The Köbner phenomenon and psoriatic arthritis

Psoriatic arthritis (PsA) affects a large percentage of patients with psoriasis. Similar to the cutaneous disease of psoriasis, PsA displays an isomorphic response (ie, the propensity to develop at traumatized sites). In some patients, traumatized joints that subsequently develop PsA are the initial manifestation of psoriasis, preceding the skin disease by months to years. Dermatologists should screen patients with psoriasis for accompanying PsA and consider recently traumatized joints that remain arthritic to be a component of this disease.     

Isotopic response, Köbner phenomenon and Renbök phenomenon following herpes zoster

Linear skin diseases may follow Blaschko’s lines, Langer’s relaxed skin tension lines or head zones (dermatomes), thus indicating an embryogenic, hematogenic or neuronal aspect in their pathogenesis. Köbner phenomenon describes the eruption of an inflammatory skin disease following mechanical alteration of the skin. Renbök phenomenon describes an area of non‐involvement in an otherwise generalized skin disease. Wolf’s isotopic response may be understood as a special subtype of Köbner phenomenon, in which one skin disease triggers a second one. Pathogenically unrelated skin diseases may follow a zosteriform distribution, if they are linked to a preceding herpes zoster by Köbner phenomenon, Renbök phenomenon or an isotopic response. We report three instructive patients diagnosed with Wegener’s granulomatosis, cutaneous graft‐versus‐host disease and lichen planus, whose skin manifestations were following or sparing a zosteriform distribution pattern. Köbner phenomenon, Renbök phenomenon or Wolf’s isotopic response may link pathogenically unrelated skin diseases to a zosteriform pattern, which may present diagnostic difficulties even for dermatologists.     

Heinrich Köbner

Ohne Zusammenfassung     

Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris

OBJECTIVE: To investigate the association between the experimentally induced Kobner phenomenon (KP-e) and the Kobner phenomenon by history (KP-h), disease activity, and therapeutic responsiveness in vitiligo vulgaris. DESIGN: Cohort study. SETTING: An outpatient clinic. PATIENTS: Sixty-one consecutive patients with vitiligo vulgaris. INTERVENTION: Three months after a standardized epidermodermal injury was induced, the KP-e was evaluated. For 1 year, UV-B (311 nm) therapy or topical fluticasone propionate plus UV-A therapy was given, depending on the severity of depigmentation. MAIN OUTCOME MEASURES: The presence or absence of the KP-e and the KP-h disease activity as scored on a 6-point scale from -1 to +4 (vitiligo disease activity [VIDA] score) and therapy-induced repigmentation grade. RESULTS: Nineteen (31%) of the patients had a positive KP-h, whereas 37 (61%) showed a positive KP-e (P<.001). The VIDA score did not always predict a positive KP-e, although patients with a positive KP-e had a higher mean VIDA score (VIDA score of 1.6) than did patients with a negative KP-e (VIDA score of 0.5) (P<.001). The responsiveness to UV-B (311 nm) therapy among KP-e-positive or KP-e-negative patients was not significantly different (P=.66). However, KP-e-positive patients who were treated with fluticasone propionate plus UV-A showed a better response than did KP-e-negative patients (P=.01). Among patients responding to both therapies, VIDA scores were significantly decreased (P<.001) compared with VIDA scores before therapy. CONCLUSION: The KP-e may function well as a clinical factor to assess present disease activity and may also predict the responsiveness to fluticasone propionate plus UV-A therapy but not to UV-B (311 nm) therapy.     

Necrobiosis lipoidica associated with Köbner's phenomenon in a patient with diabetes

Necrobiosis lipoidica (NL) is a granulomatous disease that usually presents on the lower extremities of patients with diabetes mellitus. We present a rare case of NL k?bnerizing in a surgical scar on the upper extremity of a patient with diabetes. NL is generally refractory to treatment.     

Detection of the K?bner phenomenon of the skeleton of patients with psoriasis]

Psoriasis is a humorally controlled systemic disease. The degree of "eruptive strength" of manifestation results from hereditary factors (disposition) and environmental factors (provocation). We were able to demonstrate that the well-known K?bner phenomenon of the skin also occurs on the skeleton of patients suffering from psoriasis. We analysed 83 patients in whom bone scans were carried out. Our results indicate that provocation factors such as bacterial foci and/or trauma correlate with a significantly higher number of pathological scintigraphic findings, ranging up to "hot spots". Furthermore, not only did bone fractures remained scintigraphically positive for an unusually long time, traumas of the end phalanx could be demonstrated in 70% of psoriatic patients compared with 21% of a control group. Obviously, one factor alone or a combination of factors triggers the involvement of the skeleton as a "deep K?bner phenomenon". In psoriatic patients the response of bone metabolism to disturbance differs from that of non-psoriatic patients in that there is a long-lasting dysregulation. This explains the high correlation between skin and skeletal manifestation in psoriatics. Therefore the manifestation of psoriatic disease is due not to a single-stranded linear causal interrelation but to a multicausal "network pathogenesis". Bone scintigraphy is the diagnostic method of choice in patients with psoriatic osteoarthropathy and allows an objective evaluation of therapeutic success.     

Ultraviolet light-induced Köbner phenomenon contributes to the development of skin eruptions in multicentric reticulohistiocytosis

Multicentric reticulohistiocytosis is a rare systemic disease of unknown aetiology characterized by erosive arthritis and cutaneous lesions consisting of multiple reddish-brown papules and nodules, mainly involving the face and distal upper extremities. It has been suggested that skin eruptions in multicentric reticulohistiocytosis are associated with K?bner phenomenon due to their characteristic distribution, such as on the dorsal aspects of the hands and fingers. We report here a case of a Japanese woman with multicentric reticulohistiocytosis, in whom erythematous macules and papules were widely distributed over the face, ears, neck and the V-area of the chest. Notably, repeated irradiation of ultraviolet (UV) B on the uninvolved back skin resulted in the induction of erythematous macules with infiltration of reticulohistiocytes, indicating the association of UVB-induced K?bner phenomenon with the development of skin lesions, especially on the sun-exposed area. This is the first known report demonstrating the contribution of UV-light-induced K?bner phenomenon for the development of skin eruptions in patients with multicentric reticulo-histiocytosis.     

Über die Epidermolysis bullosa hereditaria Köbner

Ohne ZusammenfassungHiezu Taf. XI–XVII.     

Heinrich Köbner und der "isomorphe Reizeffekt"

The isomorphic phenomenon belongs to the probably most well-known entities of dermatology and is closely connected to the man who was the first to describe it. Today the Koebner phenomenon is well documented in a number of skin diseases and still of considerable interest. Heinrich Koebner first reported his observation in 1872 and caused considerable diverse discussion about the origin of psoriasis in the following years. Heinrich Koebner is not only well known as "father" of the Koebner phenomenon, but also as a founder of the university dermatology clinic and pioneer of dermatology in Breslau. We not only describe the life of Heinrich Koebner, but also discuss the evolution of the term "Koebner phenomenon" and its current status.     

Über Epidermolysis bullosa traumatica hereditaria (Köbner)

Ohne ZusammenfassungMit 2 Textabbildungen.     

Beitrag zur Kenntnis der Epidermolysis bullosa hereditaria (Köbner)

Ohne Zusammenfassungleit. Arzt der Hautabteilung des Stadtkrankenhauses zu Posen.     

Fall 4. Epidermolysis bullosa hereditaria simplex (Köbner)

Ohne Zusammenfassung     

Hemorrhagic bullous lesions in a child with Henoch-Schönlein purpura

Abstract: An 8‐year‐old boy with Henoch–Schönlein purpura who developed hemorrhagic bullae is described. The occurrence of hemorrhagic bullae in children with Henoch–Schönlein purpura is rare. A perusal of the literature revealed but seven occurrences to which we add another one.     

Coronary artery thickening with mucosal lesions in Henoch-Schönlein purpura

Abstract: Henoch–Schönlein purpura (HSP) is the most common vasculitis of childhood. It is usually self‐limiting and is characterized by an immune complex–mediated vasculitis associated with IgA deposition. We present an unusual case of HSP with mucosal lesions and coronary artery thickening.     

Primary localized cutaneous amyloidosis with unusual clinical features in a patient with Sjögren's syndrome

A 69‐year‐old woman presented with a 2‐year history of an eczematous lesion covering the genital area. Histopathological examination showed deposits of amorphous, eosinophilic material and an infiltrate of plasma cells through the entire dermis into the subcutaneous fatty tissue. Congo red‐stained deposits showed apple‐green birefringence with polarizing microscopy. On immunohistochemistry, the deposited material was positively stained with anti‐κ light chain antibodies but not with anti‐λ light chain. A diagnosis of primary localized cutaneous amyloidosis (PLCA) was made, and the patient was also diagnosed as having Sjögren's syndrome (SjS) based on clinical and laboratory findings. The lesion of PLCA has spontaneously regressed over a period of 18 months. We report a unique case of PLCA and SjS that clinically demonstrated genital eczematous features and spontaneous involution, and we also describe a possible association between PLCA and SjS.