UMMS Affiliation

Department of Dermatology

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Dermatology | Nutritional and Metabolic Diseases | Pathological Conditions, Signs and Symptoms | Skin and Connective Tissue Diseases


Calciphylaxis is characterized by calcific occlusion of vessels and subsequent tissue ischemia due to thrombosis. The precise pathogenetic mechanism behind calciphylaxis remains unclear. In the original experiment by Hans Selye and colleagues, soft-tissue calcification was induced in rats by applying a sensitizing agent, followed by a “challenger” agent after a specific time period. Trauma may represent one of these “challenger” agents, serving as an inducer of endothelial dysfunction and subsequent thrombosis, leading from tissue calcification to calciphylaxis.

Koebnerization, a term used to describe the appearance of isomorphic lesions in areas of trauma, has been postulated to be a feature of calciphylaxis. This hypothesis arose from reports of patients who developed calciphylaxis following mild skin trauma, such as that caused by chronic resting of elbows on thighs, placement of ice packs, and injections involving various medications such as iron dextran, tobramycin, and especially insulin.

Rigorous studies demonstrating the relationship between calciphylaxis and Koebnerization and an underlying mechanism are limited. To better understand this association, this study retrospectively identified characteristics of patients who presented with calciphylaxis in areas of trauma, suggesting the presence of Koebnerization.


IQR, interquartile range, Koebner phenomenon, Koebnerization, calciphylaxis, pathogenesis, risk factors, trauma

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Copyright © 2021 Published by Elsevier on behalf of the American Academy of Dermatology, Inc. This is an open access article under the CC BY-NC-ND license (

DOI of Published Version



Gabel CK, Chakrala T, Dobry AS, Garza-Mayers AC, Ko LN, Nguyen ED, Shah R, St John J, Nigwekar SU, Kroshinsky D. The Koebner phenomenon may contribute to the development of calciphylaxis: A case series. JAAD Case Rep. 2021 Apr 28;13:57-61. doi: 10.1016/j.jdcr.2021.04.016. PMID: 34159240; PMCID: PMC8193369. Link to article on publisher's site

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JAAD case reports

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.