Koebner effect on normal Plaque Psoriasis

[Nick]

Koebner effect on normal Plaque Psoriasis

I have been pondering about this for a little while and I thought I would share my thoughts and see what everybody else thinks.

Part 1.

A few years back a doctor by the name of Koebner came up with this theory that in Psoriasis patients: If a Psoriasis sufferer was to damage a part of normal skin then there was a chance that during the healing process that skin would become psoriatic skin. It seems to be proven when sufferers get cut or graze their skin, but it doesn't always happen.
So basically he was saying œDamage your skin ¦.. whoosh! Psoriasis hits the damaged area�.

Part 2.

I noticed that when I suffer a flare I get flaky. I guess that applies to many of us Psoriasis members. Then I noticed that if I try peeling or scraping off the plaques, especially for my facial psoriasis, the flare takes a lot longer to fade and there have been times when it just hasn't eased off at all. Yet, there have been times when I have made the conscious decision not to peel or scratch off the flakes and even though it may look hideously crusty I just let the flakes fall naturally or with the least amount of encouragement.
Now in my experience I have found that allowing the flakes to form and fall off on their own has quite dramatically eased the effect of the flare-up. The flare doesn't seem to last as long.
Scalp psoriasis seems to act the same way for me. If I forget myself I can suddenly find that I have been having a really good dig at the plaques on my scalp without even realising it. The next thing I know is that the scalp Psoriasis has taken a hold again and seems to get worse the more I scratch and dig.

My theory.

Could it be that the Koebner effect actually is a part of the normal lifecycle of a psoriasis flare-up? Maybe Koebner was more right than he realised in that not only does Koebner Effect work on damaged skin but also works on skin that is already psoriatic.

Here's where I'm going with this.
If we flare up as part of a normal Psoriasis attack do we actively encourage the Koebner Effect on our skin by scratching or removing the flakes? Does our skin think that it is damaged even more than it really is and so makes our immune system go into overdrive which in turn only makes the psoriasis attack even worse?

My feelings on this are that maybe we are doing even more damage to ourselves when we go scratching off the flakes, even if they do look terrible. I can only speak from my own history so I'd love to hear from others if they have ever found anything similar.

[Fishs]

 

Nick .

Very interesting .. I am not altogether  ok with the damaged skin idea .. I can understand your thinking though.. It is logical .. It is a bit like the old cause and effect theory ..  analyse the effects to provoke the cause  is not a bad way to approach things ..

I agree re the immune system .. As you know I have just completed an extensive article on immunisation and innoculation re kids  and I researched that for nearly 8 months before I finished the article and no doubt about it you can certainly trick the immune system .. and your theory is certainly plausable ..

I am going to think about this one for a few days..

Fish..

[juliep]

I have never developed psoriasis on any clear skin that has been 'damaged' but I agree Nick, that the more you scratch the plaques the longer they take to heal. I wonder though if this is just the super-accelerated response of normal skin - ie if you scratch normal skin you dislodge skincells and the body automatically goes into repair and renew mode so if you scratch a plaque it does the same only at a hugely accelerated rate.

Some time ago I was diagnosed as having leukoplakia on my tongue - it looks and acts quite like a p plaque - and I have noticed that if I chew the side of my tongue in my sleep  (my worst habit and soooo hard to stop, can manage to do it even with a gumshield) then the plaque increases in size and becomes sort of flaky, so there is definately something in your theory Nick

[peterb]

A little article I found----



·        Patients may recognize that new lesions appear at sites of injury to the skin.

(This isomorphic phenomenon (Koebner reaction) typically occurs 7-14 days after the skin has been injured and has been found in 40-80% of patients with psoriasis.

In some patients, so-called reverse-Koebner reactions may be noted in which preexisting psoriatic plaques will clear after injury or trauma to the skin.

[Alison]

hmm yeh u got me thinking now

i reckon u might be onto something there nick , p left alone does clear up/calm down alot quicker than if u sit n pick at it all night.

vicious circle to break

[peterb]

Well i'll let you know after the bang I had to my leg, if it does turn into Psoriasis.  I hope not.

[puppydogeyes]

I too get the Koebner effect. I have patches on the backs of hands dating back yrs due to IV drips being put in.

When i cut myself, i get patches appear....but funnily enough not on my fingers...paper cuts etc never seem to develop into P luckily.

I was very worried about my C-sect scar but although that did get a bit red, it hasnt flared as much as i thought it would and it doesnt bother me at all. Which is really surprising as i have got quite big patches on my knees caused by a razor nick!!!   Isnt it weird, a major operation didnt cause any flare but shaving my legs did!!!  

[donnam]

I had a accident last summer when I spilled hot oil on my thighs and legs which developed into 2nd degree burns. Had no ps on these particular areas at the time.  And yes...I was clumsy in the kitchen..

 I thought for sure I was going to develop big giant ps lesions on these areas due to Koebner phenomenom.    But, it did not happen.  Go figure?  Did not even develop scars...Lucky, I tell you.      But  its puzzling because I broke out after a bad case of sunburn in the past.    PS is crazy, I tell ya.  Just when you think you know how your body reacts to certain situations, it does a complete 360 and does the opposite.  At least for me.  

My new derm firmly stated not to scratch or pick at my lesions.  It can make it 10x worse and will prevent any type of healing.  

Its easier said than done, of course, as I am a scratcher while I sleep.  But, I personally think your theory is valid or worth noting, Nick.
 

[infinity]

Hiya

I followed this link given to me from another site, ITs been most helpful and enlightening, thanks for posting it......

It seems that im someone that suffers from this too

[azflakyguy]

I am hit or miss with you theory Nick.

About 4 months age,I stood up too close to the corner of my desk. It was equal to getting sliced with a knife about 4 inches long and just above the waistband on my back. Sure enought P is in a nice straight line there now. Also, Paper cuts on my fingers turn to P.

recently, about 2 weeks ago, I scratched my leg but good. it healed and NO P?

I think there is some logic here but P is soooo unpredicatable.

I beklieve, after much reading here, that there is some tie to sunlight. I am not sensetive in the normal way. When I am in the sun without my sunglasses, I am SUPERCHARGED!!! Prior to discovering this, in the summer (more sunlight), I would work a 12 hour shift and go alll night (till 2-3 am) and never be tired. The clinical diagnosis is Seasonal Affective Disorder. It has to do with the amount of sunlight entering the eye, and the persons Circadian Rhythm. On the other side, during winter, I nearly shut down.

I now have much more control of this. I wear wraparound sunglasses most of the year, and use a light box in the winter.

I am wondering how many P sufferers have some sort of sensetivity to sunlight?

[Ystra]

a lot of whats been written here makes sense. first off, my eyes have always been sensitive to sunlight, but i thought this was due to the fact that i have blue eyes...having heard that its a natural phenomena.
second, sunlght helps clear my P. there was a year i was working on an island in greece and would go to a nude beach. within a week of daily sunbathing my P was all but gone. unfortunately, it flared up again within 2 weeks of stopping. fortunately tho, i didnt have any new spots.
as far as not scratching to speed up healing, i have to agree. my scalp at one point was a royal mess. the more i scratched the worse it got. my ex told me i scratched in my sleep all night. i think it was partly out of habit also. i took to wearing gloves when i slept and this cured me of scratching. the results were amazing. the p slowly diminished and i've been able to keep the itching  under control with certain shampoos. of course its trial and error as to which ones work for you. i also found that certain conditioners irritate my scalp.

[dippitmaggie]

known about Koebner for about 30 years my old derm told me when he saw a skint knee when I had fallen during PE.  True enough it usually happens with grazes and scalds with me and very hard to get them to go.

[Ystra]

fortunately thats something thats never happened to me. and i'm always nicking my fingers with a knife at work, or banging myself at home.

[infinity]

I have P on the backs of both hands, and on the palm of the left one and on both elbows, Whilst shaving my legs i nicked my knee and the front of the foot as it goes to the leg.
Now i have P in both of those places!!!
Is it lying beneath ALL of my skin just waiting for something to make it errupt?

This is what led me to your site, and I thank you Nick for your post  I beleive in your theory and shall run it past my Dermo when i go for my next appointment
Although i am still getting new patches where i dont remember injuring myself, but then i find horrible bruises where i dont remember hurting myself either
perhaps i just need a better memory LOL

[Nick]

Hiya Infinity

No need for thanks in my direction
Mine are just the ramblings of a deluded mind