Proposed classification for koebner, wolf isotopic, renbok, koebner nonreaction, isotopic nonreaction & other related phenomen.

Abstract

Students of skin diseases have long noted a variety of disease responses and non-responses to trauma and the presence of structural abnormalities. This article will review the series of these responses including: Koebner phenomenon, Wolf isotopic response, Renbök response, Koebner nonreaction, isotopic nonreaction, and other related skin reactions. Because most of these reported phenomena have similar morphological features the diagnosis is often made on the basis of differences in the clinical presentation. Note that some of the cutaneous reactions of similar phenomena have been described using varied nomenclature, further adding to the confusion. In view of this, we believe that at present there is a robust need to define each cutaneous reaction accordingly and classify the various types of these phenomena under a broad universal term or terms. Respecting the idea of differences might facilitate a better understanding of the pathophysiology of these entities. We then will propose an alternative classification system.

Could It be Wolf Isotopic Response?

“…[ 1 ] A recent classification defined the isotopic response as the occurrence of a dermatosis that develops in the same area of skin as another previously present but still active dermatosis. [ 2 ]…”

Post‐irradiation Renbok phenomenon in erythema multiforme: Report of a case sparing previously irradiated areas

“…2 In 2013 Kannangara et al proposed unifying these observations under the term 'sparing phenomenon'. 3 Here, we present a case of a man in his 40s who was referred to the department of dermatology for the evaluation of a cutaneous rash that developed 48 h before consultation. Past medical history included lung adenocarcinoma T4N2M1 under treatment with afatinib and a previous palliative treatment with radiotherapy (Dose: 15 Gy) on the dorsal vertebrae (D6-11) for bone metastatic disease 1 month before.…”

“…This uncommon clinical manifestation consists of the absence of lesions of a usually generalized dermatosis in a previously damaged skin area (due to physical or chemical damage or to a previous dermatosis). 3 This concept has been applied to illustrate different clinical settings: patients with alopecia areata sparing areas with psoriasis, 4 dermatophytosis sparing congenital nevi 5 or occasional cases of leukocytoclastic vasculitis sparing a tattoo. 6 It has also been reported in some drug eruptions, Stevens-Johnson F I G U R E 1 Case of sparing phenomenon (post-irradiation Renbok phenomenon) in a patient with erythema multiforme.…”

“…It has been hypothesized that a previous irradiation may cause a localized vascular damage, a loss of Langerhans cells or a reduction in lymphocyte antigen reactivity giving rise to a modification of the local immune response and a resistance to the development of a particular inflammatory dermatosis. 3,8 The characteristic clinical distribution of a Renbok phenomenon allows recognizing this peculiar and uncommon phenomenon.…”