1
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R M K, Sekar M. Arriving at SKINTED (Surgery of the Knee, Injury to the Infrapatellar Branch of the Saphenous Nerve, Traumatic Eczematous Dermatitis): A Case Report. Cureus 2024; 16:e54307. [PMID: 38496181 PMCID: PMC10944648 DOI: 10.7759/cureus.54307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) is a postsurgical localized dermatitis specifically linked to total knee arthroplasty (TKA). It is due to autonomic denervation following surgically inflicted nerve injury. It develops several months to years following a surgical trauma. It is being referred to by various names in the literature. Locoregional immune dysfunction due to lymphatic injury after surgery is the currently accepted theory. It must be distinguished from atopic dermatitis, allergic contact dermatitis/sensitization induced by topical medications or implanted metal hypersensitivity dermatitis, and post-traumatic eczema/dermatitis. We present a case of an elderly female patient in her 50s with dry eczematous lesions over the lateral aspect of the surgical incision over both knees developed three months following bilateral total knee replacement (TKR) done in view of osteoarthritis. The patient responded well to topical corticosteroid and emollient treatment. We have also reviewed the literature to provide an overview of potential concepts of etiopathogenesis described in the literature and to clear up any ambiguity surrounding various labels given to this entity.
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Affiliation(s)
- KavyaDeepu R M
- Dermatology, Chettinad Hospital and Research Institute, Chennai, IND
| | - Mohnish Sekar
- Dermatology, Venereology and Leprosy, Karpaga Vinayaga Institiute of Medical Sciences and Research Centre, Chengalpattu, IND
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2
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Hsu HT, Su HA, Chen YC. Wolf's Isotopic Response following COVID-19 Vaccination. Indian J Dermatol 2023; 68:589. [PMID: 38099130 PMCID: PMC10718238 DOI: 10.4103/ijd.ijd_414_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Hui-Te Hsu
- From the Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail:
| | - Hsuan-An Su
- From the Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail:
| | - Yu-Chia Chen
- From the Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail:
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3
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Wang J, Shen H. Keloids After Herpes Zoster: Report of Wolf's Isotopic Phenomenon and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2129-2133. [PMID: 37581010 PMCID: PMC10423577 DOI: 10.2147/ccid.s421534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
Wolf's isotopic response (WIR) refers to the appearance of a new skin disorder at the exact site of an unrelated skin disorder that had previously been cured. The most common primary skin disease in which WIR occurs is herpes zoster. Despite numerous theories being put forward to explain this occurrence, including viral, vascular, immunological, and neurological hypotheses, the pathogenesis of WIR after herpes zoster remains unclear. We report the case of a 76-year-old patient who presented with keloids at the site of the original herpes zoster. Based on this observation and a review of the literature, The clinical characteristics and possible theoretical reasons for keloids after herpes zoster will be discussed.
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Affiliation(s)
- Jian Wang
- Department of Dermatology, Zhejiang Province Dermatology Hospital, Huzhou City, Zhejiang Province, 313200, People’s Republic of China
| | - Huiliang Shen
- Department of Dermatology, Zhejiang Province Dermatology Hospital, Huzhou City, Zhejiang Province, 313200, People’s Republic of China
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4
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Xv L, Wang B, Zhu Q, Zhang G. A Case of Isotopic Response Presented with Eosinophilic Pustular Folliculitis. Clin Cosmet Investig Dermatol 2023; 16:1749-1752. [PMID: 37441695 PMCID: PMC10335306 DOI: 10.2147/ccid.s415322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
This is a 58-year-old woman who has had itching on her right back for 10 days; a month ago she developed blisters on her right back with no apparent cause and pain, and was diagnosed with "herpes zoster". Erythema and blisters with itching reappeared 10 days ago on the right side of the back, where the original blisters had subsided. The histopathological manifestations of the lesions were: mild hyperkeratosis of the epidermis, pustules within the stratum corneum, irregular proliferation of the spinous layer, spongiosis, local destruction of the basal layer, infiltration of eosinophils, neutrophils, histiocytes and scattered plasma cells in the dermis and subcutis. According to the medical history, clinical manifestations and histopathology of the lesions, the diagnosis was Wolf's isotopic response after herpes zoster.
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Affiliation(s)
- Lulu Xv
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qing Zhu
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoqiang Zhang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
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5
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Suzuki R, Numata T, Hiruma J, Maeda T, Tsuboi R, Harada K. Wolf's isotopic response after tinea corporis caused by Microsporum canis. J Dermatol 2023; 50:e159-e161. [PMID: 36606296 DOI: 10.1111/1346-8138.16685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Risa Suzuki
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Takafumi Numata
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Junichiro Hiruma
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Maeda
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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6
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Esfandiari N, Benson P, Morley K. Wolf's isotopic response: A case of dermatomal granuloma annulare after COVID-19 vaccination. JEADV CLINICAL PRACTICE 2022; 2:JVC290. [PMID: 38607911 PMCID: PMC9877862 DOI: 10.1002/jvc2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 04/14/2024]
Abstract
The SARS-CoV-2 pandemic was announced in March 2020, with the first vaccines becoming available later that year. Although generally well tolerated, there have been reports of skin reactions occurring after receiving COVID-19 vaccines, with a rare occurrence of granuloma annulare. Granuloma annulare can occur secondarily to herpes zoster infection in a phenomenon known as Wolf's isotopic response (WIR). WIR has been described to often occur after herpes zoster virus infection, at the location of the healed shingles rash, termed 'post-herpetic isotopic response' (PHIR). We present the first reported case of PHIR with granuloma annulare after the Moderna COVID-19 vaccination series. This reported reaction should not limit receipt of the COVID-19 vaccine, but awareness of this association can minimise additional work-up and treatment.
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Affiliation(s)
- Negar Esfandiari
- Division of DermatologyThe University of Vermont Medical CenterBurlingtonVermontUSA
| | - Patrick Benson
- Department of Dermatology, InterMed, P.ASouth PortlandMaineUSA
| | - Keith Morley
- Division of DermatologyThe University of Vermont Medical CenterBurlingtonVermontUSA
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7
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Ko BC, Park HJ, Choi M. Painful Erythematous Plaques on the Trunk. JAMA Dermatol 2022; 158:689-690. [PMID: 35544122 DOI: 10.1001/jamadermatol.2022.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Byeong Chang Ko
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hai-Jin Park
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Mira Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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8
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Yang Y, Wang T. Wolf's Isotopic Response of Eosinophilic Dermatitis After Herpes Zoster Infection: Case Reports and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:211-216. [PMID: 35210799 PMCID: PMC8857948 DOI: 10.2147/ccid.s343496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
Abstract
Wolf’s post-zoster isotopic response refers to the occurrence of an unrelated new skin disorder at the same site of a healed skin lesion. Mechanism of this dermatological phenomena after herpes zoster infection remains unclear. In this study, we present three rare cases of eosinophilic dermatitis following herpes zoster infection. Erythematous infiltrative plaques or scattered red papules were found in all patients after remission of a previous herpetic infection. Skin biopsy revealed dermal perivascular eosinophilic infiltration, which was histologically confirmed as eosinophilic dermatitis. Based on the clinical timeline and histopathological characteristics, we supposed that the secondary lesion to be an isotopic response of Wolf. Skin lesion in one of the current patients overlapped with her tattoo, suggesting that tattoos might also predispose patients to post-zoster isotopic events. Topical corticosteroid was applied and all patients achieved remission. We also summarize the epidemiological, clinical and histopathological characteristics of the post-zoster eosinophilic dermatitis based on review of previous literature focusing on Wolf’s isotopic response and secondary inflammatory dermatological disorders.
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Affiliation(s)
- Yuyan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, People's Republic of China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, People's Republic of China
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9
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Molluscum Contagiosum Induced Reverse Isotopic Phenomenom. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:449-451. [DOI: 10.1016/j.ad.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
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10
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Rajaintharan S, Wu YH. Isotopic response of labetalol-associated lichen planus pemphigoides on an old radiation site: A case report. J Cutan Pathol 2021; 48:1504-1507. [PMID: 34272742 DOI: 10.1111/cup.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/21/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
Over the years, the occurrences of different types of skin disorders arising from radiation sites have been observed and studied. Examples include autoimmune blistering diseases such as pemphigus, pemphigoid, and interface or inflammatory reaction patterns such as lichen planus, lupus erythematosus, and Stevens-Johnson syndrome. The phenomenon whereby a new skin disorder arises from a previously healed or irradiated site is called an isotopic response, described as a type of Koebner phenomenon. Ionizing radiation itself can profoundly affect the skin. Both early and late changes can present, which typify the progression of changes following irradiation of the skin. Herein, we report a rare case of labetalol-associated lichen planus pemphigoides that occurred at the site treated with radiation for a soft tissue malignancy after 19 years as a result of an isotopic response. The rash was well-controlled after therapy and kept a 4-year remission. The same skin reaction recurred after the reintroduction of labetalol 4 years later.
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Affiliation(s)
- Sandhya Rajaintharan
- Department of Anatomic Pathology, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | - Yu-Hung Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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11
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Mishra E, Patnaik S, Nayak S, Rout AN, Sethukumaran AG, Sahoo RL. Psoriasis as Wolf 's isotopic response over BCG scar. Indian J Dermatol Venereol Leprol 2021; 87:712-714. [PMID: 34245529 DOI: 10.25259/ijdvl_100_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Ekta Mishra
- Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Odisha, India
| | - Satyadarshi Patnaik
- Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Odisha, India
| | - Surajit Nayak
- Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Odisha, India
| | - Arpita Nibedita Rout
- Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Odisha, India
| | - Anjaly G Sethukumaran
- Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Odisha, India
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12
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Munir S, Abu-Jubara D, Abu-Jubara M, Antypas C, Petro-Sakuma C. A New Skin Manifestation at the Site of a Previously Healed Dermatosis: A Case of Wolf's Isotopic Response. Cureus 2020; 12:e11381. [PMID: 33312782 PMCID: PMC7723431 DOI: 10.7759/cureus.11381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Wolf's isotopic response (WIR) is an uncommon phenomenon that refers to the occurrence of a new skin condition at the location of a previously healed dermatosis. We describe an unusual manifestation of bacterial furunculosis which arose as an isotopic response following a herpes zoster episode. The initial skin disease in most cases is herpes zoster and the isotopic response is a granulomatous reaction. A 65-year-old female with a history of chronic lymphocytic leukemia (CLL) and currently on chemotherapy regimen presented with a pustular skin rash on the posterior scalp extending to the posterior right neck and shoulder. Prior to this presentation, the patient was treated for three weeks with valacyclovir for herpes zoster infection which improved her skin condition. During the current hospitalization, the patient's wound cultures from the pustule revealed the growth of methicillin-resistant Staphylococcus aureus (MRSA). Although the patient was on immunosuppressive therapy, her white blood cell (WBC) count increased to 9.9 x 103/μL. After receiving vancomycin and valacyclovir, her cutaneous condition eventually improved. She was transitioned to oral clindamycin and discharged to a rehabilitation facility. This case describes an immunocompromised patient who was treated for herpes zoster, improved after treatment, and then developed MRSA furunculosis at the same site. It is of significance to report such manifestations, especially in immunocompromised patients, as it could be underdiagnosed. It is also important to inquire about the patients' herpes-related medical history because herpes is the most common initial dermatosis reported in the literature. In such cases of suspected WIR, it is vital to obtain a biopsy before starting treatment with antiviral medication to rule out the possibility of malignancy.
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Affiliation(s)
- Syed Munir
- Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Dania Abu-Jubara
- Emergency Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Musa Abu-Jubara
- Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Carla Antypas
- Family Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
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13
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Ashrafzadeh S, Layegh P. Crusted scabies in a patient with pemphigus vulgaris after treatment with rituximab and corticosteroids. JAAD Case Rep 2020; 6:722-724. [PMID: 32715061 PMCID: PMC7369456 DOI: 10.1016/j.jdcr.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Correspondence to: Pouran Layegh, MD, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 91735.
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14
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Agarwal P, Mistry AS, Rathod S, Patel S. Extensive Verrucae over Healed Pemphigus Vulgaris Lesions in an Immunocompetent Female: A Rare Presentation of Wolf's Isotopic Response. Indian J Dermatol 2020; 65:211-213. [PMID: 32565563 PMCID: PMC7292444 DOI: 10.4103/ijd.ijd_384_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Wolf's isotopic response refers to the occurrence of a skin disorder at the site of another unrelated and already healed skin disease. The cases described so far in the literature include herpes (simplex or zoster) as the primary disease in most cases and a myriad of skin diseases as the secondary disease. Here, we report a case where extensive verrucae developed over the sites of healed lesions of pemphigus vulgaris, in an immunocompetent female. Pemphigus vulgaris being the primary disease and absence of verrucae over normal skin makes this case, a rare presentation.
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Affiliation(s)
- Pooja Agarwal
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Amit S Mistry
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Santosh Rathod
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Shruti Patel
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
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15
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Concurrent presentation of tumid lupus with herpes zoster infection: A variant of Wolf isotopic response? JAAD Case Rep 2019; 5:612-613. [PMID: 31341938 PMCID: PMC6629916 DOI: 10.1016/j.jdcr.2019.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Denny JWL, Valiallah N, Harland CC. Isotopic response. Clin Exp Dermatol 2018; 43:225-227. [PMID: 29315739 DOI: 10.1111/ced.13358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J W L Denny
- Department of Dermatology, Royal Marsden Hospital, London, UK
| | - N Valiallah
- Department of Dermatology, Royal Marsden Hospital, London, UK
| | - C C Harland
- Department of Dermatology, Royal Marsden Hospital, London, UK
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17
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Lee JS, Park HS, Yoon HS, Cho S. Becker's Nevus with Recurrent Eczema Limited to the Nevus Lesion. Ann Dermatol 2017; 30:83-86. [PMID: 29386838 PMCID: PMC5762483 DOI: 10.5021/ad.2018.30.1.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/02/2017] [Accepted: 07/01/2017] [Indexed: 11/20/2022] Open
Abstract
Several dermatoses have been reported in association with Becker's nevus. Eczematous dermatitis associated with Becker's nevus is extremely rare, described in only two previous case reports. We report a case of 21-year-old male with recurrent eczema lesions which were always localized within the underlying Becker's nevus lesion. This case may be explained as a Wolf's isotopic response-like phenomenon.
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Affiliation(s)
- Ji Su Lee
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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18
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Neema S, Das A, Singh NS. Psoriasis Over Healed Herpes Zoster: Wolf's Isotopic Response. Indian J Dermatol 2017; 62:542-544. [PMID: 28979027 PMCID: PMC5618852 DOI: 10.4103/ijd.ijd_661_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Command Hospital, Kolkata, West Bengal, India. E-mail:
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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19
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Caccavale S, Kannangara AP, Ruocco E. Categorization of and comments on isomorphic and isotopic skin reactions. Clin Dermatol 2015; 35:105-110. [PMID: 27938807 DOI: 10.1016/j.clindermatol.2015.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Locus minoris resistentiae (lmr) can be defined as a site of the body that offers lesser resistance than the rest of the body to the onset of disease. The well-known Köbner phenomenon is itself a clear example of lmr in dermatology. The new term locus maioris resistentiae (LMR), a site of the body that offers greater resistance than the rest of the body to the onset of disease, defines the opposite condition. Renbök phenomenon (reverse Köbner's isomorphic response) typically represents an example of LMR.
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Affiliation(s)
- Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy.
| | | | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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20
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Wu S, McShane DB, Burkhart CN, Morrell DS. Wolf's Isotopic Response: Varicella Within a Prior Immunization Reaction Site. Pediatr Dermatol 2015; 32:e110-1. [PMID: 25779371 DOI: 10.1111/pde.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Wolf's isotopic response describes the occurrence of a dermatologic condition at the site of a prior healed unrelated condition. Our report details a case of varicella occurring as a secondary condition at the site of a prior immunization reaction; herpesvirus infection has not been reported as a secondary condition in cases of Wolf's isotopic response before. Current hypotheses favor the involvement of neurohormonal modulation of local immunity in response to various forms of injury as a model for explaining these phenomena.
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Affiliation(s)
- Sam Wu
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diana B McShane
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dean S Morrell
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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