Healed Herpes Zoster Research Articles

Unusual presentation of telangiectasia macularis eruptiva perstans at the site of healed herpes zoster; Wolf's isotopic response.

There are several reported cases of Wolf's isotopic response, including infections, cancers, inflammatory and immune-related disorders. It is interesting that the majority of these occurred after herpes zoster (HZ) had healed. In this article, we describe an unusual case of adult mastocytosis/telangiectasia macularis eruptiva perstans (TMEP) at the location of recovered HZ. Given that adult mastocytosis is thought to be caused by dysregulation of the mast cell growth factor receptor, the c-Kit proto-oncogene (CD117), and the fact that the varicella zoster virus-infected cutaneous lesions contain CD117-positive mast cells (CD117+MCs), we hypothesize that CD117+ MCs may be in charge of the local immunological response and cytokine release those results in TMEP after HZ.

Localized Zosteriform bullous Pemphigoid on the Sites of a Healed Herpes Zoster: A Case Report and Literature Review

Background: Localized zosteriform bullous pemphigoid is a rare variant of bullous pemphigoid that is considered a manifestation of Wolf`s isotopic response. Only a few cases have been reported. We add another case to the body of knowledge in order to shed the light on this uncommon variant of bullous pemphigoid. Case Report: A 67-year old female patient developed vesiculobullous lesions at the sites of healed herpes zoster. The patient was diagnosed as a case of zosteriform bullous pemphigoid based on the clinical presentation and skin biopsy findings. Conclusion: Zosteriform bullous pemphigoid is a rare manifestation of Wolf`s isotopic response. A Skin biopsy must be performed early to ensure proper diagnosis and management.

Zosteriform lichen planus after healed herpes zoster: Report of a new case of Wolf\'s isotopic phenomenon

"The wolf isotopic phenomenon corresponds to the appearance of a skin disease in a place on the body that was previously affected by another, already healed dermatosis." A 35-year-old woman presented with a transversely distributed zosteriform eruption about 12 to 14 cm in length, consisting of erythematous, scaly, moderately pruritic papules on the left flank that spread to the back (does not cross the midline) for several weeks after locally healed herpes zoster (HZ) lesions. No other skin or mucosal sites were included. Routine examination of blood, urine and stool showed no abnormality. A biopsy sample was taken from one of the lesions. Histopathological examination showed typical lichen planus changes, confirming the diagnosis of post-Herpes zoster zosteriform lichen planus (ZLP). The lesions resolved after treatment with topical steroids. Zosteriform lichen planus (ZLP) is an example of a Wolf isotopic phenomenon appearing after HZ at the same site. The exact pathogenesis of ZLP is unknown, it is assumed that persistent viral proteins could be responsible for the hypersensitivity reaction.

Zosteriform lichen planus as a manifestation of Wolf’s isotopic response

Background
 Wolf’s isotopic response has been described in association with malignancy, infections, and inflammatory disorders. Lichenoid tissue reactions are a rare but recognized example of this phenomenon; only 41 cases of zosteriform lichen planus exist in publication. This case adds to the minimal literature describing lichenoid inflammatory dermatosis compatible with Wolf’s isotopic response.
 
 Methods
 Literature review and case description.
 
 Results
 A man in his 30s with a history of herpes zoster presented with a pruritic rash on his left arm. Clinical and histopathological evaluation were consistent with lichen planus in the distribution of a healed herpes zoster rash. The skin lesions improved after six weeks of treatment with clobetasol 0.05% ointment twice daily.
 
 Conclusions
 The presentation of lichen planus as Wolf’s isotopic response is uncommon, but responsive to standard topical therapy.

Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term 'isotopic response' was introduced by Wolf et al. to describe 'the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease', thus appearing 'on apparently unaffected and healthy skin'. Initially, the term was mainly related to herpes zoster, but today the name 'Wolf's isotopic response' is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea or varicella. For obvious reasons, such triggering factors cannot be taken as examples of 'unaffected and healthy skin'. Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a 'vulnerable area'. In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an 'isotopic response'. They now included 'scars, pigment changes, color changes or various other minimal changes by the first disease'. Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but 'Wolf's isotopic response'. In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the 'isotopic response' should today be taken as a historical error.

Zosteriform Lichen Planus Without the Presence of Isomorphic or Isotopic Response: de novo Eruption

Observation: Lichen planus (LP) is a condition of unknown etiology which has many clinical variants. We report a case of zosteriform LP, on the left head and neck region of a 32-year-old man, without any data of a previous history of trauma or healed herpes zoster lesions on the involved site.

Post herpes-zoster scar sarcoidosis with pulmonary involvement

Cutaneous sarcoidosis presents with a wide range of clinical presentations. An uncommon cutaneous manifestation is infiltration of old cutaneous scars with non-caseating granulomas known as scar sarcoidosis. Most of the patients with this clinical entity have other systemic manifestations, particularly pulmonary changes. We report a case of a 50 years old man, presenting with cutaneous sarcoidosis overlying scars of healed herpes zoster.

A prodigious lichen planus pigmentosus: The wolf's isotopic response

Lichen planus is a pruritic, benign, papulosquamous, inflammatory dermatosis of unknown etiology that affects either or all of the skin, mucous membrane, hair and nail. In its classic form, it presents with violaceous, scaly, flat-topped, polygonal papules. A female patient aged 43 years with a history of pruritic eruptions for a period of one month over the right armpit and back of the right chest (C8, T1, T2, T3 Dermatomes). She had a history of herpes zoster in the same localization, which had been treated with topical and oral acyclovir two months prior to this visit. This variant may represent as an example of the Wolf's isotopic response. We presented our case because of its rarity as a Dermatomal distribution of lichen planus pigmentosus (LPP) and its appearance in the area of healed herpes zoster as an isotopic response. The case well highlights this unusual condition and represents the first case reported in Indian dermatology literature to our best of knowledge. The clinical and histological features of this case are described here.

Appearance of perforating necrobiosis lipoidica at the site of healed herpes zoster: Wolf's isotopic response

Appearance of perforating necrobiosis lipoidica at the site of healed herpes zoster: Wolf's isotopic response

Granulomatous reaction at the site of healed herpes zoster in a patient with adult T-cell leukemia/lymphoma

Granulomatous reaction at the site of healed herpes zoster in a patient with adult T-cell leukemia/lymphoma

Appearance of comedones at the site of healed herpes zoster: Wolf’s isotopic response

International Journal of DermatologyVolume 50, Issue 5 p. 633-634 Correspondence Appearance of comedones at the site of healed herpes zoster: Wolf’s isotopic response Maria Pilar Sanchez-Salas MD, Maria Pilar Sanchez-Salas MD Medical Doctor Dermatology Department Hospital of Barbastro SpainSearch for more papers by this author Maria Pilar Sanchez-Salas MD, Maria Pilar Sanchez-Salas MD Medical Doctor Dermatology Department Hospital of Barbastro SpainSearch for more papers by this author First published: 20 April 2011 https://doi.org/10.1111/j.1365-4632.2009.04439.xCitations: 11 Maria Pilar Sanchez-Salas Medical DoctorDermatology Department Hospital of BarbastroBario Mato 38. 22314 Salas Altas (Huesca) SpainE-mail: [email protected] The author declares no affiliation or significant financial involvement in any organizations or entity with a direct financial interest in the subject matter or materials discussed in the manuscript. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume50, Issue5May 2011Pages 633-634 RelatedInformation

Morphea Developing at the Site of Healed Herpes Zoster

Wolf's isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed skin disease, and the most common primary skin disease of this phenomenon is herpes zoster. Several cutaneous lesions have been described to occur at the site of healed herpes zoster, and granulomatous dermatitis and granuloma annulare have been reported to be the most common second diseases. The pathogenesis of the isotopic response is still unclear. Morphea can develop at the site of regressed herpes zoster and a few such cases have been reported. We present here an additional case of morphea that developed at the site of previously healed herpes zoster, and we review the relevant literature.

Reactive perforating collagenosis with a giant lesion at the site of healed herpes zoster

Reactive perforating collagenosis with a giant lesion at the site of healed herpes zoster

Wolf's isotopic response – lichen planus at the site of healed herpes zoster in an Indian woman

Wolf's isotopic response – lichen planus at the site of healed herpes zoster in an Indian woman

Wolf's isotopic response – Furuncles at the site of healed herpes zoster in an Indian male

Wolf's isotopic response – Furuncles at the site of healed herpes zoster in an Indian male

A Case of Post-zoster Eosinophilic Dermatosis

Post-zoster eosinophilic dermatosis is a rare disease that occurs as an isotopic response in the region of previously healed herpes zoster. We report here on a case of post-zoster eosinophilic dermatosis that occurred 13 years after an episode of herpes zoster. A 48-year-old woman presented with several pruritic, brown papules and plaques in the same dermatome where her previous episode of herpes zoster had healed. Histopathologically, there was a dermal inflammatory cell infiltration composed of abundant eosinophils, lymphocytes and histiocytes. Based on these clinicopathologic findings, the patient was diagnosed with post-zoster eosinophilic dermatosis.

Wolf's isotopic response: zosteriform morphea appearing at the site of healed herpes zoster in a HIV patient

Wolf's isotopic response: zosteriform morphea appearing at the site of healed herpes zoster in a HIV patient

Tufted angioma in site of healed herpes zoster: isotopic response

Clinical and Experimental DermatologyVolume 31, Issue 5 p. 714-715 Tufted angioma in site of healed herpes zoster: isotopic response C. Y. Kim, C. Y. Kim Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorY. H. Nam, Y. H. Nam Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorG. D. Kim, G. D. Kim Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorC. W. Oh, C. W. Oh Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this author C. Y. Kim, C. Y. Kim Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorY. H. Nam, Y. H. Nam Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorG. D. Kim, G. D. Kim Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this authorC. W. Oh, C. W. Oh Department of Dermatology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University and Hospital, Jinju, Korea; and Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan, Korea E-mail: cheewon@hotmail.comSearch for more papers by this author First published: 16 June 2006 https://doi.org/10.1111/j.1365-2230.2006.02187.xCitations: 13 Conflict of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue5September 2006Pages 714-715 RelatedInformation

Wolf’s isotopic response: Rosacea appearing at the site of healed herpes zoster

A 40-year-old man developed an erythematous rash on the right side of his face 3 weeks after a herpes zoster infection at the same location. Examination revealed an erythematous papular eruption and telangiectasias along the ophthalmic and maxillary divisions of the right trigeminal nerve, exactly at the site of the consistent with previous herpes zoster infection, Wolf's isotopic response. Histological examination showed vascular ectatic dilatation and perivascular and perifollicular infiltration of lymphocytes and histiocytes consistent with rosacea. The rash was resistant to oral doxycycline and topical metronidazole 1% cream and resolved with oral isotretinoin therapy.

Zosteriform Morphea: A New Pattern

Sir, A 21-year-old male presented with multiple brown asymptomatic plaques arranged in a zosteriform pattern, confined to the left flank of abdomen (Fig. 1) of 6 months’ duration. There was no history of herpes zoster affecting the same location. His general physical and systemic examinations were within normal limits. Cutaneous examination revealed a 3–6 cm wide zosteriform band composed of brown, indurated, depressed plaques confined to the left half of the chest extending from the sternum anteriorly to the vertebral column on the back with a strict midline demarcation (Fig. 1). There was no erythema in and around the lesions. Clinical diagnosis of zosteriform morphea was made. Routine baseline investigations including complete blood cell count, ESR, clinical chemistry and urinalysis were normal. Serology for antinuclear antibodies and varicella-zoster virus was negative. Skin biopsy revealed an atrophic epidermis with flattening of rete ridges. The dermal collagen bundles were increased, thickened and hyalinized. The number of cutaneous appendages was reduced. The findings were consistent with the diagnosis of morphea. The lesions were treated with topical twicedaily application of mometasone furoate 0.1% cream. There was marked softening of the lesion within 6 months. There was no increase or appearance of new lesions during this period. Morphea is a disorder of unknown cause characterized by localized sclerosis of the skin. The condition is subdivided clinically into the following types: circumscribed plaques or bands, linear morphea or frontoparietal lesions (en coup de sabre), with or without hemiatrophy of the face. Usually, the lesions appear spontaneously, without any specific precipitating factors, but lesions have followed chickenpox, BCG vaccination, radiotherapy and injury and have developed in a hypoplastic breast (1). In the paediatric age group the linear lesions predominate, especially on the limbs; however, the zosteriform pattern of morphea has not been reported. Wakelin et al. (2) described a 53year-old man who had a 12-year history of unilateral idiopathic atrophoderma of Pasini and Pierini (IAPP) affecting the left side of his trunk in a zosteriform distribution. Within these clinically atrophic lesions, there were localized areas of induration which were typical of morphea. Histologically, both these lesions are indistinguishable. However there were no atrophic lesions suggestive of IAPP in our patient. The phenomenon of occurrence of a new skin disease at the site of another, unrelated, and already healed skin disease has been termed as ‘isotopic response’ by Wolf et al. (3). A number of skin diseases, including morphea appearing at the site of a previously healed herpes zoster, have been described (4). But there was no evidence of herpes zoster in this patient clinically or after serological investigations. A wide variety of skin diseases including lichen planus (5), porokeratosis (6), fungal infections (7), naevus (8), cutaneus malignancies (9–11) and skin metastases (12) have been reported to occur in a ‘zosteriform’ pattern. This term has been used to describe a dermatomal distribution of lesions as well as in cases actually resembling herpes zoster clinically (7, 10). The present case illustrates that morphea can occur in zosteriform pattern without any evidence of preceding herpes zoster.