ARTICLE
A 26-year-old male patient was referred to our department to update the
treatment for his psoriasis. Physical examination showed typical scaly
plaques on the trunk, limbs, and scalp. In addition to the psoriatic plaques,
we noticed multiple brownish lesions on the fingertips, especially on
D II-IV, of the left hand. On close examination
the lesions appeared punctate, grouped, scaly, and slightly hyperkeratotic
(Fig. 1). The patient's
history revealed diabetes that manifested at the age of 7 years.
Diagnosis:
persistent prick lesions possibly representing
a Köbner phenomenon
Diabetes mellitus manifesting during childhood is likely to be a diabetes
type I, which requires insulin injections. In order to substitute an optimal
amount of insulin (a basic bolus therapy) the blood
sugar level needs to be checked several times a day. For this reason a
capillary blood sample needs to be taken, usually from the ear lobe or
from the fingertip by pricking the skin with a lancet. Our patient had
been taking blood samples from the fingertips mostly of the left hand,
as he is right handed.
Comments
When a patient with diabetes has regularly taken a capillary blood sample
from the fingertip, there are usually no striking clinical features following
the prick. As our patient also suffered from psoriasis, it is tempting
to consider that the persistent lesions at the fingertips may represent
a punctate Köbner phenomenon related to his psoriasis. Similar forms
of a Köbner reaction have been described previously in patients with
psoriasis [1, 2].
REFERENCES
1. Fleck F. Zur Kenntnis des Köbnerschen Phänomens. Dermatol
Wochenschr 1951; 123: 121-5.
2. Farber EF, Roth RJ, Aschheim E, Eddy DD, Epinette WW. Role of trauma
in isomorphic response in psoriasis. Arch Dermatol 1965; 91: 246-51.
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