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Year : 2003  |  Volume : 69  |  Issue : 3  |  Page : 226

Koebner phenomenon in PLEVA

Department of Dermatology, Venereology & Leprology, BLDEA’S SBMP Medical College, Hospital & Research Centre, Bijapur, Karnataka.

Correspondence Address:
Department of Dermatology, Venereology & Leprology, BLDEA’S SBMP Medical College, Hospital & Research Centre, Bijapur, Karnataka.
[email protected]

  #  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.

How to cite this article:
Inamdar A C, Palit A. Koebner phenomenon in PLEVA . Indian J Dermatol Venereol Leprol 2003;69:226

How to cite this URL:
Inamdar A C, Palit A. Koebner phenomenon in PLEVA . Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2021 Jan 22];69:226. Available from:

  ::   Introduction Top

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 Top

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 Top

1.Ryan TJ. Cutaneous vasculitis. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Textbook of dermatology. 6th ed. London: Blackwell Science; 1998. p. 2155-227.  Back to cited text no. 1    
2.Koebner H. Zur Aetiologic der psoriasis. Vjschr Dermatol 1876;3:559.  Back to cited text no. 2    
3.Boyd AS, Neldner KH. The isomorphic response of Koebner. Int J Dermatol 1990;29:401-10.  Back to cited text no. 3  [PUBMED]  
4.Miller RA. The Koebner phenomenon. Int J Dermatol 1982;21:192-7.  Back to cited text no. 4  [PUBMED]  


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