Wolf's isotopic response, presenting as lichen planus

Abstract

The term "Wolf's isotopic response" describes the occurrence of a new skin disorder at the site of another unrelated and already healed skin disease. In most cases, herpes zoster is the inicial disease. Different disorders may develop on the same site, most commonly granulomatous and lichenoid reactions, infiltration of hematologic diseases, skin tumors and infections. There are few related cases of lichen planus presenting as isotopic response. We report a case of a 74 year-old woman, with multiple itchy, rose-colored and shiny papules that developed at site of previously healed herpes zoster, on the right arm and shoulder. The pathogenesis of this phenomenon is still unknown and further studies are needed.

The Isotopic Coresponse Phenomenon

“…The pathogenesis of this phenomenon is still unknown. Few cases describe this entity; we have found 4 reports in the literature [2]. Colocalization between lichen and vitiligo is very unusual, especially the hypertrophic variety.…”

“…we could not establish a relationship between the occurrence of these 2 diseases on the same site. Further studies are needed [2]. In our case, we have opted for a treatment that will act on both pathologies.…”

“…Although alteration of immunity limited to the site of the lesions can be incriminated [6]. The most common pathologies that can occur in the same site, are granulomatous and lichenoid reactions, infiltration of hematologic diseases, skin tumors and infections [2]. Only 4 cases of the isotopic co-response phenomenon are reported in the literature.…”

Annular elastolytic giant cell granuloma following herpes zoster infection

“…At the same time, other inflammatory diseases, malignancies and infections have been reported as secondary dermatosis, and they may occur in a time range that varies from days to years. 4 Actually, the term Wolf's isotopic response is not approved by all physicians and it is till matter of discussion if this phenomenon should be classified as a variant of the Koebner (isomorphic) response. 5 Its pathogenesis is currently unknown.…”