2014.2-11.HZ

HERPES ZOSTER ON SEGMENTAL VITILIGO: ISOTOPIC RESPONSE?

Mankesh Lal Gambhir, Kritika Pandey, Tejinder Kaur

Corresponding author:  Ass. Prof. Mankesh Lal Gambhir    e-mail: drmlgambhir@gmail.com

How to cite an article: Gambhir ML, Pandey K, Kaur T. Herpes zoster on segmental vitiligo: Wolf’s isotopic response? Our Dermatol Online. 2014; 5(2): 155-156.

Abstract

“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 of isotopic response, the initial dermatosis is herpes zoster, herpes simplex, varicella, thrombophlebitis, scrofuloderma and striae distense. The most frequent second dermatoses are granulomatous reactions, particularly granuloma annulare, and lichenoid diseases. Various etiological reasons including viral, immunologic, neural and vascular have been put forth. We report here a case in which the second disease was herpes zoster that appeared over the same dermatomes of pre-existing segmental vitiligo. The occurrence of vitiligo as first and herpes zoster as second disease in the “Wolf’s isotopic response” has not, to the best of our knowledge, been reported previously. .

 

Key words:  vitiligo; herpes zoster; isotopic response

---

Introduction

“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 of isotopic response, the initial dermatosis is herpes zoster, herpes simplex, varicella, thrombophlebitis, scrofuloderma and striae distense. The most frequent second dermatoses are granulomatous reactions, particularly granuloma annulare, and lichenoid diseases. Various etiological reasons including viral, immunologic, neural and vascular have been put forth. We report here a case in which the second disease was herpes zoster that appeared over the same dermatomes of pre-existing segmental vitiligo. The occurrence of vitiligo as first and herpes zoster as second disease in the “wolf’s isotopic response” has not, to the best of our knowledge, been reported previously.

 

Case Report

A 56 year old female presented with a two day history of multiple vesicular lesions with burning pain at the site of depigmented patches of vitiligo of 8 years duration of the same region. On examination there were grouped vesicles distributed in a dermatomal fashion over the right mid thoracic region (T5-T6). On the background were the depigmented patches of segmental vitiligo involving T2-T6 thoracic dermatome (Fig 1). A clinical diagnosis of herpes zoster with segmental vitiligo of the same dermatome was made. Tzanck smear showed multinucleated giant cells. Routine investigations were normal. Oral acyclovir tablets 800mg five times daily were given for 7 days. The lesions healed completely within two weeks, with minimal scarring.

 

Figure 1. Herpes Zoster over segmental vitiligo: isotopic phenomenon.

Discussion

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 [1]. It is important that the primary disease should have healed before the onset of the subsequent disease for it to be labeled as an isotopic response, to avoid mistaking it for reactivation of the primary disease, especially if the subsequent disease arise immediately [2]. In most cases of isotopic response, the initial dermatosis is herpes zoster [1], herpes simplex [3], varicella [3], thrombophlebitis [3], scrofuloderma [4] and striae distense [5]. The most frequent second dermatoses are granulomatous reactions, particularly granuloma annulare, and lichenoid diseases. Others are comedones and acneiform eruptions, tinea, furunculosis, contact dermatitis, nodular solar degeneration, morphea, graft-versus-host disease, eosinophilic dermatosis, reactive perforating collagenosis, lymphomas and leukemias, Kaposi sarcoma, angiosarcoma, vitiligo, basal cell carcinomas, squamous cell carcinomas and viral infections such as molluscum contagiosum or common warts. 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 [1]. It is important that the primary disease should have healed before the onset of the subsequent disease for it to be labeled as an isotopic response, to avoid mistaking it for reactivation of the primary disease, especially if the subsequent disease arise immediately [2]. In most cases of isotopic response, the initial dermatosis is herpes zoster [1], herpes simplex [3], varicella [3], thrombophlebitis [3], scrofuloderma [4] and striae distense [5]. The most frequent second dermatoses are granulomatous reactions, particularly granuloma annulare, and lichenoid diseases. Others are comedones and acneiform eruptions, tinea, furunculosis, contact dermatitis, nodular solar degeneration, morphea, graft-versus-host disease, eosinophilic dermatosis, reactive perforating collagenosis, lymphomas and leukemias, Kaposi sarcoma, angiosarcoma, vitiligo, basal cell carcinomas, squamous cell carcinomas and viral infections such as molluscum contagiosum or common warts.

 

REFERENCES

1. Wolf R, Brenner S, Ruocco V, Filioli FG. Isotopic response. Int J Dermatol. 1995;34:341–8.

2. Huang CW, Tu ME, Wu YH, Lin YC. Isotopic response of fungal granuloma following facial herpes zoster infections – report of three cases. Int J Dermatol. 2007;46:1141–5.

3. Requena L, Kutzner H, Escalonilla P, Ortiz S, Schaller JS, Rohwedders A. Cutaneous reactions at sites of herpes zoster scars: an expanded spectrum. Br J Dermatol. 1998;138:161-8.

4. Sharma RC, Sharma NL, Mahajan V, Sharma AK. Wolf’s isotopic response: Herpes simplex appearing on scrofuloderma scar. Int J Dermatol. 2003;42:664–6.

5. Thappa D. Isotopic response versus isomorphic response. Indian J Dermatol Venereol Leprol. 2004;70:36.

6. Jaka-Moreno A, López-Pestaña A, López-Núñez M, Ormaechea- Pérez N, Vildosola-Esturoa S, Tuneu-Valls A, et al. Wolf’s Isotopic Response: A Series of 9 Cases. Actas Dermosifiliogr. 2012;103:798- 805.

7. Tuzun Y, Iscimen A, Goksugur N. Wolf’s isotopic response: Trichophyton rubrum folliculitis appearing on a herpes zoster scar. Int J Dermatol. 2000;39:766–8.

8. Sharma RC, Sharma NL, Mahajan V, Sharma AK. Wolf’s isotopic response – lichen planus at the site of healed herpes zoster in an Indian woman. Int J Dermatol. 2003;42:664–6.

9. Gibney MD, Nahass GT, Leonardi CL. Cutaneous reactions following herpes zoster infection: report of three cases and a review of literature. Br J Dermatol. 1966;134:504-9.

10. Shemer A, Weiss G, Trau H. Wolf’s isotopic response: a case of zosteriform lichen planus on the site of healed herpes zoster. J Eur Acad Dermatol Venereol. 2001;15:445-7.