Abstract
Isotopic response refers to the occurrence of a new, unrelated cutaneous disease occurring at the same location of a previous healed disease. The etiology of isotopic responses is still not completely understood. Theories have included that viral particles may lead to the development of the second disease, the destruction of nerve fibers by herpes zoster may lead to an indirect influence on the immune system, an alteration of microcirculation from inflammation that causes future insults to localize to the same site, and an exaggerated and atypical hypersensitivity reaction to tissue antigens, viral antigens, or immune complex deposition. A wide variety of disease processes have been reported as the second disease in an isotopic response.Here, we discuss a case of an isotopic response following herpes zoster in which the second disease involved a granuloma annulare (GA)-like inflammatory reaction that resolved and recurred. These findings support the theory that the skin affected by herpes zoster is affected in a way that makes it a focus for the manifestation of further skin diseases.
Highlights
We discuss a case of an isotopic response following herpes zoster in which the second disease involved a granuloma annulare (GA)-like inflammatory reaction that resolved and recurred
An isotopic response is described in a patient who had herpes zoster, who subsequently developed a granuloma annulare (GA)-like inflammatory reaction in the affected area of herpes zoster that resolved and recurred
What is interesting about this presentation is the resolution and subsequent recurrence of a GA-like inflammatory reaction in a zosteriform distribution in the setting of an isotopic response
Summary
We discuss a case of an isotopic response following herpes zoster in which the second disease involved a granuloma annulare (GA)-like inflammatory reaction that resolved and recurred. “Wolf’s isotopic response” refers to the occurrence of a new, unrelated cutaneous disease occurring at the same location of a previous healed disease.[1,2,3] It has been considered to be analogous to but distinct from the Koebner phenomenon, or isomorphic response, which describes the appearance of the same disease at another location induced by injury.[1,2,3] “isotopic” means “at the same place,” and “isomorphic” means “the same morphology”.2 Here, an isotopic response is described in a patient who had herpes zoster, who subsequently developed a granuloma annulare (GA)-like inflammatory reaction in the affected area of herpes zoster that resolved and recurred.
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