PDF(Pubmed)
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.
摘要：
Koebner现象(KP)也被称为同构响应，描述了创伤后与患者现有皮肤病在临床和组织学上相同的新病变发展的过程。许多皮肤病表现出这种特征，包括可能的变化，可疑，和伪Koebner反应，后一类是由于感染因子在创伤部位播种而发生的。激光应用,一种用于改善皮肤损伤和皮肤恢复的受控皮肤损伤，也被认为是一种创伤.这提出了一个问题，即受控的热损伤是否可以被视为一种能够产生与Koebner相关的反应的机械创伤。我们对病例或研究进行了文献综述，以确定与Koebner相关或动脉粥样硬化反应类别相对应的激光诱发的皮肤病。作为一个整体,我们确定了九份关于真实KP的病例报告，两个可能的KP案例，17例激光诱导的可疑KP，包括血管炎病例，湿疹或Meyerson反应,和发疹性鳞状异型性病例（ESA）以及两个在激光应用部位发生疣的假Koebner病例。激光诱导的Koebner反应突出了KP的几个方面。首先,机械损伤的类型会影响疾病的发展，因为不同的激光与不同的KP相关联。例如,脱毛激光与真实和可疑的KP有关，例如血管炎，而表面重修激光则与ESA的发生有关。其次,激光目标意义重大，使用血管激光治疗葡萄酒色斑倾向于导致湿疹反应，而毛囊破坏往往会导致真正的KP。第三，会议的数量很重要；真正的KP和有问题的爆发鳞状非典型性KP通常在一到两个会议之后出现，而湿疹反应需要更多的疗程（至少四个）。此外,皮肤照型至关重要，由于激光治疗多毛症依赖于黑色素在毛发凸起或球茎中的吸收来破坏毛囊，因此较暗的光型显示出更高的KP频率。因为发色团与表皮中丰富的黑色素竞争。对创伤特异性Koebner反应进行大规模研究的进一步研究对于完善治疗方案至关重要，最大限度地减少激光后的不利影响，并改善皮肤病学护理结果。
