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Koebner phenomenon on tattoos may occur in psoriasis patients

16 Aug 2017

Patients with psoriasis under various forms may exhibit Koebner phenomenon after application of tattoos, a study has found.

Although the evolution of the response is benign, and psoriasis is not a contraindication for tattooing, patients are advised to get proper counselling prior to getting tattooed, researchers said.

Researchers looked at seven tattooed patients (median age 36 years; six men) with an isomorphic response or partial psoriasis patches on their tattoos. Data on demographics, past history of psoriasis, clinical presentation and outcomes were collected and analysed. A review of the literature was performed, with an attempt to classify the different clinical profile of Koebner phenomenon/psoriasis on tattoos.

Among the patients, five reported a Koebner phenomenon in a recent tattoo within days to 1 month after its completion. A total of 15 additional cases were identified from the literature (median age 22 years; eight men).

The delay of psoriasis flare-up after tattooing was found to be short, from a few weeks to several months. There also was high variability in the clinical presentation on tattoos among the five clinical subtypes/profiles of psoriasis.

A possible confusion was noted between “genuine” Koebner phenomenon on tattoos and the coincidental occurrence of psoriasis patches on tattoos in some cases from the literature. Patients were mainly managed locally, with the use of systemic treatments or biologics being rare.

Results of the attempt to sort the patients into five different Koebner phenomenon profiles according to their history and the clinical presentation of psoriasis were as follows: (1) type I occurred in patients with a known psoriasis, which was active or not controlled by the treatments, when the tattoo was applied; (2) type II occurred “de novo” in patients with no past history of psoriasis and (i) remained limited to the tattooed area or (ii) psoriasis extended to another part of the body; (3) type III entailed an “old” tattoo in the context of a generalized flare of psoriasis, such as streptococcus-triggered guttate psoriasis; (4) type IV was a pre-existing limited (or undiagnosed) psoriasis flare-up after tattooing; and (5) type V involved a random distribution of psoriasis patch/es on old tattoos.

Among the seven patients, four presented with type I, whereas two had type V.

In light of the present data, researchers emphasized that patients with psoriasis willing to get tattooed should be properly counselled.

“They should be able to discuss with their physician about their wish to get tattooed. They should not be discouraged but rather be advised wisely on the proper moment to get one, especially those under systemic treatments or biologics,” they added.

Psoriasis affects about 2 percent of the general population. The Koebner phenomenon (defined as the possible specific localization of lesions on traumatized areas and scars) affects approximately between one quarter to one-third of the patients with psoriasis, and the phenomenon occurs after various traumas and within variable delays from weeks usually to a few years after. [Lancet 2015;386:983–994; J Eur Acad Dermatol Venereol 2002;16:241–248]

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