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Dewke Reverse Koebner
from Sherry in Crockett

Hi Ed ~ Your December Briefing and Mail are terrific as usual. Thanks for keeping the Flake World up to date and entertaining us as well.

Regarding the Alabama Flaker [see link at end], her smashed fingernail, and your reverse-Koebner theory, I too have one nail that is baby perfect and the result of a derm's removing half of it when something suspicious provoked that action. He saw an oily-looking spot on the skin under the nail, and since that morning in his office someone else had had a melanoma under the nail, he thought he ought to biopsy mine, or so he said. This was long ago, maybe 20 years, and there was no melanoma. I couldn't grip the pen well enough to write legibly for a week or so, but when that nail had grown back perfectly a few months later, I considered returning to get the others "treated" too. I didn't and they're gnarly, all except the perfect one.

Last month I persuaded my new derm to use liquid nitrogen on a bumpy, bleeding spot on my arm near where it bends, since I'd had a basal cell carcinoma cut and stitched in that area a year earlier by another derm who has since moved. New derm thought the spot was most likely psoriasis and mentioned that the Koebner effect might affect it adversely if she liquid-nitro'd it. I begged, and she gave in, since she already had the liquid nitro out for four other possible precancerous areas. Guess what. That elbow spot is gone. If it was the beginning of basal cell carcinoma, perhaps the liquid nitro got it all. If it was P, perhaps the Dewke Reverse Koebner occurred.

There just might be something to doing damage to the P areas. Not just a bit of damage like idle scratching, but big, destructive damage like smashing, freezing or cutting. (OK, I just got back from the latest Bond thriller, The World Is Not Enough, and my mood may be more rambunctious than usual.) Anyway, I have a friend whose hubby is an engineer, and she has a supply of liquid nitrogen that she uses on herself every so often for things she doesn't like (I know, I know, could be cancer, but what the H, if whatever comes back, she can go to the derm then). I'm thinking of borrowing her supply next time I've got a bleeding P spot, ahem.

Happy last month of the millennium to you and yours, -Sherry in Crockett


Ed's Response: "Dewke Reverse Koebner" ... Got a nice ring to it, doesn't it? And I got that one for free. They wanted $75 of my dollars to name a star after me some years back. (There are no stars named Dewke in the universe—at least not because of me).

Adding your finger story to FIA's, it becomes more difficult not to ponder this phenomenon of using trauma to conquer lesions (a.k.a. Dewke Reverse Koebner {smile}). I believe the jury is still out on your elbow story. As you had the liquid nitro treatment last month, it may be premature to call the so-far clear result Dewke Reverse Koebner {smile}. My Koebner (regular Koebner) experience suggests 30-90 day latency isn't unusual. Let us know how your elbow looks in February.

If I get very many more emails reporting trauma cleared lesions, I'm going to write a booklet, charge $9.45, spam all the news groups. My booklet will tell how to apply dry ice to lesions to initiate Dewke Reverse Koebner {smile}. I'll have to spend a day or two conducting more research, though. I need to learn exactly when to remove the dry ice compress so that Dewke Reverse Koebner {smile} doesn't turn into frostbite and gangrene....


In ‘91 my nose was liquid nitro'd to treat a full-nose lesion (gawd was it gross!). My derm at the time wasn't willing to call this nose lesion P. She liquid nitro'd it twice over three months. When it came back the second time I went to another derm. He prescribed Wescort® Cream (a mild, .02%, Group 5 topical corticosteroid) and it went away a third time and hasn't returned. It wants to return all the time; I use the Westcort® before it has a chance to blossom. Each time I received the liquid nitro treatment the nose lesion would stay away for a few weeks—but that was all.

Then there's the case of my gut surgery scars. I've mentioned these before in discussions of Koebner Phenomenon. I had about a seven inch incision from my navel to my groin, and then four "buttons" flanking the incision (that were used to secure subcutaneous wires that were keeping my gut together while the underlying tissue sealed and healed. The four buttons and the long incision Koebnerized beautifully. A year or so after the surgery my derm took photos. All totaled, it took about six years to quiet down those lesions. It wasn't until the Methotrexate therapy that they disappeared completely.

So, the title Dewke Reverse Koebner {smile} notwithstanding, I must suggest much more evidence is in order. Anyone who cares to add their story about self-mutilation or torture to make lesions go away is encouraged to send it to me. If it ends up in my booklet, I'll let contributors buy copies at a righteous 10% discount. {wink} -Ed

Flaking in Alabama: Reverse Koebner? and "Zone" Diet

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