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KMID : 0363220160540060499
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Korean Journal of Dermatology
2016 Volume.54 No. 6 p.499 ~ p.500
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Koebner Phenomenon Related to Cupping Therapy in a Patient with Psoriasis
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Suh Hyun-Yi
Kim Kyung-Ho
Jeon Jae-Wook
Ahn Ji-Young
Park Mi-Youn
Youn Jai-Il
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Abstract
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Psoriasis is a chronic skin disease affecting 1∼3% of the population1. Not only physical trauma but also burns, insect bites, surgical incision, and radiation exposure may induce a Koebner response in psoriasis2. Cupping therapy is an ancient oriental form of alternative medicine in which local suction is created that can leave temporary bruised painful marks on the skin. Alternative medical practitioners think cupping therapy is effective because it can increase circulation around the area of cupping and eliminate the toxins3. We report the impressive case of Koebner phenomenon related to cupping therapy in a psoriasis patient. A 38-year-old man had a more than 3-year history of psoriasis. The patient had controlled well his psoriatic lesions. He had no family history of skin problems. He presented with several erythematous scaly plaques and patches with crust from his back to buttocks after he had been given two sessions of cupping therapy once a week owing to gastrointestinal problems (Fig. 1). These psoriatic plaques that developed at the cupped sites were the same area as the vacuum cups used (Fig. 1B). The skin lesions appeared as ecchymosis and vesicles on the edges of the cupping area (Fig. 1C). The cupping treatment was performed even on the psoriatic lesions, so the lesions were aggravated and other sites appeared as new psoriatic lesions (Fig. 1D). Clinically, we treated with calcipotriol and betamethasone. Cupping treatments are widely used in Asia and they have a public reputation for being safe for the treatment of various pain-related conditions such as myalgia, arthralgia, and postherpetic neuralgia3. Cupping can induce both epidermal cell injury and dermal vascular damage. Some people reported that cupping therapy created specific changes in local tissue structures as a result of local negative pressure in the cups used, which stretches the nerve and muscle4. Many studies suggest that trauma can cause both epidermal cell injury and dermal inflammation to produce the Koebner phenomenon 2. In a study that used low-pressure suction or tape stripping, or both, psoriasis developed only where the blister roof was removed. These findings suggested that rupture of the epidermis can initiate the Koebner response5. There is no research on the relationship between cupping therapy and the Koebner phenomenon. Our hypothesis is that cupping is a form of trauma, inducing the Koebner phenomenon in patients with psoriasis. The efficacy of cupping therapy has not been confirmed. The therapy can be harmful for psoriatic patients who may develop psoriasis through koebnerization. We think that cupping therapy is a useful medical practice, and it is easy to overlook factors that can cause lesions that can be categorized as trauma. Therefore, we report this case of Koebner phenomenon related to cupping therapy in a patient with psoriasis.
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KEYWORD
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Cupping therapy, Koebner phenomenon, Psoriasis
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