Discoid chronic lupus erythematosus at the site of a previously healed cutaneous leishmaniasis: an example of isotopic response

Abstract

The term "isotopic response" describes the occurrence of a new skin disorder at the site of another, unrelated and already healed one. We report here the case of a 38-year-old woman who referred to us for an infiltrated, red-brownish plaque localized on her left cheek. The patient had been treated for a cutaneous leishmaniasis, confirmed by the histologic examination, localized at the same site. She was completely healed after an appropriate local and systemic treatment. She experienced the occurrence of the new plaque at the site of the previously healed cutaneous leishmaniasis three month later. Histologic examination and laboratory tests were consistent with a diagnosis of discoid cutaneous chronic lupus erythematosus. Treatment with hydroxychloroquine, topical clobetasol and topical tretinoin resulted in flattening and clearing of the lesion. Our case is the first case of isotopic response where a discoid chronic lupus erythematosus had occurred at the site of an already healed cutaneous leishmaniasis. We speculate that the activation of type-1 interferon system may be involved in the pathogenesis of our case.

Cutaneous Lupus After Herpes Zoster: Isomorphic, Isotopic, or Both?

“…Theories underlying the pathogenesis behind Wolf’s isotopic response resembles much of the theory behind the Koebner phenomenon, with an inflammatory and autoimmune component resulting after a localized cutaneous trauma, although with the isotopic response, there may also be a neural, vascular, and viral component that explains its association with the herpes infection (19). Although cutaneous lupus has not been reported to have exhibited Wolf’s response after a herpes zoster infection, there has been report of a isotopic reaction with discoid chronic lupus erythematosus at the site of a previously healed cutaneous leishmaniasis lesion (20). Our patient had a preceding diagnosis of SLE with subsequent eruption of a new cutaneous lupus rash within the site of her prior herpes zoster lesion, making her presentation more consistent with the Koebner isomorphic response, although one could argue that our patient’s findings can be classified as an isotopic and an isomorphic reaction.…”

Wolf’s Isotopic Response after Herpes Zoster Infection: A Study of 24 New Cases and Literature Review

“…Although these patients differed from each another in clinical and pathological diagnoses, obvious epidermal changes, such as hyperkeratosis, follicular plug, atrophy of stratum spinosum, or psoriatic hyperplasia showed that epidermal and follicular changes are common in WIR skin. In addition to the diseases mentioned above with skin and hair follicle changes, there have been diseases reported in the literature with the above manifestations, such as lupus erythematosus (23,24), granulomatous folliculitis (5,25), acquired perforating folliculitis (26), Trichophyton rubrum folliculitis (27), epidermal cyst (28), giant lichenification (29), poliosis (30), and molluscum contagiosum (31). As we noted above, we propose that the local network of nerve fibres is destroyed after VZV infection.…”

Nonphoto-exposed initial cutaneous manifestation of lupus after zoster: A case of Wolf's isotopic reaction

“…Cases of systemic lupus erythematosus and discoid lupus have been reported after herpes zoster infections in a dermatomal distribution 5, 6. Despite a 20-year history of systemic lupus, the only lupus-related skin findings that the patient experienced were nonphoto-exposed and within the dermatome previously affected by zoster.…”