Koebner’s Phenomenon

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Koebner's phenomenon or Koebnerisation is named after the German dermatologist Heinrich Koebner who found that skin in people with psoriasis, which had became traumatized following an injury often developed a psoriatic lesion in the area, but where psoriasis had not previously be seen ; including cuts, bruises, burns, bumps, vaccinations, tattoos and other skin conditions. There has been a hypothesis of a 'deep Koebner phenomenon' which might trigger psoriatic arthritis.

A recent study at the University of Manchester looked at environmental risk factors for the development of psoriatic arthritis (Ref:1), with the objective to identify potential risk factors for the onset of inflammatory arthritis (IA) in a large group of patients with psoriatic arthritis (PsA).

Patients recruited into the trial needed to have psoriasis and developed IA within the previous five years. The results of the study (98 cases and 163 control cases) showed a positive association with a previous trauma, these included rubella vaccination, injury sufficient to require a medical consultation, recurrent oral ulcers and moving house. Cases were also more likely to have experienced a fractured bone requiring hospital admission

The study author’s concluded that "…a number of environmental exposures associated with the onset of IA in subjects with psoriasis. The strongest associations were with trauma thereby adding to the hypothesis of a 'deep Koebner phenomenon'…" and "…in PsA our data also suggest that exposure of the immune system to certain infection related triggers may also be of relevance…"

The researchers reported that further studies are needed to verify the observations and to examine potential immunological mechanisms that underlie them.

The article was published in the Annals of the Rheumatic Diseases (ARD) in May 2008 an abstract is available by visiting the website: http:// ard. bmj.com

(1)Ann Rheum Dis. 2008 May;67(5):672-6. Epub 2007 Sep 6. Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Pattison E, Harrison BJ, Griffiths CE, Silman AJ, Bruce IN.