Immunocompromised cutaneous district, isotopic, and isopathic phenomena—Systematic review

Abstract

Background Although the development of lesions in skin areas that have undergone injury has long been known, understanding of its pathogenesis is limited. Depending on their peculiarities, those events have been described as isomorphic, reverse isomorphic, pseudoisomorphic, isotopic, and isopathic phenomena. Ruocco's immunocompromised cutaneous district (ICD) concept was proposed to include all those phenomena. Aims We performed a systematic review and critically evaluated the current understanding about ICD and its relationship with the isotopic and isopathic phenomena. Methods To illustrate the complexity of the theme, we present a case of subclinical leprosy, whose manifestation was brisk in an old tattoo. The possible interaction between the approached phenomena, acting in the genesis of the disease, made this a pertinent study. The research was conducted under the PRISMA‐P guidelines, in seven biomedical databases between 1996 and 2018. The eligibility criteria were systematic reviews, meta‐analyses, clinical studies, and case series, written in English, French, Italian, Portuguese, or Spanish. Results Using standardized keywords, 1220 articles were identified. After applying the eligibility criteria, 53 studies were selected. Conclusion This review ratifies that all these phenomena are aspects of one single condition. They can be integrated into the ICD concept with the pathogenesis including: (a) neural damage (peripheral or central) and (b) chronic lymphedema. Both may change the local neuroimmune interaction. The identification of these phenomena and the understanding of their pathogenesis are of paramount importance, to define the diagnosis and choose the therapeutic strategy.

Cross‐reactivity between nonsteroidal anti‐inflammatory drugs in fixed drug eruption: Two unusual cases and a literature review

“…An ICD is a damaged skin area more vulnerable than the rest of the body for genetic or acquired reasons. Its vulnerability mainly consists of local dysregulation of the immune control, which often facilitates the local onset of immunity‐related eruptions or skin disorders 46,48 . Based on this concept, we suppose that the skin damage site of FDE induced by NSAIDs can be prone to develop later eruptions at the same site following unrelated drug administration.…”

Herpes zoster: A Review of Clinical Manifestations and Management

“…Specific infiltrates of chronic B-cell lymphocytic leukemia have developed in formerly HZ-affected areas [53,54]. These are examples of immunocompromised districts of skin that are at risk for the development of secondary dermatoses [55,56].…”

Onset of multiple neurofibromas in chronic lymphoedema of the lower limb

“…4 Alteration of nerves due to inflammation or trauma can influence the local immune system, through abnormal release of neuropeptides and other mediators. 5 In the present case, mast cells and/or neuropeptides in lymphedematous mucinosis in the tissue remodelling process may have induced proliferation of Schwann cells, fibroblasts, endothelial cells and mast cells, leading to the development of multiple neurofibromas.…”