Vitiligo pp 166-180 | Cite as

Environmental Factors

The Kobner's Phenomenon
Occupational Vitiligo
  • Yvon GauthierEmail author
  • Laila Benzekri
  • Raymond E. Boissy

Core Messages

  • Fitzpatrick and ourselves described the frequency of vitiligo lesions vulgaris at sites subjected to repeated trauma such as continuous pressure or repeated frictions of various origins.

  • In non-segmental vitiligo, the incidence of Kobner's Phenomenon (KP) is very varied according to reports, that is, from 15 to 70%.

  • Wounds, scars, burns, abrasion, laser, and other types of surgical abrasion are the more frequent inducing factors of the KP.

  • Many mechanisms have been hypothesised: increased release of neuropeptides noxious for melanocytes, detachment and transepidermal elimination, and lower secretion of keratino-cyte-derived factors. In normal vitiligo skin, a minor trauma (tape stripping) is possible after 72 h to induce the formation of autophagic vacuoles containing polymelanosomes and the detachment of few melanocytes from the basement membrane.

  • In the presence of a history of vitiligo in the family, the onset of permanent depigmentation following repeated scratches in children without vitiligo could indicate a ‘vitiligo diathesis.’


Lichen Planus Mechanical Trauma Vitiligo Patient Oculocutaneous Albinism Repeated Trauma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Al’Abadie MS, Senior HJ, Bleehen SS et al (1994) Neuropeptide and neuronal marker studies in vitiligo. Br J Dermatol 131:160–165PubMedCrossRefGoogle Scholar
  2. 2.
    Asboe-Hansen G (1954) Depigmentation itching. Acta Derm Venereol 34:1–3PubMedGoogle Scholar
  3. 3.
    Barona MI, Arrunategui A, Falabella R et al (1995) An epi-demiologic case-control study in a population with vitiligo. J Am Acad Dermatol 33:621–625PubMedCrossRefGoogle Scholar
  4. 4.
    Beetley F (1951) The provocation of cutaneous disease: Koebner's isomorphic phenomenon. Arch Midds Hosp 1:279–287Google Scholar
  5. 5.
    Bleehen SS, Hall-Smith P (1970) Brassiere depigmentation: light and electron microscope studies Br J Dermatol 83:157–160PubMedCrossRefGoogle Scholar
  6. 6.
    Dupré A, Christol B (1978) Cockade-like vitiligo and linear vitiligo; a variant of Fitzpatrick's trichrome vitiligo. Arch Dermatol Res 262:197–203PubMedCrossRefGoogle Scholar
  7. 7.
    Eyre RW, Krueger GG (1982) Response to injury of skin involved and uninvolved with psoriasis and its relation to disease activity: Koebner and reverse Koebner reactions. Br J Dermatol 106:153–159PubMedCrossRefGoogle Scholar
  8. 8.
    Falabella R, Arunategui A, Barona MI et al (1995) The minigrafting test for vitiligo detection of stable lesions for melanocyte transplantation. J Am Acad Dermatol 32:228–232PubMedCrossRefGoogle Scholar
  9. 9.
    Fitzpatrick TB (1971) Vitiligo. Dermatology in general Medicine. Mc Graw Hill, New York, pp 1596–1600Google Scholar
  10. 10.
    Gauthier Y (1995) The importance of Koebner's phenomenon in the induction of vitiligo vulgaris lesions. Eur J Dermatol 5:704–708Google Scholar
  11. 11.
    Gauthier Y, Bazeille J-E (1992) Autologous grafting with non cultured melanocytes: a simplified method for treatment of depigmented lesions. J Am Acad Dermatol 26:191–194PubMedCrossRefGoogle Scholar
  12. 12.
    Gauthier Y, Cario-André M, Lepreux S et al (2003) Melanocyte detachment after skin friction in non lesional skin of patients with generalized vitiligo. Br J Dermatol 148:95–101PubMedCrossRefGoogle Scholar
  13. 13.
    Gauthier Y, Cario-André M, Taieb A (2003) A critical appraisal of vitiligo etiologic theories. Is melanocyte loss a melanocytorrhagy? Pigment Cell Res 16:322–327PubMedCrossRefGoogle Scholar
  14. 14.
    Gopinathan T (1965) A study of the lesion of vitiligo. Arch Dermatol 91:397–404CrossRefGoogle Scholar
  15. 15.
    Hann SK, Chun WH, Park YK (1997) Clinical charasteris-tics of progressive vitiligo. Int J Dermatol 36:353–355PubMedCrossRefGoogle Scholar
  16. 16.
    Hatchome N, Kato T, Tagami H (1990) Therapeutic success of epidermal grafting in generalized vitiligo is limited by the Koebner's phenomenon. J Am Acad Dermatol 22 : 87–91PubMedCrossRefGoogle Scholar
  17. 17.
    Kaposi M (1891) Pathologie et traitement des maladies de la peau.Traduction Doyon and Besnier, Masson, France, pp 105–110Google Scholar
  18. 18.
    Jin Y, Mailloux C, Gowan K et al (2007) NALP1 in vitiligo-associated multiple autoimmune disease. N Engl J Med 356:1216–1225PubMedCrossRefGoogle Scholar
  19. 19.
    Koebner H (1877) Zur Aetiologie der Psoriasis. Vrtljscher Dermatol Syphil 1876 8:559–561Google Scholar
  20. 20.
    Koga M, Tango T (1988) Clinical features and course of type A and type B vitiligo. Br J Dermatol 118:223–228PubMedCrossRefGoogle Scholar
  21. 21.
    Lee AY, Kim NH, Choo W-J et al (2005) Less keratinocyte-derived factors related to more keratinocyte apoptosis in depigmented than normally pigmented suction-blistered epidermis may cause passive melanocyte death in vitiligo. J Invest Dermatol 124:976–983PubMedCrossRefGoogle Scholar
  22. 22.
    Levaï M (1958) A study of certain contributory factors in the development of vitiligo in South Indian patients. Arch Dermatol 78:364–371CrossRefGoogle Scholar
  23. 23.
    Levaï M (1958) The relation ship of pruritus and local skin conditions to the development of vitiligo. Arch Dermatol 78:372–377CrossRefGoogle Scholar
  24. 24.
    Moellmann G, Klein-Angerer S, Scollary DA et al (1982) Extracellular granular material and degeneration of kerati-nocytes in the normally pigmented epidermis with vitiligo. J Invest Dermatol 79:321–330PubMedCrossRefGoogle Scholar
  25. 25.
    Mottaz JH, Thorne G, Zelicson As (1971) Response of the epidermal melanocyte to minor trauma. Arch Dermatol 104:611–618PubMedCrossRefGoogle Scholar
  26. 26.
    Mulekar S (2007) Koebner's phenomenon in vitiligo: not always an indication of surgical failure. Arch Dermatol 143:801–802PubMedCrossRefGoogle Scholar
  27. 27.
    Njoo MD, Das PK, Bos JD et al (1999) Association of the Koebner's phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Arch Dermatol 135:407–413PubMedCrossRefGoogle Scholar
  28. 28.
    Ormsby OS, Montgomery H (1948) Koebner's phenomenon in dermatology: a study and report of some unusual stigmata of this phenomenon. Lea and Febrigerm Philadelphia, pp 306Google Scholar
  29. 29.
    Ortonne JP (1983) Vitiligo. In: Ortonne JP (ed) Vitiligo and other hypomelanosis of hair and skin. Plenum, New York, pp 163–310CrossRefGoogle Scholar
  30. 30.
    Schallreuter KU, Lemke R, Brandt Owesthofen M et al (1994) Vitiligo and other diseases: coexistence or true association? Dermatology 188:268–275CrossRefGoogle Scholar
  31. 31.
    Seif El-Nas RH, El-Hefnawi H (1963) Koebner's phenomenon in dermatology: a study and report of some unusual stigmata of this phenomenon. J Egypt Med Assoc 46:1067–108Google Scholar
  32. 32.
    Sweet RD (1978) Vitiligo as Koebner's phenomenon. Br J Dermatol 99:223–224PubMedCrossRefGoogle Scholar
  33. 1.
    Bajaj A, Gupta S, Chatterjee A (1996) Footwear depigmen-tation. Contact Dermatitis 35:117–118PubMedCrossRefGoogle Scholar
  34. 2.
    Bajaj AK, Gupta SC, Chatterjee AK (1990) Contact depig-mentation from free para-tertiary-butylphenol in bindi adhesive. Contact Dermatitis 22:99–102PubMedCrossRefGoogle Scholar
  35. 3.
    Bajaj AK, Gupta SC, Chatterjee AK et al (1996) Hair dye depigmentation. Contact Dermatitis 35:56–57PubMedCrossRefGoogle Scholar
  36. 4.
    Bajaj AK, Pandey RK, Misra K et al (1998) Contact depig-mentation caused by an azo dye in alta. Contact Dermatitis 38(4):189–193PubMedCrossRefGoogle Scholar
  37. 5.
    Bickley LK, Papa CM (1989) Chronic arsenicism with viti-ligo, hyperthyroidism, and cancer. N J Med 86(5):377–380PubMedGoogle Scholar
  38. 6.
    Bleehen SS, Pathak MA, Hori Y et al (1968) Depigmentation of skin with 4-isopropylcatechol, mercaptoamines and other compounds. J Invest Dermatol 50:103–117PubMedGoogle Scholar
  39. 7.
    Boissy RE, Nordlund JJ (1995) Biology of vitiligo. In: Arndt KA, LeBoit PE, Robinson JK et al (eds) Cutaneous medicine and surgery: an integrated program in dermatology. WB Saunders, PhiladelphiaGoogle Scholar
  40. 8.
    Boissy RE, Manga P (2004) On the etiology of contact/ occupational vitiligo. Pigment Cell Res 17:208–214PubMedCrossRefGoogle Scholar
  41. 9.
    Chumakov NN, Babanov GP, Smirnov AG (1962) Vitiliginoid dermatoses in workers of phenol-formaldehyde resin works. Bull Dermatol 36:3–8Google Scholar
  42. 10.
    Cummings MP, Nordlund JJ (1995) Chemical leukoderma: fact or fancy. Am J Contact Dermatitis 6:122–127CrossRefGoogle Scholar
  43. 11.
    Dell'Anna ML, Ottaviani M, Albanesi V et al (2007) Membrane lipid alterations as a possible basis for melano-cyte degeneration in vitiligo. J Invest Dermatol 127(5): 1226–1233PubMedCrossRefGoogle Scholar
  44. 12.
    Flickinger CW (1976) The benzenediols: catechol, resorci-nol and hydroquinone — a review of the industrial toxicology and current industrial exposure limits. Am Industr Hyg Assoc J 37:596–606CrossRefGoogle Scholar
  45. 13.
    Gellin GA, Possick PA, Perone VB (1970) Depigmentation from 4-tertiary butyl catechol — an experimental study. J Invest Dermatol 55:190–197PubMedCrossRefGoogle Scholar
  46. 14.
    Gellin GA, Maibach HI, Misiaszek MH (1979) Detection of environmental depigmenting substances. Contact Dermatitis 5:201–213PubMedCrossRefGoogle Scholar
  47. 15.
    Ghosh S, Mukhopadhyay S (2008) Chemical leukoderma: clinico-etiological study of 864 cases in perspective of developing country. Br J Dermatol 160:40–47PubMedCrossRefGoogle Scholar
  48. 16.
    Halliwell B, Chirico S (1993) Lipid peroxidation: its mechanism, measurement, and significance. Am J Clin Nutr 57(Suppl 5):715S–725SPubMedGoogle Scholar
  49. 17.
    Hernandez C, Reddy SG, Le Poole C (2008) Contact leuko-derma after application of a compounded phenol cream. Eur J DermatolGoogle Scholar
  50. 18.
    Ito Y, Jimbow K, Ito S (1987) Depigmentation of black guinea pig skin by topical application of cysteaminylphenol, cysteinylphenol, and related compounds. J Invest Dermatol 88:77–82PubMedCrossRefGoogle Scholar
  51. 19.
    James O, Mayes RW, Stevenson CJ (1977) Occupational vitiligo induced by p-tert-butylphenol: a systemic disease? Lancet 2:1217–1219PubMedCrossRefGoogle Scholar
  52. 20.
    Jimbow K, Obata H, Pathak MA et al (1974) Mechanism of depigmentation by hydroquinone. J Invest Dermatol 62:436–449PubMedCrossRefGoogle Scholar
  53. 21.
    Kahn G (1970) Depigmentation caused by phenolic detergent germicides. Arch Dermatol 102:177–187PubMedCrossRefGoogle Scholar
  54. 22.
    Lerner AB (1971) On the etiology of vitiligo and grey hair. Am J Med 51:141–147PubMedCrossRefGoogle Scholar
  55. 23.
    Levin CY, Maibach H (2001) Exogenous ochronosis. An update on clinical features, causative agents and treatment options. Clin Dermatol 2:213–217CrossRefGoogle Scholar
  56. 24.
    Malten KE, Seutter E, Hara I et al (1971) Occupational viti-ligo due to paratertiary butylphenol and homologues. Trans St Johns Hosp Dermatol Soc 57:115–134PubMedGoogle Scholar
  57. 25.
    Manga P, Sheyn D, Sarangarajan R et al (2005) The microphthalmia-associated transcription factor and tyrosi-nase related-protein 1 play a role in melanocyte response to 4-tertiary butyl phenol. J Invest DermatolGoogle Scholar
  58. 26.
    Manga P, Sheyn D, Yang F et al (2006) A role for tyrosinase related-protein 1 in 4-tert-butylphenol-induced toxicity in melanocytes. Implications for vitiligo. Am J Pathol 169(5): 1652–1662PubMedCrossRefGoogle Scholar
  59. 27.
    Mans DR, Lafleur MV, Westmijze EJ et al (1992) Reactions of glutathione with the catechol, the ortho-quinone and the semi-quinone free radical of etoposide. Consequences for DNA inactivation. Biochem Pharmacol 43:1761–1768PubMedCrossRefGoogle Scholar
  60. 28.
    Marnett LJ (1999) Lipid peroxidation-DNA damage by malondialdehyde. Mutat Res 424(1–2):83–95PubMedGoogle Scholar
  61. 29.
    McGuire J, Hinders J (1971) Biochemical basis for depig-mentation of skin by phenol germicides. J Invest Dermatol 57:256–261PubMedCrossRefGoogle Scholar
  62. 30.
    Monks TJ, Hanzlik RP, Cohen GM et al (1992) Contemporary issues in toxicology. Quinone chemistry and toxicity. Toxicol Appl Pharmacol 112:2–16PubMedCrossRefGoogle Scholar
  63. 31.
    Nakagawa Y, Tayama S, Moore G et al (1993) Cytotoxic effects of biphenyl and hydroxybiphenyls on isolated rat hepatocytes. Biochem Pharmacol 45:1959–1965PubMedCrossRefGoogle Scholar
  64. 32.
    O'Brien PJ (1991) Molecular mechanisms of quinone cyto-toxicity. Chem Biol Interact 80(1):1–41PubMedCrossRefGoogle Scholar
  65. 33.
    O'Malley MA, Mathias CG, Priddy M et al (1988) Occupational vitiligo due to unsuspected presence of phenolic antioxidant byproducts in commercial bulk rubber. J Occup Med 30(6):512–516PubMedCrossRefGoogle Scholar
  66. 34.
    Okmura Y, Shirai T (1962) Vitiliginous lesions occurring among workers in a phenol derivative factory. Jpn J Dermatol 7:617–619Google Scholar
  67. 35.
    Oliver EA, Schwartz L, Warren LH (1939) Occupational leukoderma. JAMA 113:927–928CrossRefGoogle Scholar
  68. 36.
    Ortonne J-P, Bose SK (1993) Vitiligo: where do we stand? Pigment Cell Res 6:61–72PubMedCrossRefGoogle Scholar
  69. 37.
    Pandhi RK, Kumar AS (1985) Contact leukoderma due to ‘Bindi’ and footwear. Dermatologica 170(5):260–262PubMedCrossRefGoogle Scholar
  70. 38.
    Powis G (1987) Metabolism and reactions of quinoid anticancer agents. Pharmacol Ther 35(1–2):57–162PubMedCrossRefGoogle Scholar
  71. 39.
    Quevedo WC Jr, Fitzpatrick TB, Szabo G et al (1986) Biology of the melanin pigmentary system. In: Fitzpatrick TB, Eisen AZ, Wolff K (eds) Dermatology in general medicine. McGraw-Hill, New YorkGoogle Scholar
  72. 40.
    Rodermund OE, Jorgens H, Muller R et al (1975) [Systemic changes in occupational vitiligo]. Hautarzt 26(6): 312–316PubMedGoogle Scholar
  73. 41.
    Selvaag E (1996) Chloroquine-induced vitiligo. A case report and review of the literature. Acta Derm Venereol 76:166–167PubMedGoogle Scholar
  74. 42.
    Shelley W (1974) p-Cresol: cause of ink-induced hair depig-mentation in mice. Br J Dermatol 90:169–174PubMedCrossRefGoogle Scholar
  75. 43.
    Sun CC (1987) Allergic contact dermatitis of the face from contact with nickel and ammoniated mercury in spectacle frames and skin-lightening creams. Contact Dermatitis 17:306–309PubMedCrossRefGoogle Scholar
  76. 44.
    Takahashi A, Masuda A, Sun M et al (2004) Oxidative stress-induced apoptosis is associated with alterations in mitochon-drial caspase activity and Bcl-2-dependent alterations in mitochondrial pH (pHm). Brain Res Bull 62:497–504PubMedCrossRefGoogle Scholar
  77. 45.
    Taylor JS, Maibach HI, Fisher AA et al (1993) Contact leu-koderma associated with the use of hair colors. Cutis 52(5):273–280PubMedGoogle Scholar
  78. 46.
    Yang F, Sarangarajan R, Le Poole IC et al (2000) The cyto-toxicity and apoptosis induced by 4-tertiary butylphenol in human melanocytes is independent of tyrosinase activity. J Invest Dermatol 114:157–164PubMedCrossRefGoogle Scholar
  79. 47.
    Yusof Z, Pratap RC, Nor M et al (1990) Vogt-Koyanagi-Harada syndrome — a case report. Med J Malaysia 45:70–73PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Yvon Gauthier
    • 1
    Email author
  • Laila Benzekri
    • 1
  • Raymond E. Boissy
    • 2
  1. 1.Service de Dermatologie, Hôpital Saint-AndréCHU de BordeauxFrance
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA

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