Introduction
Psoriasis is a chronic inflammatory skin disease affecting about 2–3% of the global population. It presents as well-defined erythematous plaques with silvery scales and can be challenging to manage, especially in the lower extremities where friction, edema, and limited drug delivery complicate therapy. Venous insufficiency is a common comorbidity in patients with psoriasis, and vascular interventions—such as endovenous laser ablation (EVLA)—have traditionally been evaluated for their vascular benefits rather than dermatologic outcomes. This case report highlights a striking and unexpected finding: complete remission of localized psoriasis following EVLA performed for venous insufficiency, raising important questions about the relationship between controlled trauma, venous physiology, and skin inflammation.
Case Report Overview
A 41-year-old man presented with prominent, localized psoriasis vulgaris on the left lower leg and concurrent symptoms of venous insufficiency. Psoriasis manifested as classic plaques with adherent scales, while venous disease included edema, leg pain, and visible varicosities. Duplex ultrasound confirmed reflux in the great saphenous vein. After exhausting topical and systemic options over a 25-year disease course, and evaluating the risk of Koebnerization with various venous therapies, the patient elected to undergo endovenous laser ablation (EVLA) using a Biolitec® ELVeS Radial 2ring fiber (1470 nm).
Remarkably, within weeks of EVLA, psoriatic lesions on the treated left leg began to improve, culminating in complete remission by the 6-month follow-up. The patient did not receive systemic psoriasis therapies during this period. A 3-month course of calcium dobesilate 500 mg twice daily for venous insufficiency was completed during the follow-up, after which the medication was stopped. The scalp psoriasis remained unchanged, suggesting a localized effect rather than a systemic one. The procedure was well tolerated with no adverse events related to the EVLA aside from the notable dermatologic response.
Discussion: Interpreting an Atypical Koebner Phenomenon
The Koebner phenomenon characterizes the emergence or worsening of psoriasis at sites of trauma. However, this case presents a paradox: controlled, therapeutic trauma from EVLA coinciding with complete local remission of psoriasis in the treated area. Several hypotheses warrant consideration. One possibility is localized immunomodulation triggered by restored venous return and reduced stasis, which may dampen chronic inflammatory signaling in the skin. Improved lymphatic drainage and decreased edema could lessen inflammatory cell trafficking to the dermis, thereby reducing plaque activity in the treated limb.
Another hypothesis is a direct, energy-related effect of the laser on cutaneous tissue adjacent to the venous intervention. Though EVLA targets venous walls, incidental photothermal or photochemical interactions might influence nearby inflammatory pathways. A third possibility mirrors the concept of pressure or controlled trauma delivering a therapeutic brake on local skin inflammation, as seen in some studies where compression and mechanical factors did not worsen, and may even benefit, cutaneous psoriasis with edema. These ideas underscore how trauma’s impact on psoriasis is not universally harmful; rather, it can be context-dependent and tissue-specific.
There is also interest in the broader vascular-psoriasis axis. Emerging evidence links psoriasis with higher risks of venous thromboembolism and peripheral vascular disease, suggesting bidirectional interactions between skin inflammation and vascular health. This case thus adds a new dimension: the vascular intervention period might reveal non-trivial dermatologic responses, potentially guiding future translational work toward integrated vascular-dermatologic therapies.
Clinical Implications and Future Directions
From a clinical standpoint, this case invites practitioners to approach venous insufficiency treatment in patients with psoriasis with an open mind about potential dermatologic outcomes. It reinforces the need for careful patient selection and counseling regarding unexpected responses, alongside close monitoring of skin changes after EVLA or similar interventions. Importantly, this observation should not prematurely change practice but should stimulate rigorous research, including controlled studies and mechanistic explorations of how venous interventions influence local and systemic inflammatory pathways in psoriasis.
Conclusion
This novel case report documents complete remission of localized psoriasis following EVLA for venous insufficiency, challenging conventional expectations tied to the Koebner phenomenon. While the mechanisms remain speculative, the finding highlights the complex, nuanced relationship between trauma, vascular health, and psoriasis. Further research is needed to determine whether such responses can be replicated, understood mechanistically, and translated into broader therapeutic strategies for patients with coexisting psoriasis and venous disease.
