Koebner Phenomenon Delays Therapeutic Effect of Pulsed Dye Laser on Refractory Psoriasis

Abstract

Psoriasis is a common chronic inflammatory skin disease that is histopathologically characterized by abnormal differentiation and hyperproliferation of keratinocytes, infiltration of T lymphocytes, and alternations of the dermal vasculature. Pulsed dye laser (PDL) is commonly used to treat cutaneous vascular lesions, and it has been studied for the treatment of localized psoriatic lesions. A 30-year-old female patient with refractory psoriasis on her forehead was treated using PDL. After two sessions, the size of the psoriatic lesion increased, which might have occurred due to koebnerization. As the patient continued to receive PDL treatment, the lesion showed significant improvement with no recurrence on the one-year follow-up. We present here a case of refractory psoriasis treated with PDL and demonstrates an association between a delayed therapeutic effect and the Koebner phenomenon.