Peristomal psoriasis secondary to the Koebner phenomenon: a diagnostic challenge
Psoríase periestomal secundária ao fenômeno de Koebner: um desafio diagnóstico
Cristina Coelho, Maria Lages, Joana Matos, Arminda Guilherme, Susana Cadinha, Inês Machado Cunha
Abstract
Peristomal skin complications are prevalent in ostomy patients, substantially impacting quality of life and contributing to increased health care costs. Contact dermatitis is one of the most common conditions affecting this population. Atypical cases can mimic this condition, making diagnosis challenging, especially when the clinical course deviates from expectations. We present the case of a 61-year-old man with psoriasis who underwent an ileostomy in 2023. In 2024, he developed a persistent peristomal lesion unresponsive to hydrocortisone. A negative allergological study and favorable response to psoriasis treatment supported the diagnosis of Koebner phenomenon-induced psoriatic lesions. This case highlights the need to consider the Koebner phenomenon in peristomal skin complications, particularly in patients with preexisting dermatological conditions. The Koebner phenomenon occurs in psoriasis when trauma or external stimuli induce secondary lesions in previously unaffected skin. Early recognition and interdisciplinary management improve outcomes and quality of life for ostomy patients.
Keywords
Resumo
As complicações cutâneas periestomais são prevalentes em doen‑ tes com ostomia, tendo um impacto significativo na sua qualidade de vida e contribuindo para o aumento dos custos de cuidados de saúde. A dermatite de contacto é uma das condições mais comuns. Casos atípicos podem mimetizar esta condição, tornando o diagnóstico desafiante, especialmente quando a progressão clínica se desvia das expectativas. Apresentamos o caso de um homem de 61 anos com psoríase, submetido a uma ileostomia em 2023. Em 2024, desenvolveu uma lesão de novo, periestoma, persistente, que não respondeu à hidrocortisona tópica. O estudo alergológico negativo e a boa resposta ao tratamento usado na psoríase contribuíram para apoiar a hipótese de se tratarem de lesões psoriáticas induzidas pelo fenômeno de Koebner. Este caso destaca a necessidade de considerar o fenômeno de Koebner nas complicações cutâneas periestomais, principalmente naqueles doentes com patologia dermatológica prévia. Este fenômeno ocorre na psoríase quando o trauma ou estímulos externos in‑ duzem lesões secundárias em pele previamente não afetada. O reconhecimento precoce e o cuidado interdisciplinar melhoram os resultados e a qualidade de vida dos pacientes com ostomia.
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References
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Submitted date:
08/28/2025
Accepted date:
10/28/2025
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