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Karampinis E, Georgopoulou KE, Goudouras G, Lianou V, Kampra E, Roussaki Schulze AV, Zafiriou E. Laser-Induced Koebner-Related Skin Reactions: A Clinical Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1177. [PMID: 39064606 PMCID: PMC11278978 DOI: 10.3390/medicina60071177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
The Koebner phenomenon (KP), also known as the isomorphic response, describes the process by which new lesions that are clinically and histologically identical to a patient's existing skin disease develop following trauma. Many skin diseases exhibit this characteristic, with variations that include possible, questionable, and pseudo-Koebner reactions, with the latter category occurring due to infectious agents seeding at a trauma site. Laser application, a type of controlled skin injury used for improving cutaneous lesions and skin rejuvenation, is also considered a form of trauma. This raises the question of whether controlled thermal injury can be regarded as a type of mechanical trauma capable of producing Koebner-related reactions. We conducted a literature review of cases or studies to identify laser-induced dermatoses that correspond to Koebner-related or pathergy reaction categories. As a whole, we identified nine case reports on true KPs, two cases on possible KPs, seventeen cases on laser-induced questionable KPs comprising cases of vasculitis, eczema or Meyerson reactions, and eruptive squamous atypia cases (ESA) as well as two pseudo-Koebner cases involving wart occurrences at laser application sites. Laser-induced Koebner reactions highlight several aspects of the KP. Firstly, the type of mechanical damage influences disease promotion, as different lasers are associated with different KPs. For example, hair removal lasers are linked with true and questionable KPs such as vasculitis while resurfacing lasers were found to be more connected with ESA occurrence. Secondly, the laser target is significant, with vascular laser application for port-wine stains tending to result in eczematous reactions, while hair follicle destruction can frequently lead to true KPs. Thirdly, the number of sessions matters; true KPs and eruptive squamous atypia questionable KPs typically appear after one to two sessions, whereas eczematous reactions require more sessions (at least four). Additionally, skin phototype is crucial, with darker phototypes showing a higher KP frequency as laser treatment for hypertrichosis relies on melanin absorption in the hair bulge or bulb for follicle destruction, as chromophore competes with the abundant melanin in the epidermis. Further research with larger-scale studies into trauma-specific Koebner reactions is vital for refining treatment protocols, minimizing post-laser adverse effects, and improving dermatological care outcomes.
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Affiliation(s)
- Emmanouil Karampinis
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
| | | | - George Goudouras
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
| | - Vicky Lianou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
| | - Elli Kampra
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
| | - Angeliki Victoria Roussaki Schulze
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece; (E.K.); (G.G.); (V.L.); (A.V.R.S.)
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Sabeti S, Ball KL, Burkhart C, Eichenfield L, Faith EF, Frieden IJ, Geronemus R, Gupta D, Krakowski AC, Levy ML, Metry D, Nelson JS, Tollefson MM, Kelly KM. Consensus Statement for the Management and Treatment of Port-Wine Birthmarks in Sturge-Weber Syndrome. JAMA Dermatol 2021; 157:98-104. [PMID: 33175124 PMCID: PMC8547264 DOI: 10.1001/jamadermatol.2020.4226] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. Objective To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs). Evidence Review In this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended. Findings Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis. Conclusions and Relevance These recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.
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Affiliation(s)
- Sara Sabeti
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | | | - Craig Burkhart
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
| | - Lawrence Eichenfield
- Department of Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children’s Hospital, San Diego, California
| | - Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Ilona J. Frieden
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - Roy Geronemus
- Department of Dermatology, New York University School of Medicine, New York, New York; Laser & Skin Surgery Center of New York, New York
| | - Deepti Gupta
- Department of Pediatrics and Division of Dermatology, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Andrew C. Krakowski
- Department of Dermatology, St Luke’s University Health Network, Easton, Pennsylvania
| | - Moise L. Levy
- Pediatric and Adolescent Dermatology, Dell Children’s Medical Center, Austin, Texas and Departments of Pediatrics and Medicine (Dermatology), Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - J. Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Megha M. Tollefson
- Department of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Kristen M. Kelly
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
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The Pathogenesis of Port Wine Stain and Sturge Weber Syndrome: Complex Interactions between Genetic Alterations and Aberrant MAPK and PI3K Activation. Int J Mol Sci 2019; 20:ijms20092243. [PMID: 31067686 PMCID: PMC6539103 DOI: 10.3390/ijms20092243] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Port wine stain (PWS) is a congenital vascular malformation involving human skin. Approximately 15-20% of children a facial PWS involving the ophthalmic (V1) trigeminal dermatome are at risk for Sturge Weber syndrome (SWS), a neurocutaneous disorder with vascular malformations in the cerebral cortex on the same side of the facial PWS lesions. Recently, evidence has surfaced that advanced our understanding of the pathogenesis of PWS/SWS, including discoveries of somatic genetic mutations (GNAQ, PI3K), MAPK and PI3K aberrant activations, and molecular phenotypes of PWS endothelial cells. In this review, we summarize current knowledge on the etiology and pathology of PWS/SWS based on evidence that the activation of MAPK and/or PI3K contributes to the malformations, as well as potential futuristic treatment approaches targeting these aberrantly dysregulated signaling pathways. Current data support that: (1) PWS is a multifactorial malformation involving the entire physiological structure of human skin; (2) PWS should be pathoanatomically re-defined as "a malformation resulting from differentiation-impaired endothelial cells with a progressive dilatation of immature venule-like vasculatures"; (3) dysregulation of vascular MAPK and/or PI3K signaling during human embryonic development plays a part in the pathogenesis and progression of PWS/SWS; and (4) sporadic low frequency somatic mutations, such as GNAQ, PI3K, work as team players but not as a lone wolf, contributing to the development of vascular phenotypes. We also address many crucial questions yet to be answered in the future research investigations.
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Roncone K, Kindley KJ, Zlotoff B. Eczematous dermatitis in an infantile hemangioma with minimal or arrested growth. Pediatr Dermatol 2018; 35:261-262. [PMID: 29266347 DOI: 10.1111/pde.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infantile hemangiomas (IHs) with minimal or arrested growth differ from standard IHs in that they have a reduced or absent growth phase. An association between IHs with minimal or arrested growth and superimposed eczematous dermatitis has not been described in the literature. We present a case detailing this association in which an IH with minimal or arrested growth responded well to treatment with propranolol and the superimposed eczema cleared completely with topical hydrocortisone.
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Affiliation(s)
- Krista Roncone
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kimball Jade Kindley
- Department of Dermatology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Barrett Zlotoff
- Department of Dermatology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Lee JW, Chung HY. Capillary Malformations (Portwine Stains) of the Head and Neck. Otolaryngol Clin North Am 2018; 51:197-211. [DOI: 10.1016/j.otc.2017.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tang Y, Xie H, Li J, Jian D. The association between treatment reactions and treatment efficiency of Hemoporfin-photodynamic therapy on port wine stains: A prospective double blind randomized controlled trial. Photodiagnosis Photodyn Ther 2017; 18:171-178. [PMID: 28216012 DOI: 10.1016/j.pdpdt.2017.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/06/2017] [Accepted: 02/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research has focused on treatment efficiency and/or treatment reactions of photodynamic therapy (PDT) on port-wine stain (PWS). But few studies reported the association between them. Hence, here we investigated the association between the treatment efficiency and treatment reactions after Hemoporfin (HMME) mediated photodynamic therapy (PDT) on PWS through a prospective study. METHODS Patients (n=50) with PWS were randomly assigned to the HMME group or the placebo group. Three quit after the first treatment, and forty-seven received two sessions of treatment at an 8-week interval. They were given the treatment at day 1 and evaluations were performed at day 1, day 4 and week 8 in each session. HMME group was treated with HMME while the placebo group was given normal saline instead in the first session, double-blindly. While in the second session, both groups received HMME-PDT treatment. RESULTS After a single treatment, swelling was more severe in younger patients (p<0.05) and the lesion far from centro-facial showed more severe pruritus and scab. Compared with a single treatment, burning sensation had a higher occurrence rate, while burning sensation and scab were less severe in the second treatment. Importantly, severity of scab and pain (5min after irradiation) were found possibly correlated with the treatment efficiency. CONCLUSION HMME-PDT on PWS induces several treatment reactions, including pruritus, burning sensation, pain, swelling, blisters and scab. Two sessions of treatments do not have any accumulation effects on treatment reactions. And there might be a positive correlation between treatment efficiency and the severity of scab or pain (at early stage of the therapy), which might help in regulating treatment modalities.
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Affiliation(s)
- Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, China.
| | - Dan Jian
- Department of Dermatology, Xiangya Hospital, Central South University, China.
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Li G, Zhou Z, Gold MH. Eczematous dermatitis after vascular laser therapy: a report of two cases. J COSMET LASER THER 2010; 12:112-5. [PMID: 20146560 DOI: 10.3109/14764170903449794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Eczematous dermatitis was found in two port wine stain (PWS) lesions in two different individuals following variable pulsed 532-nm laser therapy. Both of the individuals described in this report had received low-dose superficial X-ray several years prior to the development of the eczematous dermatitis. The eczematous dermatitis in the PWS lesions was characterized by oozing, crusting, and pruritus, which showed a tendency to expand to other sites when exacerbated. Treatment with topical corticosteroid ointments produced some temporary improvement, but the dermatitis in both cases recurred when the topical medications were stopped. The mechanism of action for the development of an eczematous dermatitis in a PWS remains unclear, but may be related to multiple factors including abnormal hemodynamic forces resulting from the malformed vessels, an abnormal production of cytokines, local pathophysiological and immunological changes resulting from either the X-ray therapy or the laser therapy, and atopic constitution inherent in these individuals. These hypotheses and ideas need further study for additional insight into this rare, but reported adverse event.
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Affiliation(s)
- Guang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences, Nanjing, China
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