Vitiligo as a Köebner phenomenon after oncoplastic breast surgery
Palavras-chave:
breast neoplasms, vitiligo, conservative treatment, breast cancer, oncoplastyResumo
The Köebner phenomenon is characterized by the appearance of several types of dermatological lesions after traumatic stimulation. The triggering of this phenomenon after breast surgery is uncommon and usually associated with psoriatic lesions. The aim of this study was to describe two cases of vitiligo as the initial manifestation of Köebner phenomenon after breast oncoplastic surgery. Case 1: female, 41 years old, no history of dermatological pathologies, presenting with tubular carcinoma in the right breast. Quadrantectomy and sentinel lymph node biopsy were performed, followed by reconstruction with mammoplasty. Later, the patient started on tamoxifen and underwent radiotherapy, without complications. Thirty days after treatment, the patient presented progressive depigmentation of the areola-papillary complex. Topical treatment was started with dermatological ointment tacrolimus monohydrate and, after one year, the condition was completely resolved. Case 2: 52-yearold woman with previous history of vitiligo on the face, with complete clinical response after dermatological treatment. She was diagnosed with ductal carcinoma in situ on the left breast and underwent quadrantectomy, by means of mammoplasty using the round block technique. Afterwards, she underwent radiotherapy and started tamoxifen. Four years after the surgery, she developed dyschromia in the ipsilateral periareolar region and was diagnosed with vitiligo. Local dermopigmentation was offered, but the patient opted for an expectant conduct and clinical follow-up. To our knowledge, this is the first description of Köebner phenomenon after breast oncoplastic surgery. In these cases, the therapeutic approach must be multidisciplinary and count on the assessment of multiple clinical and individual parameters.
Downloads
Referências
Köbner H. Zur Aetiologie Psoriasis. Vjschr Dermatol. 1876;3:559.
Weiss G, Shemer A, Trau H. The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol. 2002;16(3):241- 8. https://doi.org/10.1046/j.1473-2165.2002.00406.x
Ghafourian E, Ghafourian S, Sadeghifard N, Mohebi R, Shokoohini Y, Nezamoleslami S, et al. Vitiligo: Symptoms, Pathogenesis and Tratment. Int J Immunopathol Pharmacol. 2014;27(4):485-9. https://doi.org/10.1177/039463201402700403
Ji YZ, Liu SR. Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms. Biosci Rep. 2019;39(12):BSR20193266. https://doi.org/10.1042/BSR20193266
Ganguly AK, Laghimsetty S, Bhagyalakshmi N. Koebner Phenomenon Triggered by External Dacryocystorhinostomy Scar in a Patient With Psoriasis: A Case Report and Literature Review. Ophthalmic Plast Reconstr Surg. 2018;34(2):e52-e53. https://doi.org/10.1097/IOP.0000000000001016
Mulekar SV, Asaad M, Ghwish B, Al Issa A, Al Eisa A. Koebner Phenomenon in Vitiligo: Not Always an Indication of Surgical Failure. Arch Dermatol. 2007;143(6):799-816. https://doi.org/10.1001/archderm.143.6.801
Alolabi N, White CP, Cin AD. The Koebner phenomenon and breast reconstruction: Psoriasis eruption along the surgical incision. Can J Plast Surg. 2011;19(4):143-4. https://doi.org/10.1177/229255031101900411
Bernstein EF, Kantor GR. Treatment-resistant psoriasis due to a mastectomy sleeve: an extensive Koebner response. Cutis. 1992;50(1):65-7.
Behranwala KA, Gui GPH. The Koebner phenomenon in a myocutaneous flap following immediate breast reconstruction. Br J Plast Surg. 2002;55:267-8. https://doi.org/10.1054/bjps.2002.3807
Ji YZ, Liu SR. Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms. Biosci Rep. 2019;39(12). https://doi.org/10.1042/BSR20193266
Wu CC, Wang S, An JJ, Smith DR, Chin C, Jadeja PH, et al. Koebner phenomenon: Consideration when choosing fractionation for breast irradiation. Adv Radiat Oncol. 2018;3(2):108-110. https://doi.org/10.1016/j.adro.2017.11.004
Dalmasso C, Tournier É, de Lafontan B, Modesto A, Dalenc F, Chantalat É, et al. Uncommon dermatologic disorders triggered by radiation therapy of breast cancer: A case-series. Cancer Radiother. 2017;21(3):216-221. https://doi.org/10.1016/j.canrad.2016.11.004
Charalambous H, Bloomfield D. Psoriasis and radiotherapy: exacerbation of psoriasis following radiotherapy for carcinoma of the breast (the Koebner phenomenon). Clin Oncol (R Coll Radiol). 2000;12(3):192-3. https://doi.org/10.1053/clon.2000.9149
Weitzen R1, Pfeffer R, Mandel M. Benign lesions in cancer patients: Case 3. Vitiligo after radiotherapy for breast cancer in a woman with depigmentation disorder. J Clin Oncol. 2005;23(3):644. https://doi.org/10.1200/JCO.2005.03.078
Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, et al. Interventions for vitiligo. Cochrane Database Syst Rev. 2015;(2):CD003263. https://doi.org/10.1002/14651858.CD003263.pub5
Dowlen H, Owers K. Koebner phenomenon following steroid injection for trigger finger. J Hand Surg. 2011;36(6):517. https://doi.org/10.1177/1753193411409132 17. Ezzedine K, Whitton M, Pinart M. Interventions for Vitiligo. JAMA. 2016;316(16):1708-9. https://doi.org/10.1001/jama.2016.12399
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2020 Régis Resende Paulinelli, Leonardo Ribeiro Soares, Carla Paulinelli Seba
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
