SIGNIFICANCEWolf's isotopic response (WIR) is widely accepted as a clinical concept. Twenty-four new patients presented with WIR after herpes zoster were enrolled in this study including first described disease. Based on the mini literature review and histopathological study in this study, we tend to a hypothesis that WIR caused by neuro-immune impairment and propose a classification method based on pathological findings, the epidermal and follicular changes, dermal tissue changes, inflammatory infiltrations and malignant invasions in WIR. Through the study in this paper, clinicians are reminded to be aware of this phenomenon, especially the possibility of associated tumorous diseases.Wolf's isotopic response refers to the occurrence of a new skin disease at the exact site of an unrelated skin disease that had previously healed. Various cutaneous lesions have been described after herpes zoster. This study included 24 patients with Wolf's isotopic response after herpes zoster infection, which presented as manifestations ranging from inflammatory disease to carcinoma. Histopathological examinations in 12 patients and immunohistochemical analyses in 10 patients allowed exploration of secondary microscopic changes in the lesions. CD4 + /CD8 + T-cell ratios were normal and infiltrating cells included mast cells, eosinophils, and tumour cells. Our study has described additional patients with confirmed Wolf's isotopic response following herpes zoster infection; moreover, it has extended the spectrum of Wolf's isotopic response to include impetigo. We suggest Wolf's isotopic response classification categories for herpes zoster-associated Wolf's isotopic response. Additionally, clinicians should consider the possibilities of different diseases in Wolf's isotopic response, especially malignancies. ActaDV ActaDV Advances in dermatology and venereologyActa Dermato-Venereologica T. Wang et al. 954 www.medicaljournals.se/acta ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica T. Wang et al. 956 www.medicaljournals.se/acta ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica T. Wang et al. 958