Koebner Phenomenon: Injuries That Trigger Psoriasis Flare-Ups

A blog by Novartis

Psoriasis lesions flare up skin injuries

Find out whether skin injuries or skin trauma has caused your psoriasis lesions to develop and what you can do about it — brought to you by Not Alone with Psoriasis, a blog by Novartis.

What Is the Koebner Phenomenon?

In 1876, German dermatologist Heinrich Koebner discovered that psoriasis patients who experienced skin injuries developed psoriatic lesions on the traumatised spots 1. These were characterised by distinct lines that followed scars from cuts and scrapes or surgical incisions. This observation gave rise to what scientist now refer to as Koebner Phenomenon or sometimes also called as “koebner response” or “isomorphic response” by medical practitioners.2

Scientists don’t know exactly what causes the Koebner phenomenon, only that it triggers full blown flare-ups for about 25% of psoriasis patients. They do know that Koebner responses are more likely to happen in people who are already having flare ups - particularly those with severe psoriasis and it is more likely to occur during winter.3

It could be triggered by simple accidents like a bump, cuts, and bruises. Skin could be irritated by a waistband, belt buckle, or clothing straps4.

Even everyday activities like getting vaccinations, sunburn, or scratches could trigger it5. For example, when using a manual razor with blades you might accidentally injure the top layer of your skin and this might cause psoriasis to flare-up6.

Have You Experienced This? How Can You Tell?

Many patients are blissfully unaware of whether they have experienced the Koebner phenomenon. It could take 10-14 days, or even up to several years, before psoriasis plaques form after initial impact on the skin7. Track your flare-up’s and speak to your doctor at the earliest opportunity in case you suspect you may have injured your skin.

Koebner phenomenon plaques are just like psoriasis flare-up’s: they can be raised, red, scaly, itchy, and painful. Most of these lesions are linear and or follow the shape of the injury itself (say a shaving nick, blister, or insect bite). However, sometimes the lesions are less distinct, as in the case of a sunburn or rash8.

Plaque Psoriasis lesions Koebner phenomenon

Common Causes of Koebner Phenomenon 9, 10

  1. Injuries stemming from animal bites, surgical incisions, shaving cuts, burns, bruises, or rubbed skin
  2. Friction between skin and clothing, like clothing straps, belt buckles, tight shoes
  3. Mild irritations from nail manicures, hair dyes, etc.
  4. Allergic reactions or skin irritations caused by drugs
  5. Therapeutics like UV light and irradiation.
  6. Weather (flare-up’s during winter months)
Psoriasis triggers Koebner phenomenon scratching]

Ways to Prevent Trauma to the Skin

Here are the extra precautions you should take to keep your skin from getting injured especially when performing day-to-day chores when you have psoriasis11:

  1. Use topical moisturizers or ointments for dry itchy skin. Keep your nails trimmed to avoid skin injury when you are tempted to scratch.
  2. Use sun protection to prevent sunburns: or reduce your exposure to radiation.
  3. Cover your arms or legs when carrying out activities that might involve skin contact, like gardening or running to avoid scrapes, bruising, and other accidental bumps. This also protects against insect stings or bites.
  4. Avoid razors, tweezers, harsh scrubs, etc. while grooming or showering: get an electric razor or a professional to groom you gently.
  5. Treat infections immediately: if your skin becomes infected, you are more likely to develop psoriatic lesions.
  6. Avoid applying irritants on your skin: avoid using chemicals with coloring or fragrances that contain preservatives or irritants.
  7. Avoid skin trauma like acupuncture and tattooing.

Treating and Minimising Lesions

Lesions caused by the Koebner phenomenon are basically signs of inflammation.

In order to manage psoriasis, dermatologists would first assess the severity of your psoriasis, how it affects your quality of life, and the availability of medications12. Then you’d need to discuss whether you have any other medical illnesses that might affect your medication options13.

Dermatologists normally advise patients to start with topical creams if the symptoms are mild14. Topical creams that contain steroids and Vitamin D are used to control psoriasis lesions15.Moisturisers and moisturising shampoos (if you have scalp psoriasis) will help minimise scales, soothe and relieve itchiness16.

Psoriasis triggers Koebner phenomenon scratching]
psoriasis prevention Koebner phenomenon

Another option is phototherapy or light therapy, which involves exposing the skin to ultraviolet light. Do consult a dermatologist, because a certain percentage of psoriasis patients do not respond well to light exposure17.

For moderate to severe psoriasis symptoms, there is systemic medication and biologics injections18. Commonly used systemic medication like methotrexate, cyclosporine, acitretin while biologics such as tumour necrosis factor alpha inhibitors (TNF alpha inhibitors), interleukin IL-17 inhibitors, IL12 and IL-23 inhibitors are effective in reducing skin lesions19.Both treatments may result in side effects, do consult your dermatologist/doctor on treatment options before starting treatment. For more information on biologic treatments, do visit http://mypsoriasis.my/biologic-treatment-for-psoriasis.

Check in with your doctor if you think you have incurred any skin injuries or if lesions show up in unusual spots – this could mean you are at risk for psoriasis flare-ups due to the Koebner phenomenon.

Early detection and treatment will help in managing your psoriasis in order that you experience a more normal life.

Visit our Facebook page to find out more information about psoriasis.

Read stories like this and more about psoriasis on our MyPsoriasis blog.

Visit #Ask4Clear and find the best dermatologist near you today!

Psoriasis treatment lesions Koebner phenomenon

If you enjoyed this article, read Biologic Treatment For Psoriasis: 4 Tips You Should Know


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Dr. Peter Ch’ng Wee Beng

Dr Ch’ng obtained his specialty training from the Royal College of Physicians in London. Subsequently, he obtained his Advanced Masters in Dermatology from the National University of Malaysia. He was previously the Head of Dermatology of the State of Pahang and Hospital Sungai Buloh.

His call to dermatology started way before he even contemplated doing medicine. His father suffered from severe psoriasis, and was in and out of hospital a lot in the late 1970s. His father’s condition made him see that skin disease is not just an aesthetic problem, as it can cause the patient and the entire family so much grief. His practice today reaffirms his belief, with many patients expressing deep relief and gratitude after their treatment.

Place of Practice

FB: @peterchngskinspecialist

Articles by Dr. Peter Ch’ng
Dr. Ch'ng Chin Chwen

Dr. Ch'ng is a NSR registered consultant dermatologist. She graduated as a gold medalist from Univeristy Malaya in 2006. She obtained Membership of the Royal Colleges of Physician of the United Kingdom in 2010 and joined dermatology team in University Malaya in the same year. She completed Advanced Master in Dermatology (UKM) in 2014 and a visiting fellowship in Cutaneous Laser Surgery in Mahidol University (Thailand) in 2017. Her special interest include acne, psoriasis, urticaria, contact dermatitis/eczema and procedural dermatology.

Dr. Ch'ng started her instagram account @cccskindoc providing free skin care tips and education to public. She believes everyone deserves up-to-date and accurate information on skin care to embrace the skin that he or she is in.

Place of Practice

IG: @cccskindoc

Articles by Dr. Ch'ng Chin Chwen
Dr. Khor Yek Huan

Dr Khor graduated from National University of Malaysia (UKM), Kuala Lumpur in 2002. He obtained his Internal Medicine specialty training from the Royal College of Physicians of London in 2007 and further subspecialized in Dermatology by obtaining his Advanced Master in Dermatology from UKM in 2013. Dr Khor served as the Head of Dermatology service for Perlis from 2013 to 2015 before transferring back to Penang. Currently, he is the Deputy Head of Department of Dermatology in Hospital Pulau Pinang. He is also a visiting consultant dermatologist at KPJ Penang Specialist Hospital and Northern Skin Specialist Clinic.

Dr Khor is active in academic activities, performing as an honorary lecturer for Allianze University College of Medical Sciences and Penang Medical College. He is active in research as well with the publication of original papers in dermatological journals and serves as a reviewer for Malaysian Journal of Dermatology. His dedication to the profession earned him Excellent Service Award from the Ministry of Health in 2009 and 2017.

Place of Practice

Email: nssc.penang@gmail.com

Articles by Dr. Khor Yek Huan
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