Pseudo-koebnerization in viral warts

Pseudo-koebnerization refers to the appearance of new lesions of an infectious dermatosis along sites of trauma due to autoinoculation of the pathogen, rather than a true isomorphic response.It is commonly seen in viral infections such as cutaneous warts caused by human papillomavirus (HPV).Minor trauma -scratching, shaving, friction, or maceration -facilitates implantation of viral particles into adjacent skin, leading to the linear spread of lesions along the direction of injury. 1 In viral warts, this phenomenon often manifests as linear or grouped verrucous papules corresponding to scratch marks or areas subjected to repeated friction.e lesions typically have a rough, hyperkeratotic surface and may show punctate black dots representing thrombosed capillaries.In the present case, the image demonstrates multiple linear streaks of small verrucous papules over the extensor aspect of the elbow, arranged along scratch lines.ese papules follow a linear pattern suggestive of autoinoculation, representing pseudo-koebnerization.In addition, a larger hyperkeratotic wart with a rough, papillomatous surface is visible inferiorly, likely representing the primary lesion from which viral particles were spread through scratching Figure 1.