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Indian Journal of Dermatology, Venereology & Leprology, Vol. 69, No. 3, May-June, 2003, pp. 225-226 Case Report Koebner phenomenon in PLEVA Arun C. Inamdar, Aparna Palit Department of Dermatology, Venereology & Leprology, BLDEA'S SBMP Medical
College, Hospital & Research Centre, Bijapur, Karnataka, India.
Code Number: dv03010 Abstract Koebner phenomenon has been described in relation to many immunological, inflammatory and infectious dermatoses since the time of its first description. We report a man with pityriasis lichenoides et varioliformis acuta showing Koebner phenomenon. Key Words: Koebner phenomenon, Pityriasis lichenoides et varioliformis acuta, PLEVA Introduction Pityriasis lichenoides et varioliformis acuta (PLEVA) is an acute or subacute and at times relapsing papulovesicular disease of unknown etiology.1 The initial lesion is an edematous, pink papule which undergoes central vesiculation and hemorrhagic necrosis to give rise to a reddish brown crust. A purely vesicular form of the disease also exists.1 Koebner phenomenon has been described in many dermatoses, but a search of the literature did not reveal any report of its occurrence in PLEVA. Here we describe a case of the vesicular form of PLEVA showing Koebner phenomenon. Case report A 65-year-old electrician presented with a history of crops of multiple, intensely itchy, vesicular skin lesions of 2 months' duration. He was hypertensive and was on treatment with amlodepine for the past one year. On examination, he was found to have multiple umbilicated vesicular lesions, distributed mainly over the extremities, in various stages of evolution. A few lesions showed central necrosis. The vesicles were not grouped but showed distinct koebnerization along the lines of scratching (Figure 1). Very few lesions were present on the trunk. There were no systemic symptoms. Routine hematological, biochemical and radiological examinations were within normal limits. Histopathological examination from a vesicular lesion showed spongiosis, subepidermal bulla formation and an angiocentric infiltrate comprised of lymphocytes and neutrophils in the superficial and deep dermis consistent with the clinical diagnosis of PLEVA. Discussion Isomorphic phenomenon, a feature of psoriasis, was originally described by Heinrich Koebner in 1876.2 Although best known in psoriasis, the Koebner phenomenon may also be seen in certain other dermatoses. Boyd and Neldner have classified all reported cases of Koebner phenomenon into four different groups:3 (1) True isomorphic phenomenon, diseases in which the phenomenon is reproducible by a variety of insults (type 1), e.g. psoriasis, lichen planus and vitiligo; (2) Koebner phenomenon seen in infectious diseases, pseudoisomorphic phenomenon (type 2), e.g. warts, molluscum contagiosum; (3) diseases occasionally localized to sites of trauma (type 3), e.g. erythema multiforme, Darier's disease, lichen nitidus, Hailey-Hailey disease, perforating folliculitis, reactive perforating collagenosis, Kaposi's sarcoma, and (4) single reports or a few examples of a number of disorders associated with Koebner phenomenon (type 4). The fourth group includes different dermatological disorders, varying from anaphylactoid purpura, bullous pemphigoid, erythrokeratoderma variabilis, lichen amyloidosis, urticaria pigmentosa, dermatitis herpetiformis to DLE, multicentric reticulohistiocytosis and xanthoma eruptivum. The pathogenesis of Koebner phenomenon is not known.4 Scratching secondary to the intense pruritus associated with PLEVA in the index case might have caused the lesions in a linear isomorphic pattern. References
Copyright 2003 - Indian Journal of Dermatology, Venereology & Leprology. Free full text also available from: http://www.ijdvl.com The following images related to this document are available:Photo images[dv03010f1.jpg] |
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