementation of more effective therapies.

28684 Vitiligo following ablative laser for melasma

Vitiligo is a pigment disorder of the skin, characterized by areas of depigmentation. Different factors could affect the induction and progression of vitiligo such as emotional shock, stress, sunburn, and trauma. The Koebner phenomenon is the appearance of new lesions on previously unaffected skin secondary to trauma. I present a 35 year-man who developed areas of depigmentation on the cheeks, bilaterally, with asymmetry, after the use of ablative laser for melasma, followed by application of depigmenting agents.

28533 Vitiligo following intense pulsed light (IPL) for hair removal in the face and axilla

Vitiligo is a pigment disorder of the skin, affecting approximately 1% of the world population, characterized by areas of depigmentation, evidenced by circumscribed white maculae. Different factors could affect the induction and progression of vitiligo such as emotional shock, stress, sunburn, and trauma. The Koebner phenomenon is the appearance of new lesions on previously unaffected skin secondary to trauma. The treatment for vitiligo is challenging and includes different methods for control of the disease and repigmentation. The intense pulsed light (IPL) devices have a broad spectrum, emitting varying wavelengths in the skin, usually generating local heat. Among other conditions, it is also used for hair removal. I present a 30-year woman, with no previous personal or family history of vitiligo, who developed depigmented areas in the frontal region and both axillas, following the second session with IPL for hair removal. Based on clinical aspects and Wood’s lamp examination, diagnosis as vitiligo was made. She was treated with 308-nm monochromatic excimer lamp (MEL) in association with topical tacrolimus. Dermatologists should be aware of this possible adverse effect of ILP and start early vitiligo treatment.

Risk Factor Profile and Quality of Life of Psoriasis Vulgaris

Background: Psoriasis is an autoimmune human skin disease. It is a chronic and recurrent lesion characterized by erythema patches with well-defined borders with rough, multi-layered, and transparent scales with a significant negative impact on patients' quality of life. Several risk factors for psoriasis can decrease patient’ quality of life. Purpose: To determine the risk factor profile and quality of life of psoriasis patients at the dermatology and venereology outpatient clinic at Dr. Soetomo General Academic Hospital Surabaya. Methods: This was a cross-sectional study involving new and control psoriasis patients. Their risk factors were evaluated using questionnaires, and their quality of life was measured using the DLQI questionnaires. The data was collected at the Dermatology and Venereology outpatient unit Dr. Soetomo General Academic Hospital Surabaya. Result: Of the 24 patients, the biggest risk factor for psoriasis patients was trauma/ Koebner phenomenon, as reported in 15 patients (62.5%), and 11 patients’ (45.8%) quality of life was affected. Conclusion: Trauma was the largest risk factor for psoriasis, and psoriasis has significantly affected patient’ quality of life.

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.

Linear lesions in dermatology: a clinicoaetiopathological study.

Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

Lichen planus occurring as Koebner phenomenon at the site of “cupping”

Lichen planus occurring as Koebner phenomenon at the site of “cupping”

Mind-Body Interventions as Alternative and Complementary Therapies for Psoriasis: A Systematic Review of the English Literature.

Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

Perioral Köebner Phenomenon Following Lip Licking Dermatitis in a Patient with Acrofacial Vitiligo

Koebner phenomenon was first described by Heinrich Koebner in 1876 as the appearance of new skin lesions on previously unaffected skin secondary to trauma. Among the several recognized triggers, such as burns and friction, allergic and irritant reactions may also emerge as overlooked causes of koebnerization.

425 A superfacial ulcer on the scrotum

A 54-year-old man presented to the dermatology clinic with an itchy red papule on the right scrotum for 2 years, which gradually expanded to a yellow central ulcerated plaque and the crust was not easy to be removed. Topical mupirocin and corticosteroids were not effective. Fluorescent microscopy for fungus was negative, as well as antibodies to syphilis and HIV. There was no similar history in his family, and he had hypertension for 14 years, type 2 diabetes for a year with normal renal function. Biopsy revealed epidermal necrosis and crust with transepidermal penetration and elimination of collagen. Therefore, the diagnosis was acquired reactive penetrating collagenosis (ARPC). Follow-up for 3 months after resection without recurrence. Reactive perforating collagenosis is a rare skin disease that includes both inherited and acquired forms. ARPC is associated with diabetes, chronic renal failure, hyperuricemia and hypertension. It usually occurs on the trunk and limbs, characterized by multiple umbilicated hyperkeratotic papules or nodules with Koebner's phenomenon clinically, but no scrotal lesions have been reported.

Localized psoriasis post hand burn

The Koebner Phenomenon (KP) is the appearance of new skin lesions on previously unaffected skin secondary to trauma. This phenomenon is given the fact that the new lesions that appear are clinically and histologically identical to the patient’s underlying cutaneous disease [1].

Psoriasis Characteristics for the Early Detection of Psoriatic Arthritis.

Delays in the diagnosis and treatment of psoriatic arthritis (PsA) are common. These delays contribute to impairments in quality of life and joint damage. This study aims to calculate the incidence rate of PsA over time and identify clinical features that may be used for PsA prediction in patients with psoriasis (PsO). The study population for PsA incidence analysis included 1128 participants enrolled in the Utah Psoriasis Initiative between 2002 and 2014. Clinical evaluation and medical record review were performed to identify new cases of PsA after enrollment. To identify PsO features associated with PsA, the population was restricted to 627 participants who did not have PsA before PsO phenotyping and had been followed up for subsequent PsA diagnosis. We conducted Cox proportional hazard regressions to estimate the HR of PsA associated with PsO characteristics and other health-related features. PsA incidence rate increased for > 60 years following PsO onset (trend P < 0.0001). There was a significant association between PsA and induration severity in untreated lesions (P < 0.001, HR 1.46), history of fingernail involvement (P < 0.001, HR 2.38), pustular PsO (P < 0.001, HR 3.32), fingernail involvement at enrollment (P < 0.001, HR 2.04), and Koebner phenomenon (P < 0.001, HR 1.90). Multivariate analysis yielded a model that included a history of fingernail involvement (P < 0.001, HR 2.16) and untreated induration (P < 0.001, HR 1.41). Risk of PsA increases steadily for > 60 years following PsO onset. Patient-reported history of PsO characteristics has greater predictive power than physician-measured features at enrollment visits. The characteristics identified in this study provide guidance for screening for PsA risk in patients with PsO.

A case study on psoriasis

Psoriasis is a non-contagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is generally thought to be a genetic disease which is triggered by environmental factors. Psoriasis is estimated to affect 2-4% of the population of the western world. The rate of psoriasis varies according to age, region and ethnicity; a combination of environmental and genetic factors is thought to be responsible for these differences. Psoriasis affects both sexes equally. It can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25 years. Approximately one third of people with psoriasis reports being diagnosed before age 20. In India the prevalence of psoriasis varies from 0.44 to 2.8%, it is twice more common in males compared to females, and most of the patients are in their third or fourth decade at the time of presentation. In addition to the appearance and distribution of the rash, specific medical signs may be used by medical practitioners to assist with diagnosis. These may include Auspitz's sign (pinpoint bleeding when scale is removed), Koebner phenomenon (psoriatic skin lesions induced by trauma to the skin), Candle grease sign and itching and pain localized to papules and plaques. A patient of sixty five years old was suffering from Psoriasis for last 12 years resorted to all systems of treatment but failed, was finally treated by constitutional treatment and was cured for last 5 years. The case taking was done in a standardized format and all symptoms were passed through standard procedures to arrive at totality of symptoms such as analysis of symptoms, conceptual image, analysis of the case/ synthesis, reportorial totality/ evolutional totality, miasmatic diagnosis, repertorisation. The medicine was prescribed in 50 millesimal scale in infrequent repetition scheduled. Change of potency and medicine were done as per the guidelines of tenets of Homoeopathy and cure was achieved to an intractable chronic disease like Psoriasis.

Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort

Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort

A peristomal plaque of sudden occurrence.

Koebner phenomenon regards the formation of a psoriatic lesion after a trauma, including tattoo, insect bite or other injuries. Although this manifestation is not specific for psoriasis, physicians should be aware because early recognition may be helpful in making the diagnosis when present.