Pemphigus foliaceus masquerading as postoperative wound infection: report of a case and review of the Koebner and related phenomenon following surgical procedures.
BACKGROUND
The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization.


OBJECTIVE
To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures.


METHODS
We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures.


RESULTS
To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized.


CONCLUSIONS
Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management.
Rotunda
Adam M
AM
Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
Bhupathy
Anand R
AR
Dye
Robert
R
Soriano
Teresa T
TT
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002921:Cicatrix / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009666:Nose / Q000473:pathology / Q000601:surgery; D010392:Pemphigus / Q000175:diagnosis* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000473:pathology