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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Rarely associated with itch. Psoriatic arthropathy is not associated with presence of rheumatoid factor in the serum. May be aggravated by physical or chemical trauma. The Koebner phenomenon is the appearance of lesions at the site of local trauma. If it involves exposed arms/forearms/scalp with shedding of scales which may be a source of staphylococcal infection.
Special Groups
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Sandipan Dhar, Sahana M. Srinivas
Koebner phenomenon has been documented more commonly in nonsegmental vitiligo [3]. Sometimes children present with initial vitiligo lesions on knees, elbows, shins, arms, and hands due to Koebner phenomenon, as children are known to have trauma on these areas due to play activities. Koebner phenomenon indicates disease activity. Koebner phenomenon had varied incidence, ranging from 11.3% in a Handa and Dogra study [7] to 21% in a Sheth et al. study [12].
Basics of onychopathology
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Pyoderma gangrenosum is a rare neutrophilic dermatosis of unknown etiology. Gastrointestinal, rheumatic, and other diseases are often associated linking it to the group of autoinflammatory disorders.218 It is characterized by progressive cutaneous ulceration that may start with a tiny tender papule or pustule, which rapidly enlarges. Differentiation from an infection is crucial and may sometimes be difficult.219,220 The pathogenesis includes immune complexes mediating neutrophilic vascular lesions. Trauma and Koebner phenomenon may elicit new lesions. Nail involvement was observed in association with cyclosporin A treatment.221,222 The histopathology of pyodermia gangrenosum is nonspecific and requires clinical data. In the beginning, there is an infiltrate mainly composed of neutrophils. This develops into a necrotizing and suppurative lesion with a lymphocytic margin with perivascular and intramural lymphocytes. Around these, cuffs of neutrophils may be seen. Sometimes, a sweet-like aspect is present.
An update on cutaneous complications of permanent tattooing
Published in Expert Review of Clinical Immunology, 2019
A wide number of dermatoses can develop on a tattoo (Table 3) [9–13]. Patients with dermatoses prone to Koebner phenomenon are peculiarly at risk including psoriasis [83], vitiligo [84], or lichen planus [85] (Figure 5(b)). Granulomatous reaction to tattoos, whether the reaction is restricted to one color or not, may reveal systemic sarcoidosis (Figure 5(c)) [86]. Granulomatous reaction and sarcoidosis tend to appear mostly, but not exclusively, on black tattoos [86,87](Figure 5(c)). The presence of other cutaneous lesions or extracutaneous granulomas helps in distinguishing sarcoidosis from a hypersensitivity reaction [86]. TAGU (TAttoo Granulomas with Uveitis) is an exclusion diagnosis that encompasses patients who are developing granulomatous tattoo reactions exclusively associated with uveitis but without any formal proof of systemic sarcoidosis [88]. Lastly, granulomatous tattoo reactions associated with targeted therapies and immunotherapies, such as BRAF-MEK, CTLA-4, and PD-1/PD-L1 inhibitors for cancer start to be reported. Reactions are most likely to occur within old black tattoos and may be associated with sarcoidosis or not [89].
Effects of a topical ointment on responses to treatments used for common genital diseases and on quality of life
Published in Cogent Medicine, 2020
Clarence de Belilovsky, Jean-Marc Bohbot
During psoriasis, 33%–63% of women will develop genital psoriasis (Meeuwis et al., 2011). It causes pruritus, pain, burning sensation, and dyspareunia. It typically expresses as flares but may become chronic and impair QoL and sexual health (Ryan et al., 2015). Treatment includes the use of long-term, sequential or intermittent application of moderate to potent TSs. However, these steroids are often not potent enough to induce a complete response, and thus to completely relieve patients from their symptoms (pruritus mainly; Czuczwar et al., 2016). Patients should avoid trigger factors associated with the Koebner phenomenon. Emollient use is recommended during extra-genital psoriasis to reduce treatment-induced irritation and maintain therapeutic results (Paulsen et al., 2005).
Adult-onset Still’s disease accompanied by erythema multiforme presenting as an atypical rash
Published in Scandinavian Journal of Rheumatology, 2020
A 36-year-old Japanese woman experienced sore throat, arthralgia, and fever. One week after the onset of symptoms, she visited a local clinic and was prescribed amoxycillin. Six days later, she noticed erythema on her extremities, which extended to her face, and presented to our hospital. On physical examination, she was alert and conscious. Her temperature was 37.9°C, blood pressure 153/83 mmHg, heart rate 124 beats/min, and respiratory rate 20 breaths/min. Her tonsils were red but not enlarged. Her cervical lymph nodes were palpable and tender. Her bilateral wrist, knee, and ankle joints were painful; however, no swelling or warmth was noted. Erythematous maculopapular rash with target lesions was observed all over the body (Figure 1). Koebner phenomenon was not noted. Laboratory examination showed a white blood cell count of 32 300/μL with 98% neutrophils, haemoglobin level of 12.5 g/dL, platelet count of 40.9 × 104/μL, aspartate transaminase level of 65 U/L, alanine aminotransferase level of 65 U/L, lactate dehydrogenase level of 503 U/L, and C-reactive protein (CRP) level of 14.98 mg/dL. The serum ferritin level was 6436 ng/mL, rheumatoid factor level was 55 IU/mL, and antinuclear antibody was positive at a titre of 1:80. The patient was negative for anti-Epstein–Barr virus (EBV) capsid antigen immunoglobulin M (IgM) antibody, and positive for its IgG antibody. No conclusion was reached for Epstein–Barr nuclear antigen antibodies because of a non-specific reaction. The patient was negative for EBV-DNA and anti-cytomegalovirus (CMV) IgM antibody and positive for anti-CMV IgG antibody. These results indicated past infection. Blood and urine cultures yielded no bacteria. Whole-body computed tomography showed slight hepatosplenomegaly. She refused to undergo skin biopsy.