Distinguishing Features: Linear Rashing is Not Always Koebnerization

Main Article Content

Nneamaka Ezekwe
Thy Huynh
Robert Brodell

Keywords

Dermatology, Cutaneous Sarcoidosis, Psoriasis, Scar Sarcoidosis, Immunocompromised District, Koebner, Koebner Phenomenon

Abstract

Cutaneous sarcoidosis and psoriasis are dermatologic conditions that can have a similar clinical appearance.  Psoriasiform sarcoidosis shows thick white or silvery scaling reminiscent of psoriasis and both conditions can be linear.  Psoriasis is associated with linear scaled patches that are induced by mechanical trauma (Koebner Phenomenon).  Linear lesions in cutaneous sarcoidosis are not a result of koebnerization, rather cutaneous granulomas appear in well-healed scars decades after the trauma within what can be termed an immunocompromised district.  This paper will focus on the features that distinguish psoriasis and cutaneous sarcoidosis, since prompt diagnosis leads to appropriately targeted treatment.

References

1. Wanat KA, Rosenbach M. A Practical Approach to Cutaneous Sarcoidosis. Am J Clin Dermatol. 2014;15(4):283-297. doi:10.1007/s40257-014-0079-3

2. Huynh TN, Jackson JD, Brodell RT. Tattoo and vaccination sites: Possible nest for opportunistic infections, tumors, and dysimmune reactions. Clin Dermatol. 2014;32(5):678-684. doi:10.1016/j.clindermatol.2014.04.016

3. Mahony J, Helms SE, Brodell RT. The sarcoidal granuloma: A unifying hypothesis for an enigmatic response. Clin Dermatol. 2014;32(5):654-659. doi:10.1016/j.clindermatol.2014.04.013

4. Ruocco V, Brunetti G, Puca R V., Ruocco E. The immunocompromised district: A unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites. J Eur Acad Dermatology Venereol. 2009;23(12):1364-1373. doi:10.1111/j.1468-3083.2009.03345.x

5. Ruocco E, Brunetti G, Brancaccio G, Lo Schiavo A. Phlebolymphedema: Disregarded cause of immunocompromised district. Clin Dermatol. 2012;30(5):541-543. doi:10.1016/j.clindermatol.2012.04.004

6. Bhagavathula N, Nerusu KC, Fisher GJ, et al. Amphiregulin and epidermal hyperplasia: amphiregulin is required to maintain the psoriatic phenotype of human skin grafts on severe combined immunodeficient mice. Am J Pathol. 2005;166(4):1009-1016. doi:10.1016/S0002-9440(10)62322-X

7. Pedace FJ, Muller SA, Winkelmann RK. The biology of psoriasis. An experimental study of the Koebner phenomenon. Acta Derm Venereol. 1969;49(4):390-400.

8. Mañá J, Marcoval J. Skin manifestations of sarcoidosis. Presse Med. 2012;41(6):e355-e374. doi:10.1016/J.LPM.2012.02.046

9. Ruocco E, Gambardella A, Langella GG, Lo Schiavo A, Ruocco V. Cutaneous sarcoidosis: an intriguing model of immune dysregulation. Int J Dermatol. 2015;54(1):1-12. doi:10.1111/ijd.12566

10. Hiroaki U. Scar Sarcoidosis can be an Expression of the Isomorphic Response of Koebner against the Scar. Kawasaki Med J. 2001;27(2):67-73.

11. Ghorpade A. Sarcoidosis presenting as psoriasiform Koebnerized papules in an Indian male. Int J Dermatol. 2013;52(10):1282-1284. doi:10.1111/j.1365-4632.2011.05155.x

12. Ueki H. Koebner phenomenon in lupus erythematosus with special consideration of clinical findings. Autoimmun Rev. 2005;4(4):219-223. doi:10.1016/J.AUTREV.2004.11.007

Most read articles by the same author(s)