Immunocompromised Districts of Skin: A Case Series and a Literature Review

Abstract

BACKGROUND:The concept of immunocompromised districts of skin has been developed by Ruocco and helps to explain certain aspects of the macromorphology of skin diseases. This concept unites the isomorphic response of Koebner and the isotopic response of Wolf.CASE REPORTS:We present different cutaneous conditions which can lead to immunocompromised districts of skin such as scars, radiodermatitis, lymphedema, disturbed innervation or mechanical friction etc. Typical and rarer skin disorders associated with them are discussed and illustrated by their observations.CONCLUSION:At this moment, we wish to inform dermatologists and non-dermatologists about Ruocco’s concept and its implications.

Angiosarcoma of the Auricle in a Patient with Xeroderma Pigmentosum Variant

“…Generally, skin angiosarcoma arises more commonly in sun-exposed areas, but may also occur as a result of trauma, lymphedema, and radiation exposure. These common sites of skin angiosarcoma correspond roughly to the so-called immunocompromised districts described by Ruocco et al [13], who considered that they represent areas of peculiar vulnerability to tumors, infections and immune disorders in cutaneous regions that have been affected by chronic lymphoedema, herpetic infections or other heterogeneous forms of injury, such as vaccinations, UV or ionizing radiation, thermal burns, and traumas [13,14]. After the causes of these events have disappeared, the affected district may appear clinically normal, but its immune status is often permanently compromised.…”

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].…”

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].…”

“…It describes a site of regional neuroimmunocutaneous destabilization of skin secondary to chronic lymphoedema, paraplegia, infections, or trauma. The concept of an immunocompromised district unites the different phenomenon such as the isomorphic response of Koebner and the isotropic response of Wolf [140,141].…”