Koebnerised Psoriasis and the Koebner Phenomenon
Skin injuries can make psoriasis worse. About one-quarter to one-half of psoriasis patients will experience new lesions forming at the site of healing wounds. This condition is referred to as a Koebner response or phenomenon.
A Koebner phenomenon is most often associated with psoriasis patients, but can happen in people affected with many other types of skin conditions including eczema, systemic juvenile rheumatoid arthritis, lichen planus, and warts. We will look at the history of the condition, its causes, the skin injuries and conditions in which it is associated, and some methods to prevent it from happening.
History of Koebnerised Psoriasis and the Koebner Phenomenon
Dr Koebner, a German physician from the 19th century, discovered the phenomenon in a psoriasis patient who was bitten by a horse and developed new lesions at the site the wound. Many more instances of the phenomenon were subsequently recorded, and the relationship between skin injuries and new lesions was recognized and named after its discoverer. The phenomenon is also referred to as an isomorphic response or isomorphic phenomenon (iso meaning "same" and morph meaning "shape").
Causes of Koebnerised Psoriasis
Wounds which cause a Koebner phenomenon may be small- such as those associated with vaccinations, scrapes, scratches, and insect bites; they may also be larger - such as those associated with surgery, bad sunburns, and rashes. The cause for this phenomenon is unknown, however, it occurs most often in patients who develop psoriasis before age 15. Analyzing the initial changes to the skin after an injury in comparison to healthy skin allows the development of the Koebner Phenomenon in its early stages to be studied.
Approximately 10% of psoriasis sufferers experience the Koebner Phenomenon with every skin injury or condition, and its chances of occurring increase when the psoriasis is in an active stage. In rare cases, it occurs on the site of old scars.
Associated Skin Injuries and Conditions of Koebnerised Psoriasis
The skin injuries conditions associated with a Koebner phenomenon can be physical, chemical, electrical, infective, or inflammatory. These include, among many others:
- Adhesive taping
- Chemical irritation
- Cuts and scrapes
- Pressure against the skin
- Sunburn and peeling
- Herpes blisters
- Lichen planus
- Parasites (scabies)
Avoiding a Koebner Phenomenon: Treatments and Prevention
In order to prevent a Koebnerised psoriasis flare-up, it is important for patients to take care to avoid skin injuries and treat rashes as quickly as possible. If caught early enough, treatment is possible, and preventative measures can be taken if a skin injury is anticipated.
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