Year : 2012 | Volume
: 57 | Issue : 3 | Page : 241--242
Beating palmoplantar psoriasis away
Paschal V D'Souza
Department of Dermatology and Venereology, ESI-PGIMSR, Basaidarapur, New Delhi, India
Paschal V D«SQ»Souza
Department of Dermatology and Venereology, ESI-PGIMSR, Basaidarapur, New Delhi
|How to cite this article:|
D'Souza PV. Beating palmoplantar psoriasis away.Indian J Dermatol 2012;57:241-242
|How to cite this URL:|
D'Souza PV. Beating palmoplantar psoriasis away. Indian J Dermatol [serial online] 2012 [cited 2021 Apr 10 ];57:241-242
Available from: https://www.e-ijd.org/text.asp?2012/57/3/241/96219
Trauma is known to precipitate several skin diseases like psoriasis, vitiligo and lichen planus (Koebner's phenomenon).  It is also known to cause disappearance of lesions in some cases (reverse Koebner's phenomenon).  However, most incidents of trauma are usually accidental and are not meant to achieve a desired end response. Observations in the following two cases lead us to believe that trauma/pain had considerable influence over their disease behavior and warrants a deeper look.
A 40-year-old male had a history of chronic palmoplantar psoriasis for the past 20 years. The lesions improved in summers but never cleared completely despite fairly regular treatment. About five years back, he was picked up by the police for interrogation in a petty crime case. He was subjected to repeated physical violence over his palms and soles over a night as a part of his interrogation. The skin lesions completely cleared over the next 48-72 hours and he remained symptom-free for five years. A mild recurrence led him to report to us for treatment with a request that some gentler form of pain therapy may be administered for again inducing prolonged remission. The request was denied and he was put on conservative treatment. He has been under follow up for the last six months with partial improvement in his condition.
A 23-year-old girl having a 10-year-old history of annular ostraceous psoriasis involving 40% of body surface including palms and soles with gross subungual hyperkeratosis involving several digits of hands and feet has been on regular follow up for the past five years. She has received several medications including topical coal tar, salicylic acid (3-6%), different strengths of various topical corticosteroids, short courses of oral antibiotics, methotrexate, antioxidants and omega 3 fatty acids. There have been varying degrees of improvement during different periods of observation but the subungual hyperkeratosis persisted and increased during this time. She then decided to visit a therapist who offered her acupuncture therapy. After six weeks of alternate day treatment where she was subjected to multiple needle piercing of both palms and soles, there was about 90% improvement in palms, soles and nail lesions along with significant improvement in other areas. She remains under good control and continues to take both forms of therapy.
The hypothesis behind reverse Koebner's phenomenon is unclear. Humoral factors causing clearing of lesions after injury have been suggested.  The possibility of pain causing release of certain mediators from nerve endings or their presence in the inflammatory transudate released during tissue damage due to trauma as is likely in our first case may have caused the remarkable clearing of these lesions. The interesting aspect is that the remission was sustained for considerable period of time. Acupuncture has been used as a standard form of treatment in traditional Chinese medicine for several disorders including psoriasis.  The possibility of a refined form of trauma, induced by needle piercing at certain points in acupuncture therapy, working through reverse koebner's phenomenon, is worth considering.
The million dollar question is-should controlled administration of trauma/pain be considered as a standard part of the therapeutic armamentarium in the management of a chronic skin disease which compromises the quality of life, such as this one? As Koebner's and reverse Koebner's phenomenon appear to be mutually exclusive, the patients may be selected on the basis of their response to a standardized injury devised in the management protocol.  Encouraging results have been achieved using modalities like cryotherapy and dermabrasion in psoriasis invoking similar principles. ,
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