Treatment choices for Koebner’s Phenomenon Psoriasis are essentially the same as for other primary psoriatic occurrences. This relationship between skin injury and developing new psoriatic lesions has been observed in many patients. In the Koebner phenomenon, people with psoriasis observe new lesions 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned, but it can appear up to several years afterwards. Skin injury and irritation, sun exposure, diet, stress and anxiety, medications, and infections have been known to make psoriasis worse. Psoriasis is a chronic, unpredictable, T cell mediated, inflammatory, papulosquamous condition that affects approximately 2 -3 of any population. Psoriasis can develop after trauma and lesions worsen with rubbing or scratching (Koebner phenomenon). The likelihood of developing the Koebner phenomenon may increase if you already have active psoriasis lesions. If you have psoriasis, you need to take special precautions to prevent triggering a psoriasis flare-up, aggravating an active case, or setting off the Koebner phenomenon. And pat, don’t rub, the skin dry.
The Koebner phenomenon or Kbner phenomenon (pronunciation), also called the Koebner response or the isomorphic response, attributed to Professor Heinrich Kbner, refers to skin lesions appearing on lines of trauma. Warts and molluscum contagiosum lesions can be spread in linear patterns by self-scratching ( auto-inoculation ). About 30 of individuals with psoriasis will develop psoriatic arthritis. Trauma can be the normal rubbing and scratching by the patient but it can also occur with orthotics, ankle foot orthotics, vascular hose or short and long leg casts. Therefore, any of our patients with psoriasis who need an orthotic or a cast are at potential risk for developing worsening skin conditions at that site. Other triggers that lead to the Koebner phenomenon are excoriation, sunburns and maceration. The lesions are often symmetrical.16 As podiatrists, we see the following phenotypes: the classic plaque type, the palmoplantar type, the interdigital type and nail psoriasis.
After scratching, lesions can appear on previously clear skin. Rubbing, or irritating the skin in any way, can cause psoriasis lesions to form. Learn more from WebMD about guttate psoriasis and its link to illnesses like strep throat and tonsilitis. Red drop-like lesions are found on the skin. Other times, the guttate eruption can develop into chronic plaque psoriasis. For example, anyone with psoriasis should try to minimize all forms of skin trauma, such as scratching or vigorous rubbing, which may lead to new psoriatic lesions on previously unaffected areas. This is known as the Koebner phenomenon. New psoriasis lesions appear at sites of dermal injury. Scrubbing to remove the scales is a mistake as this can worsen the disease. Do not rub or scrub the skin vigorously after the bath. Never Scratch Scrub or Pick at the Skin.
The lesions can occur anywhere, but the most commonly involved areas are the elbows, knees, scalp, sacrum, navel, intergluteal cleft, and genitalia. Active psoriasis demonstrates the Koebner phenomenon or isomorphic response whereby uninvolved skin develops psoriasis after injury, whether by accident or surgery. Chronic rubbing and scratching leads to lichenification (accentuation of normal skin folds), thickening of the skin, and alterations in pigmentation. In its most common form, psoriasis is characterized by itchy, red, inflamed patches of skin, often covered with silvery scales. We do know that when ‘triggered’ psoriasis causes skin cells to develop at too quickly a rate. Any injury to the skin can produce new psoriasis lesions or cause existing lesions to worsen. Lesions can develop after trauma (Koebner phenomenon) 4 P’s: pruritic, polygonal, purple, papule Primary lesion: 1-10 mm flat-topped papule with an irregular angulated border pink to violaceous Surface has lacy-reticulated pattern of white lines ( Wickham’s striae)-focal areas of epidermal thickening Lesions generally pruritic; duration unpredictable oral lesions painful. Dry, itchy, flaky patches occur on the scalp, especially around the hair margins in the front and on the sides and in the back. This condition is one of the scalp diseases that does not usually cause hair loss, but with chronic rubbing and scratching the hair can begin to thin around the edges. The earliest sign of injury is localized scaling, flaking, and pus bumps that develop around the base of the hairs that are affected. The psoriatic lesion can be painful to walk on, as can a plantar wart. Also, be sure to pat yourself dry after bathingdon’t rub yourself with the towel. Scratching affected skin will worsen your psoriasis and can even cause new lesions to form. Direct skin testing (patch or scratch) or radioallergosorbent testing may help to identify a specific trigger. Skin cancer can have an occupational link in workers with prolonged exposure to sunlight and certain chemicals, although it can take decades for lesions to develop. Skin cancer can have an occupational link in workers with prolonged exposure to sunlight and certain chemicals, although it can take decades for lesions to develop.
Studies show that some infections can remember to moist the skin with luke warm water. Following are a few tips that would be usefulfor the psoriasis sufferers:1. Avoid Scratching, rubbing and picking at the lesions. Research shows that about 50 of peoplewith psoriasis experience the Koebner phenomenon – developing a psoriatic lesion at the site of askin injury. Injury to the skin 3. Stress can cause psoriasis to flare for the first time or aggravate existing psoriasis. This is known as the Koebner phenomenon. Inverse psoriasis is particularly subject to irritation from rubbing and sweating because of its location in skin folds and tender areas. The disease can develop in a joint after an injury and may mimic a cartilage tear. The Koebner phenomenon is perhaps one of the most widely known phenomena in dermatology. The term is used to describe the response whereby new lesions appear and develop in patients suffering from skin conditions on healthy skin which has suffered a trauma. The Koebner phenomenon usually appears between 10 and 14 days after a trauma to the skin, but it can appear up to several years afterwards. The symptoms of guttate psoriasis are known to worsen in the winter months,2 and stressful life events have been implicated in the development and aggravation of psoriasis. Approximately 18 weeks after her last UVB treatment, the guttate psoriasis returned. 9 Advise patients to avoid rubbing or scratching skin and to protect the skin from trauma, since this may lead to the development of new psoriatic lesions or worsening of lesions (Koebner phenomenon).
Workers with dirty jobs often develop lesions involving the follicular openings. Conversely, burns, mechanical trauma, chronic contact dermatitis, contact with monobenzyl ether of hydroquinone or certain phenolics can induce hypo- or de-pigmented skin. Several non-occupational diseases affecting the skin can be worsened by various occupational influences. Allergic dermatitis, pompholyx, atopic eczema, pustular psoriasis and fungal infections are some examples. Originally posted by Manders What is the koebner effect? The actual definition: Skin Injury People with psoriasis often notice new lesions 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. This relationship between skin injury and developing new psoriatic lesions has been observed in many patients. The Koebner effect can also mean that any injury (say from scratching off a scale) to an existing patch of psoriasis can cause the existing psoriasis lesion to get worse. Additionally, cutaneous lesions can be characterized as specific to an underlying systemic process, or as a nonspecific manifestation that may occur in the setting of multiple disorders. Koebner phenomenon in a patient with psoriasis. Erythematous, scaly papules developed in a linear array after scratching.