Introduction
Psoriasis is a chronic inflammatory skin disease affecting 2–3% of the global population. While trauma is often linked to psoriasis flares via the Koebner phenomenon, emerging observations suggest a more nuanced relationship between skin disease and vascular treatment. Venous insufficiency, commonly managed with endovenous laser ablation (EVLA), can involve local trauma to tissue and changes in venous hemodynamics. Here we report a novel case where EVLA, performed for venous insufficiency, coincided with complete remission of localized psoriasis on the treated limb, prompting a discussion of possible mechanisms and implications for practice.
Case Presentation
A 41-year-old male presented with prominent localised psoriasis vulgaris on the left leg and concurrent venous insufficiency, including oedema and varicose veins. The psoriasis had a 25-year history and had not achieved complete resolution with prior topical and systemic therapies. Duplex ultrasound confirmed reflux in the great saphenous vein. Given the vascular symptoms and concerns about inducing a Koebner flare, the treatment plan weighed non-thermal options against EVLA, a thermal procedure with inherent tissue trauma. After counseling, the patient elected EVLA using a Biolitec® ELVeS Radial 2ring fiber (1,470 nm).
Intervention and Outcomes
The EVLA procedure proceeded without complication. Remarkably, within a few weeks post-procedure, psoriatic lesions on the left lower extremity began to remit and achieved complete clearance by the six-month follow-up. A three-month course of calcium dobesilate for venous insufficiency was administered during this period and subsequently stopped; no changes were noted in scalp psoriasis. The remission appeared localized to the treated leg, with no systemic alteration in disease activity observed.
Discussion
The literature on psoriasis and venous interventions is sparse, and this appears to be among the first reports describing psoriasis remission following EVLA. While the Koebner phenomenon predicts flares after trauma, this case demonstrates a paradoxical, localized remission, suggesting potential immunomodulatory effects of EVLA or improvements in local tissue environment that influence psoriasis activity. Several hypotheses warrant exploration:
- Local immunomodulation — EVLA may alter the inflammatory milieu within the treated limb by reducing venous stasis and edema, potentially decreasing pro-inflammatory mediators that fuel psoriatic plaques.
- Improved perfusion and drug delivery — Enhanced venous return could modify local absorption or effectiveness of topical therapies, or alter the trafficking of inflammatory cells in the skin.
- Direct laser effects — The energy used in EVLA might exert non-specific photothermal effects that incidentally affect psoriatic tissue in adjacent areas, though this remains speculative.
- <strongReconsidering trauma-psoriasis interactions — The observation aligns with the broader understanding that trauma does not uniformly worsen psoriasis and may, in certain vascular or inflammatory contexts, yield unexpected benefits.
A recent systematic review has highlighted the complex relationship between psoriasis and vascular disease, including associations with venous thromboembolism and peripheral vascular disease. This case adds to the conversation by suggesting that treating venous insufficiency could, in select patients, influence cutaneous disease activity in local regions.
Clinical Implications and Future Directions
Clinicians should acknowledge the potential for vascular interventions to impact dermatologic outcomes in patients with coexisting psoriasis and venous disease. While this remains an isolated report, it underscores the need for prospective studies to:
- Characterize the prevalence and predictors of psoriasis changes after EVLA or other venous therapies.
- Investigate the underlying mechanisms driving localized psoriasis remission in the context of venous intervention.
- Develop guidelines for counseling patients with dual diagnoses about potential dermatologic responses to vascular treatments.
Conclusion
This case documents a rare, localized remission of psoriasis following endovenous laser ablation for venous insufficiency, challenging conventional assumptions about trauma and psoriasis. Although causality cannot be established from a single case, the observation invites broader investigation into the immunologic and vascular interactions that govern psoriasis activity in treated limbs.
