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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 4  |  Page : 194-195  

Renbök phenomenon in an alopecia areata patient with psoriasis


1 Department of Dermatovenereology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
2 Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Date of Web Publication11-Apr-2014

Correspondence Address:
Yuval Ramot
Department of Dermatology, Hadassah-Hebrew University Medical Center, P. O. Box 12000, Jerusalem 9112001
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.130397

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   Abstract 

The Renbök phenomenon designates the withdrawal of a lesion when a different one appears. We describe a 23-year-old patient with psoriasis, who experienced regression of a psoriatic plaque on the scalp concurrently with the appearance of a patch of alopecia areata (AA). In 3 months, plaques of psoriasis appeared inside the patch of hair loss, accompanied by terminal hair growth in the plaques. Such rapid interchange between these two autoimmune disorders have not been described previously, and might reflect a quick substitution between two different T-cell populations, namely Th-17 and Th-1. Better understanding of the trigger for such an exchange can help in elucidating the pathogenesis for AA.

Keywords: Alopecia areata, psoriasis, Renbök phenomenon


How to cite this article:
Ovcharenko Y, Serbina I, Zlotogorski A, Ramot Y. Renbök phenomenon in an alopecia areata patient with psoriasis . Int J Trichol 2013;5:194-5

How to cite this URL:
Ovcharenko Y, Serbina I, Zlotogorski A, Ramot Y. Renbök phenomenon in an alopecia areata patient with psoriasis . Int J Trichol [serial online] 2013 [cited 2019 Nov 22];5:194-5. Available from: http://www.ijtrichology.com/text.asp?2013/5/4/194/130397


   Introduction Top


In 1991, Happle et al. coined the term "Renbök" phenomenon to describe the opposite of the Koebner phenomenon, designating the withdrawal of a lesion with the appearance of another one. [1] It was originally described in alopecia areata (AA) patients experiencing hair growth in psoriatic lesions. [1] Although psoriasis can often co-exist with AA, [2] reports on psoriasis-induced Renbök phenomenon in AA have been exceedingly sparse, and did not demonstrate the interchanging nature of these two disorders. [3],[4],[5],[6]


   Case Report Top


A 23-year-old female patient presented in April 2012 with a flare of psoriasis, involving the trunk, extremities and the scalp. She had a similar flare at the age of 13, and also history of patch-type scalp AA, both resolved following topical steroid treatment. Two months later, in June 2012, she experienced localized hair loss on the scalp, concomitantly with complete resolution of the psoriatic plaque in this region. On examination, a 3 cm patch of nonscarring hair loss was observed, and dermoscopic examination revealed perifollicular pigmentation, exclamation hairs and yellow dots, corresponding to AA. Interestingly, the psoriatic plaque engulfed the AA area, but sharply stopped at its border [Figure 1]a. The patient was treated topically for her AA with clobetasol propionate, with stabilization of hair loss when the patch reached a size of 5 cm × 6 cm in September 2012. In parallel, the patient had reappearance of psoriatic plaques inside the area of hair loss, which coincided with the presence of terminal hairs localized to these psoriatic plaques [Figure 1]b.
Figure 1: (a) A 3-cm diameter patch of hair loss on the scalp. A thick psoriatic plaque is shown adjacent to the area of hair loss, but sharply stops at its border. (b) Plaques of psoriasis appear inside the area of hair loss, accompanied by thick terminal hairs

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   Discussion Top


AA is believed to be an autoimmune T-cell mediated disease, although its exact mechanism is still obscure. [7] While it has been reported to occur in association with other autoimmune disorders, such as vitiligo, colocalization of these two disorders remains a rare clinical entity. [8] Colocalization with psoriasis, another autoimmune disease, is also rare, and usually there is remission of AA in psoriatic plaques, the so called Renbök phenomenon.

The mechanism underlying the Renbök phenomenon is not entirely clear, although recent advances in the understanding of the pathogenesis of AA and psoriasis point to the possibility that changes in the local cytokine milieu based on the presence of different T-cell populations, result in interchange between these two disorders. Psoriasis is a Th-17-mediated disease, [9] while AA is presumed to be a Th-1 mediated disorder. [10] Each inflammatory pathway increases its own response and inhibits opposing pathways, therefore preventing the co-existence of two different diseases in the same location. The trigger for the switching point between one pathway to the other is unknown, and the Renbök phenomenon offers an exclusive opportunity to dissect this elusive point.

Our patient is unique in that it represents a case of rapid change from one disorder to the other. In a time frame of 3 months, the same location on the scalp demonstrated remission of psoriasis and induction of AA, and later reappearance of psoriasis accompanied by hair growth, representing a rapid change from Th-17 to Th-1 and back to Th-17 response.

 
   References Top

1.Happle R, Van Der Steen P, Perret C. The Renbök phenomenon: An inverse Köebner reaction observed in alopecia areata. Eur J Dermatol 1991;1:39-40.  Back to cited text no. 1
    
2.Ganor S. Diseases sometimes associated with psoriasis. II. Alopecia areata. Dermatologica 1977;154:338-41.  Back to cited text no. 2
    
3.Criado PR, Valente NY, Michalany NS, Martins JE, Romiti R, Aoki V, et al. An unusual association between scalp psoriasis and ophiasic alopecia areata: The Renbök phenomenon. Clin Exp Dermatol 2007;32:320-1.  Back to cited text no. 3
[PUBMED]    
4.Wylie GR, Burden D. Renbok phenomenon between psoriasis and alopecia areata. Clin Exp Dermatol 2011;36:816-7.  Back to cited text no. 4
[PUBMED]    
5.Garnacho-Saucedo GM, Salido-Vallejo R, Alvarez-López MÁ, Casas de la Asunción E, Ruano-Ruiz J, García-Nieto AV, et al. Renbök phenomenon in a patient with alopecia areata universalis. Arch Dermatol 2012;148:964-5.  Back to cited text no. 5
    
6.Oiso N, Kawada A. Renbök phenomenon in a patient with alopecia areata universalis and psoriasis. J Dermatol 2012;39:288-9.  Back to cited text no. 6
[PUBMED]    
7.McElwee KJ, Gilhar A, Tobin DJ, Ramot Y, Sundberg JP, Nakamura M, et al. What causes alopecia areata? Exp Dermatol 2013;22:609-26.  Back to cited text no. 7
    
8.Ramot Y, Thomaidou E, Mali A, Zlotogorski A. An extraordinary colocalization of alopecia areata and vitiligo. Int J Trichology 2010;2:108-9.  Back to cited text no. 8
    
9.Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol 2009;129:1339-50.  Back to cited text no. 9
    
10.Barahmani N, Lopez A, Babu D, Hernandez M, Donley SE, Duvic M. Serum T helper 1 cytokine levels are greater in patients with alopecia areata regardless of severity or atopy. Clin Exp Dermatol 2010;35:409-16.  Back to cited text no. 10
    


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