Occupational psoriasis of the hands: Koebner reaction due to allergic contact dermatitis against cutting fluids [Berufsbedingte psoriasis palmaris: Köbner-phänomen, induziert durch allergisches kontaktekzem bei kontakt zu kühlschmiermitteln]

Abstract

The Köbner phenomenon is a delayed skin reaction frequently observed in some dermatoses and usually triggered by a localized trauma. Psoriatic lesions in particular tend to show this kind of reaction. Koebner reactions may rarely also be caused by allergic processes. We present the case of a 44-year-old CNC (Cumputerized Numerical Control) lathe operator who developed psoriatic lesions on the hands for the first time after an initially acquired allergic contact dermatitis against water based cutting fluids. After the replacement of the contact allergen at work, psoriatic lesions on the hands recurred due to intense mechanical impact at the work place. The patient attended preventive measures of secondary and tertiary individual prevention of occupational skin diseases, e.g. intensive skin care management and health educational training in skin protection, and received a specific antipsoriatic therapy. However, the skin condition improved only on a short-term basis. After exhaustion of all preventive measures without long-term healing, the patient decided to give up his profession.