From the Guidelines
The treatment for Koebner phenomenon in psoriasis focuses on preventing skin trauma and managing the underlying psoriasis. The primary approach involves avoiding skin injury through protective measures like wearing loose clothing, using gentle skin care products, and preventing scratching or rubbing of the skin. For active lesions, topical corticosteroids (such as betamethasone dipropionate 0.05% cream applied twice daily for 2-4 weeks) are first-line treatments to reduce inflammation, as supported by the guidelines of care for the management of psoriasis and psoriatic arthritis 1. Topical vitamin D analogs like calcipotriol (50 μg/g applied once or twice daily) can be used alone or combined with steroids. For widespread or severe cases, systemic treatments may be necessary, including methotrexate (starting at 7.5-15 mg weekly), biologics like adalimumab (initial dose 80 mg subcutaneously, then 40 mg every other week), or phototherapy (narrowband UVB, 3 sessions weekly for 6-12 weeks), as recommended by the British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005 1. These treatments work by suppressing the inflammatory response and abnormal skin cell proliferation that characterize psoriasis. Keeping the underlying psoriasis well-controlled is crucial since Koebner phenomenon is more likely to occur during active disease phases, as highlighted in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 4 1. Some key considerations in the management of psoriasis include:
- The use of topical therapies, such as corticosteroids and vitamin D analogs, as first-line treatments for mild to moderate disease, as outlined in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 3 1.
- The role of phototherapy, including narrowband UVB, in the treatment of moderate to severe psoriasis, as discussed in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 5 1.
- The potential benefits and risks of systemic treatments, including methotrexate, biologics, and cyclosporine, in the management of severe or refractory psoriasis, as reviewed in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 6 1.
From the Research
Koebner Phenomenon in Psoriasis
The Koebner phenomenon is a condition where new psoriatic lesions emerge in healthy skin regions following an injury or trauma to psoriatic patients 2. This phenomenon can be triggered by various agents, including tattooing, radiation, skin incision, viral infections, and striae.
Triggers of Koebner Phenomenon
Some of the triggers of the Koebner phenomenon include:
Mechanisms of Koebner Phenomenon
The mechanisms involved in the Koebner phenomenon include:
- Involvement of mast cell-derived inflammatory mediators such as tryptase, IL-6, IL-8, IL-17, and IL-36γ 2
- Increased expression of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) 2
- Critical role of α 2 β1 integrins, S100A7 (psoriasin) and S100A15 (koebnerisin) 2
- Change in the ratio of CD4+/CD8+ T cells 2
- Down-regulation of mechanosensitive polycystin 1 protein 2
- Decrease in inflammation controlling atypical chemokine receptor 2 (ACKR2) 2
- Reduced expression of N-methyl-d-aspartate (NMDA) receptors (NMDARs) on the keratinocytes 2
- Increase in levels of chemokines (CXCL8 and CCL20) 2
Treatment of Koebner Phenomenon
While there is no specific treatment mentioned for the Koebner phenomenon, the lesions that develop as a result of this phenomenon can be treated with anti-psoriatic therapies 5. However, the efficacy of cupping therapy, a traditional Chinese medicine used to heal psoriasis, is controversial, and psoriatic patients may develop localized psoriasis through koebnerization as a result of cupping therapy rather than achieve desirable therapeutic benefits 4.