Do you experience psoriasis flare-ups on the site of an injury?
Welcome to Koebner Phenomenon. An active inflammatory case of psoriasis can demonstrate the Koebner phenomenon in which new lesions form at a site of trauma or pressure.
First discovered in 19th century by a dermatologist named Heinrich Koebner, the Koebner response is triggered by physical stress to the skin and happens most often in people with psoriasis, but it happens in other skin conditions, too, including warts and vitiligo.
I know the Koebner curse first hand. Prior to clearing my skin, I have had severe psoriasis on my lower legs for around 35 years. In particular on the sites where I have had injuries, which explains why my knees as well as elbows have some pesky, heavy duty layers. By using the principles and strategies that I share on PsoriasisLife, I have been blessed with a long period of psoriasis free legs. That suddenly changed when I slipped on the edge of a rock pool two months ago. A chip in my tibia bone not only hurt, it also triggered an outbreak of psoriasis on and around the site of the fracture and wound. Almost exactly like the time I fracture my tibia in the same place almost six years earlier.
Creams can cause Koebner
Some topical drugs, such as coal tar and anthralin have been described also to cause a flare-up of psoriasis, leading to the Koebner phenomenon in patients with active psoriasis. This is where skin that is irritated by chemical agents may be affected by the release of potent proinflammatory neuropeptides from the nerve endings in the region affected.
Rethink the ink to cover psoriasis
I first came across Koebner phenomenon when I researched the potential for tattoos to disguise psoriasis that remains in the same area long term. I am convinced this is not a good idea. The mechanics of tattooing are both considered an injury to the skin and a chemical irritant because of the introduction of the ink. Each reaction has its own pace. It takes about 10-20 days after a skin injury for plaques to show up. Sometimes it can take as long as 2 years. The internet has plenty of pictures of people who thought a tattoo would be a good way to cover up psoriasis, and who subsequently experienced the Koebner response.
Tattoos are one of many ways we deliver a message about our values, passions and beliefs, while clear skin may be your own way of displaying your victory.
Avoiding Koebner related flare-ups
Avoid skin injury:
- Preventing cuts and abrasions by looking before you leap, wearing personal protective clothing where necessary and immediately treating wounds to reduce the inflammation on the site.
- Prevent insect bites by covering up and using only insect repellents that have naturally occurring ingredients as they are easier for our skin to assimilate. Avoid scratching bites. Treat bites with a natural and simple ingredient such as honey, aloe vera, vinegar, food grade oil, bicarb of soda paste or onion poultice.
- Rethink the tattoo.
- Prevent sunburn by timing your sun exposure and covering up when you are overstaying your time in the sun.
Avoid skin irritants such as harsh chemical agents and commercial products that contain petrochemicals.
Reference
Sagi I, Trau H, The Koebner phenomenon. Clin Dermatol. 2011 Mar-Apr;29:231-236
Eedy DJ, Johnston CF, Shaw C, Buchanan KD, Neuropeptides in psoriasis: an immunocytochemical and radioimmunoassay study. J Invest Dermatol. 1991;96:434-438
