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

Abstract

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

A New Skin Manifestation at the Site of a Previously Healed Dermatosis: A Case of Wolf’s Isotopic Response

“…Therefore, the comparable pathophysiology between WIR and HZV proposes a possible link between the two conditions. The latency and time intervals between primary and secondary dermatosis can range from a few weeks to months, to years which may be due to a type III or IV hypersensitivity reactions [ 4 , 9 ]. A variety of skin conditions have been reported to present at the initial site of healed HZV such as lichenoid dermatitis, granulomatous reactions, skin tumors, psoriasis, and infections [ 10 ].…”

“…A variety of skin conditions have been reported to present at the initial site of healed HZV such as lichenoid dermatitis, granulomatous reactions, skin tumors, psoriasis, and infections [ 10 ]. Recent literature reveals more cases presenting with underlying malignancies [ 9 - 10 ]. Although a biopsy was not obtained in this case, its indication could help to identify the histopathological pattern of the second dermatosis as well as to rule out the infiltration of hematologic malignancies [ 10 - 11 ].…”

First case of primary diffuse large B‐cell lymphoma of skin as Wolf's postherpetic isotopic response

“…The occurrence of other (cutaneous) diseases in the affected dermatome is known as isotopic or Wolf's response. 2 We report on a 77-year-old woman presenting with a zosteriform lesion on the left gluteal area. Three weeks ago, she suffered from HZ HZ bears an increased risk for lymphoid malignancy with adjusted hazard rates between 1.58 and 1.82.…”

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review

“…For several conditions, the development of a BCC at the same site as the non-neoplastic cutaneous condition is probably unrelated to the condition; it merely represents the skin cancer occurring in an immunocompromised district of skin. Indeed, the BCC at the site may result from either a Koebner isomorphic response or the sequalae of a Wolf isotopic response [135][136][137][138][139][140][141].…”

“…In the original description, the healed skin disorder was a herpesvirus infection resulting from either herpes simplex virus or varicella-zoster virus. The isotopic response observed at the site of the prior herpesvirus infection include comedonic-microcystic reactions, dysimmune reactions, granulomatous reactions, infections, leukemic or lymphomatous infiltrations, other miscellaneous conditions, and malignant solid tumors (such as basal cell carcinoma), [137][138][139].…”