Background: The clinical significance of Koebner's phenomenon (KP) in vitiligo with respect to disease activity and course is still debatable. Recently, a new classification is introduced for the assessment of KP. Objectives: To evaluate the new assessment method for KP in clinical practice and to determine its clinical significance, both with respect to the clinical profile, course of vitiligo and treatment response. Methods: Seven hundred generalized vitiligo patients were included in this observational cohort study. KP was classified according to the new classification system in different subtypes [KP1: by history, KP2A and KP2B: by clinical examination (A: lesions on friction areas, B: linear, artefactual lesions)]. Results: KP1 was positive in 34.1% of the patients, 66.3% were KP2A positive and 15.1% had KP2B. The BSA was significantly (P<0.001) higher in presence of any KP subtype and more disease activity was found in KP1+ and KP2B+ patients. An earlier age of onset and elevated risk of further depigmentation despite treatment was observed in all KP positive groups. In KP2A+ and KP2B+ patients, depigmentation of wrists/ankles was more common. In the KP2A+ group, a significant higher prevalence of thyroid disease was found while autoimmune diseases were less prevalent in KP2B+ patients. Conclusion: The new assessment method for KP, taking into account both history and clinical examination, seems to be a useful and valuable tool to asses KP in daily practice. Our results support the hypothesis that KP may function as a clinical parameter to assess and predict the clinical profile and course of vitiligo.
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Geel et al. (2012) studied this question.