T h e n e w e ngl a nd j o u r na l o f m e dic i n e
n engl j med 368;17 nejm.org april 25, 2013 1635
A73-year-old man who had had plaque psoriasis for more than 20
years on the arms, legs, and scalp presented for consultation on a
new rash. He had been using topical steroid creams and shampoos to
control occasional psoriatic flares. The patient had undergone
acupuncture for lower back pain 2 months before presentation, and
shortly thereafter new guttate psoriasis developed in the areas
directly punctured with needles. Skin examination revealed multiple
discrete, erythematous, scaly, indurated papules on the lower back
and buttocks, areas which had not previously been affected. He
reported no upper re-spiratory symptoms. Irritation and infection
are rare complications of acupuncture when performed to established
standards. Needling of the skin can produce trauma that is
sufficient to cause Koebners phenomenon and subsequent guttate
psoriatic flare. The patient declined systemic therapy, and
clobetasol cream was prescribed for application to affected areas.
The psoriatic flare of the lower back and buttocks resolved after
treatment with the clobetasol cream. Given the patients reaction,
he was advised to discontinue acupuncture.DOI:
10.1056/NEJMicm1205716Copyright 2013 Massachusetts Medical
Society.
Psoriasis Flare from Koebners Phenomenon after Acupuncture
Jashin J. Wu, M.D.
Kaiser Permanente Los Angeles Medical Center Los Angeles, CA
Caroline Caperton, M.D., M.S.P.H.
Jackson Memorial Hospital Miami, FL
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