Ultraviolet Light-induced Köbner Phenomenon Contributes to the Development of Skin Eruptions in Multicentric Reticulohistiocytosis

Abstract

Multicentric reticulohistiocytosis is a rare systemic disease of unknown aetiology characterized by erosive arthritis and cutaneous lesions consisting of multiple reddish-brown papules and nodules, mainly involving the face and distal upper extremities. It has been suggested that skin eruptions in multicentric reticulohistiocytosis are associated with Köbner phenomenon due to their characteristic distribution, such as on the dorsal aspects of the hands and fingers. We report here a case of a Japanese woman with multicentric reticulohistiocytosis, in whom erythematous macules and papules were widely distributed over the face, ears, neck and the V-area of the chest. Notably, repeated irradiation of ultraviolet (UV) B on the uninvolved back skin resulted in the induction of erythematous macules with infiltration of reticulohistiocytes, indicating the association of UVB-induced Köbner phenomenon with the development of skin lesions, especially on the sun-exposed area. This is the first known report demonstrating the contribution of UV-light-induced Köbner phenomenon for the development of skin eruptions in patients with multicentric reticulo-histiocytosis.

Multicentric Reticulohistiocytosis Associated with an Early Form of Systemic Lupus Erythematosus: A Case Report of a Rare Disease, with Mini Review of the Literature

“…In the case we presented, the photo-distributed pattern, the facial erythema, and the concomitance with the summer season suggested a cutaneous photosensitivity, a condition already observed in association with MRH, because of the UV light-induced Koebner phenomenon [ 19 ]. However, it is also associated with connective tissue diseases.…”

Multicentric Reticulohistiocytosis with Dermatomyositis-like Eruptions

“…This suggested that he might have had photosensitivity, which is a feature of connective tissue diseases, although a photosensitive rash is also a skin manifestation of MRH ( 7 , 17 ). There has been a case report of MRH in which skin lesions developed after repeated ultraviolet B irradiation ( 18 ).…”

Successful Treatment of Multicentric Reticulohistiocytosis with Adalimumab, Prednisolone and Methotrexate

“…Various treatments have been reported, including non-steroidal anti-inflammatory agents, prednisolone, isoniazid, MTX, cyclosporine, cyclophosphamide, alendronate and minocycline, alone or in combination (3,12). In addition, sun-protective clothing and sunscreens are recommended to prevent the development of skin eruptions, via the ultraviolet light-induced Kӧbner phenomenon (13). To the best of our knowledge, there are currently 10 reported cases of MRH that have been treated with anti-TNF agents, such as infliximab (3-6), etanercept (7-9) and adalimumab (10,11), but the clinical outcome is controversial.…”