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Koebnerization due to face masks: A new cause of facial psoriasis - A report of two cases

 Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India

Date of Submission27-Oct-2020
Date of Decision14-Jan-2021
Date of Acceptance21-Apr-2021

Correspondence Address:
Pankaj Das,
Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi - 110 010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_594_20

How to cite this URL:
Das P, Arora S, Singh GK, Bahuguna A. Koebnerization due to face masks: A new cause of facial psoriasis - A report of two cases. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=345908

Dear Sir,

COVID-19 pandemic has presented unprecedented challenges to mankind. Lockdown measures, social distancing, use of hand sanitizers, and face masks are the new normal. While these measures prevent transmission of COVID-19, the use of hand sanitizers and face masks may be new triggers for some dermatoses.[1] We report two cases of psoriasis who developed new lesions on the face mask area due to Koebner's phenomenon.

Our first case was a middle-aged female and was a known case of psoriasis vulgaris for the past 7-year duration. In her latest visit to our OPD, she complained of fresh onset of lesions on the face on the area covered by face mask for 3 weeks, similar to lesions already present on other parts of the body. Clinical examination revealed examination of bilateral cheeks in the form of discrete to confluent erythematous scaly plaques [Figure 1]a. Examination of the other body parts revealed psoriatic lesions. Grattage test and Auspitz sign were positive on the face too. The second case was a young adult male who was a known case of psoriasis for the past 11 years, presented with new-onset lesions on the face in the area covered by face mask for the past 6 weeks. Apart from classical psoriatic lesions on other parts of the body, examination of the face revealed involvement of margins of the beard area in the form of erythema and scaling tending to symmetry [Figure 1]b. There was relative sparing of the areas not covered by face mask and the area under the beard. Grattage test and Auspitz sign were positive. Both the patients were counseled about the face mask as the probable cause behind the appearance of new psoriatic lesions on the face due to Koebner's phenomenon and were advised to use emollients frequently supplemented by lotion 1% pimecrolimus at night.
Figure 1: (a): Involvement of cheek in the form of multiple discrete to confluent erythematous scaly plaques. (b) The posterior margins of the beard and the area beyond show erythema and scaling

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Facial psoriasis, though assumed by clinicians to be rare, may affect 21.9% to more than half of the patients of psoriasis.[2],[3] Facial psoriasis has been considered as a sign of severe psoriasis.[4] The most frequently affected sites on the face are upper and lower aspects of the forehead and preauricular areas (73.9%, 46.2%, and 45.7%), respectively.[5] Involvement of cheeks and beard area is relatively uncommon in facial psoriasis and in the presented cases, may be attributed to Koebner's phenomenon due to the use of face masks, as they were previously absent in these two cases. Mutalik and Inamdar[6] recently reported a case of face mask-induced psoriasis due to Koebner's phenomenon. Our observation further reinforces the possibility of face mask-induced koebnerization as the cause behind facial psoriasis.

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  References Top

Agrawal S, Jaiswal S, Mishra DB, Rathi S. Dermatological manifestation due to preventive measures used during COVID-19 pandemic. Indian Dermatol Online J 2020;11:838-41.  Back to cited text no. 1
  [Full text]  
Hellgren L. Psoriasis. A statistical, clinical and laboratory investigation of 255 psoriatics and matched healthy controls. Acta Derm Venereol 1964;44:191-207.  Back to cited text no. 2
Harrison PV, Walker GB. Facial psoriasis. Clin Exp Dermatol 1985;10:41-4.  Back to cited text no. 3
Canpolat F, Cemil BC, Eskioğlu F, Akis HK. Is facial involvement a sign of severe psoriasis? Eur J Dermatol 2008;18:169-71.  Back to cited text no. 4
Yoon HS, Park JY, Youn JI. Clinical study of facial psoriasis. Korean J Dermatol 2006;44:1397-402.  Back to cited text no. 5
Mutalik SD, Inamdar AC. Mask-induced psoriasis lesions as Köebner phenomenon during COVID-19 pandemic. Dermatol therapy. 2020;1:84-7.  Back to cited text no. 6


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