Thijs Saartje, Balti Eric, Degraeve Corinne, Coremans Peter
Department of Diabetes and Endocrinology, VITAZ Hospital, Sint-Niklaas, Belgium.
Molenstraat 160 Private Dermatology Clinic, Kruibeke, Belgium.
JCEM Case Rep. 2022 Nov 30;1(1):luac016. doi: 10.1210/jcemcr/luac016. eCollection 2023 Jan.
Koebner phenomenon is an uncommon skin-related complication of subcutaneous insulin injection in patients with diabetes mellitus. This reaction, also referred as isomorphic phenomenon, has previously been described in various conditions including vitiligo, lichen planus, and psoriasis. We report a 56-year-old woman insulin-treated patient with type 2 diabetes mellitus who developed new-onset, sharply well-demarcated erythematous scaly plaques at the insulin injection sites consistent with Koebner phenomenon. These lesions occurred after withdrawal of methotrexate initiated for the treatment of psoriasis. The lesions responded well to guselkumab, an interleukin-23 targeting agent but not ciclosporin. Of note, unlike previously reported cases, our patient developed isomorphic response under treatment with insulin analogues and during psoriasis flare-up. This case highlights the paramount role of thorough and cautious examination of injection and insertion sites in patients at risk undergoing subcutaneous continuous glucose monitoring or treated with continuous transdermal/subcutaneous insulin injections.
同形反应是糖尿病患者皮下注射胰岛素时一种罕见的皮肤相关并发症。这种反应，也被称为同形现象，此前已在包括白癜风、扁平苔藓和银屑病等多种病症中有所描述。我们报告了一名56岁接受胰岛素治疗的2型糖尿病女性患者，其在胰岛素注射部位出现了新发的、边界清晰的红斑鳞屑斑块，符合同形反应。这些皮损是在为治疗银屑病而开始使用甲氨蝶呤停药后出现的。皮损对靶向白细胞介素-23的药物古塞库单抗反应良好，但对环孢素无反应。值得注意的是，与先前报道的病例不同，我们的患者在使用胰岛素类似物治疗期间以及银屑病发作时出现了同形反应。该病例强调了对接受皮下连续血糖监测或接受连续经皮/皮下胰岛素注射的高危患者的注射和穿刺部位进行全面且谨慎检查的至关重要性。
