A prospective study of the Koebner reaction and T lymphocytes in uninvolved psoriatic skin

T lymphocyte and dendritic cell subpopulations were counted in untraumatized, uninvolved skin of 27 patients with psoriasis. Eight of the patients proved to be Koebner-positive, as determined by tape stripping and punch biopsy, and 19 Koebner-negative. In the epidermis the CD4/CD8 T cell ratio was significantly higher in the Koebner-positive vis-à-vis Koebner-negative patients (median CD4/CD8 = 1.68 and 0.75, respectively: p less than 0.05). This resulted from a small increase in CD4 and a larger decrease in CD8 epidermal T cells in the Koebner-positive group. However, numbers of epidermal dendritic cells did not differ significantly between the two groups. In the dermis the CD4/CD8 T cell ratio was also higher in the Koebner-positive than in Koebner-negative patients (median of 3.56 and 2.57, respectively). These findings demonstrate that the tendency of uninvolved skin of psoriatic individuals to become lesional after trauma is associated with a predominance of CD4 over CD8 T cells in the epidermis.