Sato Ayumi, Fukumoto Takeshi, Yoshioka Ai, Nishigori Chikako
Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.
Dermatol Reports. 2022 Oct 27;15(2):9567. doi: 10.4081/dr.2022.9567. eCollection 2023 Jun 7.
The Koebner phenomenon (KP) is the emergence of new lesions in an uninvolved skin area caused by different types of stimulations, including mechanical stress, chemical stress, trauma, or injury. KP affects patients with certain skin diseases and is frequently observed in patients with psoriasis. We report the case of a 43-year-old obese male welder who developed psoriatic lesions only in areas of repeated burns due to his occupation. He was repeatedly exposed to mild burns in his anterior neck and the periorbital region as he was welding without shield protection. Subsequently, erythema appeared in the same region. Skin appearance and skin biopsy suggested psoriasis vulgaris (PV), and immunohistochemical analysis of anti-interleukin (IL)-17, a crucial element in the development of PV, showed the positivestained cells. The anti-IL-17 staining was prominent around the thickened epidermis as psoriatic lesions. IL-17 produced by T helper 17 cells stimulates keratinized cells and promotes chemokine secretion involved in neutrophil migration. Our case showed that patients, even without a history of PV, may have a risk of developing KP and PV via the enhanced production of IL- 17 locally in the repeated burn area. No recurrence of skin symptoms was observed when the patient used a fully defensive shield during welding.
同形反应（KP）是指在未受累皮肤区域因不同类型刺激（包括机械性应力、化学性应力、创伤或损伤）而出现新皮损的现象。KP 会影响患有某些皮肤病的患者，且在银屑病患者中较为常见。我们报告了一例 43 岁肥胖男性焊工的病例，该患者仅在因职业原因反复烧伤的部位出现了银屑病皮损。他在焊接时未使用防护面罩，导致前颈部和眶周区域反复受到轻度烧伤。随后，同一区域出现了红斑。皮肤外观和皮肤活检提示为寻常型银屑病（PV），对 PV 发病关键要素抗白细胞介素（IL）-17 的免疫组化分析显示细胞呈阳性染色。抗 IL-17 染色在增厚的表皮周围（即银屑病皮损处）较为明显。辅助性 T 细胞 17 产生的 IL-17 刺激角质形成细胞并促进参与中性粒细胞迁移的趋化因子分泌。我们的病例表明，即使没有 PV 病史的患者，也可能因反复烧伤区域局部 IL-17 产生增加而有发生 KP 和 PV 的风险。当患者在焊接时使用完全防护面罩后，未观察到皮肤症状复发。
