Cutaneous T-cell lymphoma sparing resolving dermatomal herpes zoster lesions: an unusual phenomenon and implications for pathophysiology

Twersky, Joy M.; Nordlund, James J.

doi:10.1016/j.jaad.2003.12.027

Cited by 23 publications

(21 citation statements)

References 19 publications

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“…For example, some of the numerous reports of zosteriform metastases published in the literature 61-63 might well be typical cases of Wolf's post-herpetic response subsequent to asymptomatic shingles (so-called 'zoster sine herpete', from Latin, meaning zoster without herpes). 58 Alongside the cases of post-herpetic isotopic response, there are also reports of widespread skin disorders (contact dermatitis, 64 cutaneous T-cell lymphoma, 65,66 Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) 66 ) which spared precisely the cutaneous areas that had been the herpes zoster site. These interesting observations, apparently the opposite of Köbner phenomenon (Renbök phenomenon) [34][35][36] and of the isotopic response (thus named isotopic nonresponse by Wolf et al 38 ), show that cutaneous areas previously affected by herpes zoster but healed behave in an unpredictable manner with the passing of time.…”

Section: Herpes-infected Sites (Wolf's Isotopic Response)mentioning

confidence: 99%

“…These interesting observations, apparently the opposite of Köbner phenomenon (Renbök phenomenon) [34][35][36] and of the isotopic response (thus named isotopic nonresponse by Wolf et al 38 ), show that cutaneous areas previously affected by herpes zoster but healed behave in an unpredictable manner with the passing of time. In particular, in these sites, the immune balance seems to be generically compromised, either defectively (which could be deduced by the secondary appearance of malignancies, viral and fungal infections or by the local absence of an elsewhere diffused contact dermatitis 64 or SJS/TEN 66 indicating a reduction of immunity) or excessively (as proven by the secondary occurrence of lichen planus, lichen-type reactions, graft-versus-host disease, contact dermatitis 38 or by the local absence of an elsewhere diffused cutaneous T-cell lymphoma 65,66 indicating an induction of immunity). The immunocompromised district…”

Section: Herpes-infected Sites (Wolf's Isotopic Response)mentioning

confidence: 99%

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The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

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Systemic immunodeficiency is known to facilitate the onset of opportunistic infections, tumours and immune disorders in any district of the body. There are clinical events, such as chronic lymphoedema, herpetic infections, vaccinations and heterogeneous physical injuries which can selectively damage and immunologically mark the cutaneous district they act upon. After the causing event has disappeared, the affected district may appear clinically normal, but its immune behaviour is often compromised forever. An immunocompromised district becomes a site which is particularly susceptible to subsequent outbreaks of opportunistic infections, tumours and immune disorders confined to the district itself. In this review, there is an ample case-report collection of opportunistic disorders (infectious, neoplastic, immune) which appeared in immunocompromised districts. The cases have been grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphoedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns and traumas. Whatever the immunocompromising factor, a common denominator which facilitates the occurrence of tumours, infections and dysimmune reactions in an immunocompromised district may reside in locally hampered lymph drainage and/or locally altered neuromediator signalling. In fact, any obstacle to the normal trafficking of immunocompetent cells through lymphatic channels or any interference with the signals that the neuropeptides and neurotransmitters released by peripheral nerves send to cell membrane receptors of immunocompetent cells, can significantly alter the local immune response, thus paving the way for heterogeneous opportunistic disorders in the immunocompromised district.

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Section: Herpes-infected Sites (Wolf's Isotopic Response)mentioning

confidence: 99%

Section: Herpes-infected Sites (Wolf's Isotopic Response)mentioning

confidence: 99%

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

View full text Add to dashboard Cite

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“…Ampicillin and clotrimaxazole-trimethopim were the most noted culprits [2,3,9]. An area subjected to herpes zoster was the often resistant site for the many diseases including leprosy and CTCL [10][11][12][13]. Psoriasis sparing an area of alopecia areata and previously irradiated site was found in three occasions and non occurrence of drug reaction and CTCL in an area exposed to ultra violet light (swimming suit sparing) were documented in two instances [3][4][5]14,15].…”

Section: Literature Review and Summarymentioning

confidence: 99%

“…Irradiation has been reported to induce loss of Langerhans cell and other immunological changes in the subjected skin [18]. Reduction of Langerhans cell number and it's activity in herpes zoster lesion and their peripheral area has recently been documented by Katayama et al and Nikkles et al [10,12,13]. This abnormality in Langerhans cell number could influenced drug reaction, allergic contact dermatitis and CTCL didn't occur in the area affected by irradiation and herpes zoster.…”

Section: Cellular Alterationsmentioning

confidence: 99%

The Sparing Phenomenon. A case series of the inverse Koebner and related phenomena

Kannangara¹,

Fleischer²,

Yosipovitch³

2013

Our Dermatol Online

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Introduction:The sparing of the involvement of a cutaneous disease in a site that has been previously subjected to a skin disease, congenital nevus or physical insult has been reported in literature by various names, including the inverse Koebner phenomenon. Objectives: To review cases that we have seen and to document the reported cases and unify them with a single term, the "Sparing phenomenon". Materials and Methods:We report four new examples of this phenomenon and performed a PubMed literature search on related search terms and summarized the reported cases. Results: We report four new cases of this phenomenon. An additional 16 reported cases of the sparing phenomenon were identified. Herpes zoster was the most reported inflammatory disease site followed by; skin irradiation was the commonly documented physical insult. Drug reactions and psoriasis were the most common diseases that spare these sites. The time gap between first and second insult was highly variable. Conclusions: We proposed the term "Sparing phenomenon" to describe the skin disease sparing on an area which was previously subjected to skin disease or physical insult. By introducing this new term to the dermatology glossary, it would be easy to collect and analysis to understand the immuno-pathophsiology of this skin reaction described in various names.

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“…Various hypotheses have tried to explain the pathophysiology of this phenomenon, claiming structural or microenvironmental changes in the spared skin. Knowing the diversity of conditions implicated in the different cases reported (table 1) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32], the mechanisms implicated might be multiple and complex.…”

Section: Introductionmentioning

confidence: 99%

The ‘Sparing Phenomenon' of Purpuric Rash over Tattooed Skin

Pinal‐Fernandez

Soláns-Laqué²

2013

Dermatology

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Cutaneous complications associated with decorative tattooing are well known. However, the inhibition of a purpuric reaction by a tattoo is a fact that, as far as the authors know, has not been described before, fitting the definition of a ‘sparing phenomenon', the absence of manifesting a particular skin disease in an area previously affected by another condition. From the clinical observation of purpuric lesions apparently inhibited by a tattoo in a 26-year-old patient, we performed an exact binomial test on the observed and expected proportion of purpuric lesions inside (0%, 95% confidence interval, CI, 0-2.6%) and outside (100%, 95% CI 97.4-100%) the tattooed skin, demonstrating a nonrandom distribution respecting the tattooed area (p < 0.001) and identifying the composition of the ink used in the tattoo (color pigment, glycerine, Hamamelis virginiana extract, water and alcohol). Moreover, we reviewed the cases of sparing phenomenon described in the literature. In conclusion this is the first report of a sparing phenomenon of purpuric lesions over tattooed skin.

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Cutaneous T-cell lymphoma sparing resolving dermatomal herpes zoster lesions: an unusual phenomenon and implications for pathophysiology

Cited by 23 publications

References 19 publications

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

The Sparing Phenomenon. A case series of the inverse Koebner and related phenomena

The ‘Sparing Phenomenon' of Purpuric Rash over Tattooed Skin

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