Koebner phenomenon in patient with hypertrophic chronic cutaneous lupus erythematosus

Koebner phenomenon was described for the first time by Heinrich Koebner in 1876. Development of new lesions as a consequence of cutaneous trauma was observed in uninvolved skin of the patient with psoriasis. Nowadays it is known that the Koebner phenomenon (also called isomorphic response) can be present in a variety of dermatoses including lichen planus, vitiligo, erythema multiforme, Darier disease and lichen striatus [1–3]. There are very few literature reports about the Koebner phenomenon in systemic or cutaneous lupus erythematosus (CLE) [4–9].
The aim of the study is to present the case of the Koebner phenomenon as a consequence of scratching in a patient with hypertrophic disseminated chronic CLE (CCLE). A 53-year-old female patient was admitted to the Department of Dermatology due to multiple hyperkeratotic, erythematous lesions located on the scalp, face, upper part of the trunk and upper extremities. The patient was diagnosed with discoid lupus erythematosus (DLE) in 2010. Past treatment involved moderate and high potency topical steroids and 250 mg of chloroquine orally for several years. Recently she received oral methylprednisolone, but despite increasing the daily dose from 4 mg up to 16 mg, the disease was progressing continuously.
Physical examination on the day of admission revealed linear atrophic scars with peripheral inflammation within the skin of the trunk. Arrangement of the lesions suggested repetitive excoriations (Figure 1 A). Moreover numerous erythematous and hyperkeratotic, nodular lesions were found on the trunk and upper extremities. The most severe and painful skin lesions with the verrucous surface, fissures, recurrent bleeding and features of superinfection were located on the hands (Figure 1 B). Scarring alopecia on the scalp was present. Mucous membranes were not affected. The patient complained about pruritus and admitted to scratching. She also reported paraesthesia of the fingers.
Complete blood count was normal, except thrombocytosis (445 × 103/µl; normal range: 400 × 103/µl). Laboratory testing showed an increased erythrocyte sedimentation rate (77 mm/h; normal range: 0–12 mm/h) and C reactive protein (14.8 mg/l; normal range: 0–5 mg/l). C3 complement was decreased (0.083 g/l; normal range: 0.1–0.4). Autoantibody screening revealed positive antinuclear antibodies (ANA) with a titre of 1 : 640, with no particular subtype found. The following tests were negative: lupus anticoagulant,...


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