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Associations With Early Age at Onset and Multiple Previous Therapies

John W. Melski, MD; Jeffrey D. Bernhard, MD; Robert S. Stern, MD

Arch Dermatol. 1983;119(8):655-659.

Abstract
• Among 1,253 patients with psoriasis who were enrolled in a study of photochemotherapy, 33% had a history of a Koebner response (KR) at the site of physical trauma. The early onset of psoriasis and previous treatment with multiple types of therapy were each independently associated with the KR. Among patients with both onset before age 15 years and previous treatment with four or more types of therapy, 75% reported the KR, compared with only 5% of patients with onset after age 30 years and no previous therapy. At the time of enrollment in the photochemotherapy study, the history of the KR was not associated with worsening, the duration of psoriasis, or the extent of skin surface involved. Patients with the KR may manifest their disease earlier in life or may be more prone to flare after any type of treatment.

(Arch Dermatol 1983;119:655-659)

Author Affiliations
From the Photochemotherapy Follow-up Study and Laboratory of Computer Medicine, Department of Medicine, Beth Israel Hospital (Dr Melski), and Departments of Dermatology, Beth Israel Hospital and Massachusetts General Hospital (Drs Melski, Bernhard, and Stern), Harvard Medical School; Center for the Analysis of Health Practices (Dr Stern), Harvard School of Public Health; and Charles A. Dana Research Institute and Harvard-Thorndike Laboratory of Beth Israel Hospital (Drs Melski and Stern), Boston.

Footnotes
Accepted for publication Aug 18, 1982.

Reprint requests to Laboratory of Computer Medicine, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02215 (Dr Melski).

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