Koebner Phenomenon Related to Cupping Therapy in a Patient with Psoriasis

( Hyun-yi Suh ),( Kyung-ho Kim ),( Jae-wook Jeon ),( Ji-young Ahn ),( Mi-youn Park ),( Jai-il Youn ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.6

Psoriasis is a chronic skin disease affecting 1∼3% of the population1. Not only physical trauma but also burns, insect bites, surgical incision, and radiation exposure may induce a Koebner response in psoriasis2. Cupping therapy is an ancient oriental form of alternative medicine in which local suction is created that can leave temporary bruised painful marks on the skin. Alternative medical practitioners think cupping therapy is effective because it can increase circulation around the area of cupping and eliminate the toxins3. We report the impressive case of Koebner phenomenon related to cupping therapy in a psoriasis patient. A 38-year-old man had a more than 3-year history of psoriasis. The patient had controlled well his psoriatic lesions. He had no family history of skin problems. He presented with several erythematous scaly plaques and patches with crust from his back to buttocks after he had been given two sessions of cupping therapy once a week owing to gastrointestinal problems (Fig. 1). These psoriatic plaques that developed at the cupped sites were the same area as the vacuum cups used (Fig. 1B). The skin lesions appeared as ecchymosis and vesicles on the edges of the cupping area (Fig. 1C). The cupping treatment was performed even on the psoriatic lesions, so the lesions were aggravated and other sites appeared as new psoriatic lesions (Fig. 1D). Clinically, we treated with calcipotriol and betamethasone. Cupping treatments are widely used in Asia and they have a public reputation for being safe for the treatment of various pain-related conditions such as myalgia, arthralgia, and postherpetic neuralgia3. Cupping can induce both epidermal cell injury and dermal vascular damage. Some people reported that cupping therapy created specific changes in local tissue structures as a result of local negative pressure in the cups used, which stretches the nerve and muscle4. Many studies suggest that trauma can cause both epidermal cell injury and dermal inflammation to produce the Koebner phenomenon 2. In a study that used low-pressure suction or tape stripping, or both, psoriasis developed only where the blister roof was removed. These findings suggested that rupture of the epidermis can initiate the Koebner response5. There is no research on the relationship between cupping therapy and the Koebner phenomenon. Our hypothesis is that cupping is a form of trauma, inducing the Koebner phenomenon in patients with psoriasis. The efficacy of cupping therapy has not been confirmed. The therapy can be harmful for psoriatic patients who may develop psoriasis through koebnerization. We think that cupping therapy is a useful medical practice, and it is easy to overlook factors that can cause lesions that can be categorized as trauma. Therefore, we report this case of Koebner phenomenon related to cupping therapy in a patient with psoriasis.

침과 부황에 의한 Koebner 현상을 보인 다형홍반

장은주 ( Eun Joo Jang ),이동윤 ( Dong Yoon Lee ),이지연 ( Ji Yeoun Lee ),김미경 ( Mi Kyeong Kim ),윤태영 ( Tae Young Yoon ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.9

Since its first description in 1887 as the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma, the Koebner phenomenon has been described in numerous diseases. Several types of injury can trigger the Koebner phenomenon, such as physical injury, surgical wound, irritation, sunburn, or radiation therapy. In this report, we describe a 43-year-old woman who developed erythema multiforme which was accompanied by the Koebner phenomenon after getting acupuncture and cupping glass therapy. The purpose of the report is to broaden our awareness of the spectrum of injury that can trigger the Koebner phenomenon. (Korean J Dermatol 2011;49(9):809~811)

Squamous cell carcinoma arising on previous skin graft donor site as Koebner phenomenon

( Jung-hwan Kim ),( Yeo-rye Cho ),( Ho-jin Kim ),( Hee-chul Eun ),( Ki-hoon Song ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Squamous cell carcinoma (SCC) is the second most frequent type of primary skin cancer. The Koebner phenomenon is defined as the appearance of cutaneous lesions following trauma and is observed in a series of skin diseases including vitiligo, psoriasis, lichen planus and rarely angiosarcoma. Here, we report a rare case presenting large SCC that was suspectively occur in relate to Koebner phenomenon. A 65-year-old man presented with occurred on the donor site of split thickness skin graft. The patient had multiple surgical histories due to multiple SCCs and in one of them, SCC of left palm was recovered by split-thickness skin graft harvested from his right thigh, the site that SCC in situ was newly occur. The most common treatment option for squamous cell carcinoma is surgery. But microinvasive SCC can also be treated by AFL-PDT, and since there is a history of SCC form skin donor site, the patient was treated with AFL-PDT. After 2 sessions of AFL-PDT, the lesions were almost cleared and there was no recurrence for a year. SCC that occurred at previous donor site on this patient suggests that it can arise by the Koebner phenomenon, and AFL-PDT is another good option for such patients as AFL-PDT is less invasive and showed better cosmetic outcome than surgical removal.

A case of remote reverse Koebner phenomenon in childhood multiple keratoacanthoma

( Jongwook Oh ),( Min-geol Lee ),( Tae-gyun Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Keratoacanthoma (KA) is a variant of well-differentiated squamous carcinoma of the skin. The natural course of KA is characterized by rapid growing and subsequent spontaneous regressing phases. Multiple KA is a rare variant and most cases are associated with Muir-Torre syndrome, multiple KA of the Ferguson-Smith type, generalized eruptive KA, and KA centrifugum marginatum. Multiple KA usually occurs in adulthood and there have been few reports describing multiple KA in early lifetime. A 1-year-old Korean boy visited our clinic with three discrete, non-tender, indurated nodules with central keratin core on his occipital area, which rapidly grew over the past 1 month prior to his visit. Skin biopsy from one mature lesion showed a central invaginating hyperkeratosis and arborizing architecture composed of well-differentiated squamous cells which were consistent with KA. Surprisingly, after sampling biopsy specimen from one representative lesion, all three lesions exhibited a process of rapid regression within 2 weeks period (remote Koebner phenomenon). The patient has not demonstrated any signs for recurrence up to 6 months. Thus, our patient presented a rare case of multiple KA in childhood spontaneously healed by remote reverse Koebner phenomenon.

Koebner 현상에 의해 선상태선의 임상 양상을 보인 광택태선

송영찬 ( Young Chan Song ),고종현 ( Jong Hyun Ko ),오병호 ( Byung Ho Oh ),이양원 ( Yang Won Lee ),최용범 ( Yong Beom Choe ),안규중 ( Kyu Joong Ahn ),송계용 ( Kye Yong Song ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.11

Lichen nitidus is an uncommon, asymptomatic cutaneous shiny papular eruption and it can rarely show Koebner`s phenomenon, which may clinically resemble lichen striatus. It is known that for such cases, the clinicopathological correlation is the most important factor for making the diagnosis and immunohistochemical staining for CD4, CD8 and CD68 can be helpful to differentiate these two diseases. We experienced a case of Koebner phenomenon, which clinically mimicked lichen striatus, in a patient suffering with lichen nitidus. (Korean J Dermatol 2008; 46(11): 1517∼1520)

Koebner 현상이 동반된 전신성 광택태선 1예

김기준,김시용,김영조,최규철,정병수 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.1

Lichen nitidus is a rare chronic dermatitis of unknown etiology. It is characterized by round, flat-topped, flesh-colored papules 2 to 3 mm in diameter that may occur in groups but do not coalesce. The lesions of lichen nitidus are usually localized to the upper extremities, genitalia, chest, and abdomen, but less commonly, they may be generalized. Although the eruption is usually asymptomatic, it is sometimes mild pruritic, and the Koebner phenomenon may be observed very exceptionally. We reported a case of generalized lichen nitidus with Koebner phenomenon.

Koebner Phenomenon Delays Therapeutic Effect of Pulsed Dye Laser on Refractory Psoriasis

Jae Wan Park,Sun Hye Shin,Hye Sung Han,유광호 대한의학레이저학회 2020 MEDICAL LASERS Vol.9 No.1

Psoriasis is a common chronic inflammatory skin disease that is histopathologically characterized by abnormal differentiation and hyperproliferation of keratinocytes, infiltration of T lymphocytes, and alternations of the dermal vasculature. Pulsed dye laser (PDL) is commonly used to treat cutaneous vascular lesions, and it has been studied for the treatment of localized psoriatic lesions. A 30-year-old female patient with refractory psoriasis on her forehead was treated using PDL. After two sessions, the size of the psoriatic lesion increased, which might have occurred due to koebnerization. As the patient continued to receive PDL treatment, the lesion showed significant improvement with no recurrence on the one-year follow-up. We present here a case of refractory psoriasis treated with PDL and demonstrates an association between a delayed therapeutic effect and the Koebner phenomenon.

Psoriasis developed after tattooing

( Hyun Yi Suh ),( Hong Lim Kim ),( Kyung Ho Kim ),( Jae Wook Jeon ),( Ji Young Ahn ),( Mi Youn Park ),( Jai Il Youn ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Koebner phenomenon was initially reported as the formation of psoriasiform lesions after cutaneous trauma in the uninvolved skin of people with psoriasis in 1877 by Heinrich Koebner. More recently, the definition has been extended to include lesions developed after trauma in people with no pre-existing dermatosis. A 26-year-old man visted our clinic for erythematous scaly papuloplaques on the left arm around tattoo and forehead. He had tattoos on his arm before 5 months. The skin lesions on the forehead had appeared first since the 4 month and then on his forearms around tattoos, they had been appeared since 1month. The lesions were mild itchy. He had no family history of skin problems and no previous skin conditions. A skin biopsy was performed in the left forearms. Skin biopsy in lesion showed parakeratosis. perivascular inflammatory and the exogenous pigment of the tattoo is in the dermis. We treated with topical steroid agent for his skin lesion. We report this impressive case that getting a tattoo in the patient without pre-existing dermatosis should induce psoriasis by Koebner phenomenon.

Less Keratinocyte-Derived Factors Related to More Keratinocyte Apoptosis in Depigmented than Normally Pigmented Suction-Blistered Epidermis May Cause Passive Melanocyte Death in Vitiligo

Lee, Ai-Young,Kim, Nan-Hyung,Choi, Won-Ik,Youm, Yun-Hee Blackwell Publishing 2005 The Journal of investigative dermatology Vol.124 No.5

<P>Stem cell factor (SCF) of keratinocyte origin regulates melanocyte growth and survival. Deprivation of survival factors causes the apoptosis of melanocytes. Vitiligo often develops following physical trauma, even if this is minor. The exact mechanism of the Koebner phenomenon in vitiligo is unclear. Apoptosis of keratinocytes, which occurs more in depigmented suction-blistered epidermis than in the normally pigmented counterpart, could reduce levels of keratinocyte-derived factors such as SCF and basic fibroblast growth factor (bFGF). Levels of SCF expression were examined in the depigmented and normally pigmented paired epidermis of 19 patients with vitiligo, and bFGF expression in six patients. The expression of SCF (p<0.001) and bFGF was usually reduced in the depigmented compared with the normally pigmented epidermis. Apoptosis of cultured normal human keratinocytes, which was induced by staurosporine, resulted in a concentration-dependent decrease in levels of SCF mRNA and protein. Normal human melanocytes proliferated more in medium containing SCF or keratinocyte (XB-2) feeder than in medium with neither. Deprivation of SCF or keratinocyte feeder in the culture medium induced a marked decrease in melanocytes as a result of apoptosis. Therefore, lower expression of keratinocyte-derived factors, including SCF, in vitiliginous keratinocytes, which could result from keratinocyte apoptosis, might be responsible for passive melanocyte death and may explain the Koebner phenomenon.</P>

골수 이형성 증후군에 발생한 특이한 급성 발열성 호중구성 피부병(Slveet 증후군) 1례

한지숙,이진헌,최승원,민유홍,고윤웅,이광훈,이광길 大韓血液學會 1997 大韓血液學會誌 Vol.32 No.3