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

A crack in the armor: Wolf isotopic response manifesting as cutaneous lupus

“…However, despite the growing number of reports, the pathogenesis behind Wolf isotopic response remains uncharacterized. Current theories propose viral, immunologic, neural, vascular, and multifactorial etiologies for the isotopic response, supporting the concept of dermatologic locus minoris resistentiae, in which a congenital or acquired altered defense capacity causes a region of the skin to be more vulnerable to infection, malignancy, and inflammatory diseases [1,8].…”

Nonisomorphic and nonisotopic multidermatomal discoid lupus erythematosus – A rare subtype of cutaneous lupus erythematosus

“…In all these cases, lesions of DLE were noted over a particular dermatome at the site of healed herpes zoster in patients who had already been suffering from SLE. [ 4 5 6 ] This phenomenon has been described as an isomorphic or isotopic response[ 4 5 6 ] and the proposed mechanisms include altered immunity, neuronal damage, or vulnerable connective tissue as a result of varicella zoster viral infection. [ 6 ] Our case presented with multiple violaceous plaques involving right mandibular and submandibular region suggestive of V3 (mandibular division of trigeminal nerve) and C3 dermatome.…”

“…[ 4 5 6 ] This phenomenon has been described as an isomorphic or isotopic response[ 4 5 6 ] and the proposed mechanisms include altered immunity, neuronal damage, or vulnerable connective tissue as a result of varicella zoster viral infection. [ 6 ] Our case presented with multiple violaceous plaques involving right mandibular and submandibular region suggestive of V3 (mandibular division of trigeminal nerve) and C3 dermatome. We report this unique case of DLE on account of its de novo, multi dermatomal presentation with no history of pre-existing dermatosis, or trauma at the site of lesions and without any evidence of systemic involvement.…”

“…[ 3 ] Dermatomal involvement in DLE is rare and that too has been reported in patients of systemic lupus erythematosus (SLE) at site of healed herpes zoster either as an isomorphic or isotopic phenomenon. [ 4 5 6 ] Here, we report a case of DLE on account of its unusual morphology, de novo multidermatomal configuration, without previous episode of herpes zoster or trauma.…”

Multiple granuloma annulare lesions presenting simultaneously with herpes zoster infection: Wolf's isotopic response

“…To the Editor: We read with great interest the case reported by Storer et al 1 in the November 2016 issue of JAAD Case Reports that described a 56-year-old white woman with a 20-year history of systemic lupus erythematosus who had non–photo-exposed initial cutaneous manifestation of lupus within a dermatome previously affected by zoster. In this patient, the cutaneous lupus lesions appeared 1 year after herpes zoster infection.…”