“Wolf’s isotopic response”: the originators speak their mind and set the record straight

doi:10.1016/j.clindermatol.2017.02.003

Clinics in Dermatology

Volume 35, Issue 4, July–August 2017, Pages 416-418

https://doi.org/10.1016/j.clindermatol.2017.02.003 Get rights and content

Abstract

Having been the first to have introduced the concept of “isotopic response” three decades ago, we wanted to express some of our thoughts on its current application, now that more than 100 such cases have been reported in the literature. It is, of course, gratifying to read about its appropriate application, and it is our hope that others will refrain from distorting its original meaning.

Section snippets

Definition and short history

The concept of “isotopic response” was introduced by Wolf and Wolf in 1985¹ (then labeled “isoloci” response) to describe a new dermatologic entity. They had originally defined it as the occurrence of a new skin disorder at the site of another unrelated and already healed skin lesion.

Cases of isotopic response had been reported before then, but Wolf and Wolf¹ first recognized that these were not merely unusual presentations with an unexpected localization, but that they rather represented a new

Expansion of the inclusion criteria

An isotopic response implies that a second disease has appeared at the site of an already healed skin disease, specifically, on apparently unaffected healthy skin. This requirement turns out to be somewhat problematic, because healed skin is very often no longer completely “normal” and may continue to show signs of damage for months and even years after an injury or disease.[6], [7] Although this problem was noted in the original paper,³ we wish to take the opportunity to slightly alter our

Isotopic versus isomorphic response: Two different phenomena with some overlap

The isotopic response has many similarities to the isomorphic response of Köbner, but the two terms differ considerably. The isomorphic response describes the appearance of the same (already existing) disease at another location, whereas the isotopic response describes the appearance of a new disease at the same site as that of a healed one. The term isomorphic means “the same morphology,” whereas isotopic means “at the same place.” The inclusion criterion for an isotopic response required that

Do we need the new term “Wolf’s postherpetic isotopic response” in addition to the original “Wolf’s isotopic response”?

Although the first disease in the majority of cases of Wolf’s isotopic response is a herpes (zoster or simplex) infection, there are a significant number of cases in which other skin disorders precede the second disease.[8], [10] We also believe that there are many other unreported cases, and that herpes zoster is overrepresented in the literature because its localization is easy to remember and the appearance of a second disease in the same dermatomal location is unlikely not to be noted.

The

Conclusions

Having been the first to have introduced the concept of “isotopic response” (first “isoloci response”¹ and then “isotopic response”³), we wanted to express some of our thoughts on its application more than 30 years later, in view of the experience of more than 100 such cases having been reported in the literature. It is, of course, gratifying to read about its appropriate application in current papers,⁸ and it is our hope that others will refrain from distorting its original meaning.[12], [13]

References (13)

R.A. Clark
Gone but not forgotten: lesional memory in psoriatic skin
J Invest Dermatol
(2011)
D. Grabell et al.
The role of skin trauma in the distribution of morphea lesions: a cross-sectional survey of the Morphea in Adults and Children cohort IV
J Am Acad Dermatol
(2014)
R. Wolf et al.
The role of skin trauma (isotopic and isomorphic) in the distribution of morphea
J Am Acad Dermatol
(2015)
R. Wolf et al.
Wolf’s isotopic response: the first attempt to introduce the concept of vulnerable areas in dermatology
Clin Dermatol
(2014)
R. Wolf et al.
Tinea in a site of healed herpes zoster (isoloci response?)
Int J Dermatol
(1985)
H. Köbner
Zur aetiologie der Psoriasis
Vjschr Dermatol
(1876)

There are more references available in the full text version of this article.

Cited by (15)

Wolf's isotopic response of lichen planus following contact dermatitis
2022, JAAD Case Reports
Citation Excerpt :
Wolf’s isotopic response (WIR) is the emergence of an unrelated skin eruption at the site of a previously healed skin eruption. While this phenomenon is classically incited by varicella zoster virus reactivation, any dermatosis may precede WIR.1-3 Possible mechanisms include the immunocompromised district hypothesis, in which the inciting lesion impairs regional skin immunity, thereby increasing the risk of a subsequent dermatosis.4,5
Concurrent presentation of tumid lupus with herpes zoster infection: A variant of Wolf isotopic response?
2019, JAAD Case Reports
Köbner, Renbök, Wolf phenomena and so on… has the time come for simplification?
2018, Annales de Dermatologie et de Venereologie
Depuis la fin du XIX^e siècle, les dermatologues savent par observations que les dermatoses peuvent interagir (ou bien éviter d’interagir) avec une grande variété d’agressions cutanées ou bien même avec une autre dermatose préexistante. Des tentatives pour nommer et classer ces phénomènes ont été faites : phénomène de Köbner, réaction isotopique de Wolf, phénomène Renbök etc. Cependant, avec le temps, ces phénomènes se sont enrichis en nuances et subtilités, tandis que des phénomènes similaires ont été décrits sous différents termes, ajoutant une confusion certaine dans la littérature. Nous faisons ici une mise au point historique, sémantique et nosologique de ces différents phénomènes. Nous prônons l’utilisation de classifications plus simples avec des termes universels distinguant les phénomènes d’affinité et d’épargne, qu’ils soient isomorphiques ou isotopiques et selon les lésions sous-jacentes (post-traumatique, post-herpétique, post-vaccination, post-radiothérapie, territoire neurologique déficitaire, mosaïcisme génétique ou autre).
Since the end of the 19th century, dermatologists have observed that skin conditions may respond (or not) to a wide variety of skin injuries or even to other existing skin conditions. Attempts were made to name and classify such phenomena: Köbner phenomenon, Wolf's isotopic response, Renbök phenomenon, etc. However, over time, further subtleties and nuances came to be grafted onto the initial descriptions, while comparable phenomena were described using different terms, all of which resulted in considerable confusion in the literature. Herein we review the history, semantics and nosology of these different phenomena. We also propose the use of a simpler, more homogenous and universal nomenclature that distinguishes between affinity and sparing phenomena, whether isomorphic or isotopic and which is based on the lesions involved (trauma, vaccination, radiotherapy, neurologic defect, herpes, genetic mosaicism and so on).
Extra-facial Lever granuloma on a herpes zoster scar: Wolf's isotopic response
2018, Annales de Dermatologie et de Venereologie
Le granulome de Lever est une affection dermatologique rare qui se localise classiquement sur le visage. Nous rapportons l’observation d’un granulome de Lever extra-facial apparu sur des cicatrices de zona du tronc, ce qui constitue une réaction isotopique particulière.
Un homme de 60 ans consultait pour une lésion cutanée prurigineuse évoluant depuis deux mois. Il avait comme unique antécédent un zona lombaire gauche. À l’examen, nous constations une plaque érythémateuse infiltrée de 2,5 cm de diamètre dans la région para-vertébrale lombaire gauche. Le bilan biologique était normal. L’examen histologique révélait un processus inflammatoire sans néovaisseaux, riche en éosinophiles, avec vasculite chronique et infiltrat polymorphe, permettant de retenir le diagnostic de granulome de Lever.
Le granulome de Lever est une forme localisée de vasculite des petits vaisseaux du derme. Bien qu’il touche généralement le visage, les atteintes extra-faciales existent. Le caractère original de cette présentation, hormis sa localisation, réside dans le fait que le granulome s’était développé sur une cicatrice de zona, ce qui correspond à une réaction isotopique de Wolf. Ce phénomène, décrit par R. Wolf, est l’apparition d’une nouvelle dermatose sur le lieu d’une ancienne dermatose guérie, le plus souvent herpétique. La physiopathologie est encore incertaine. Cette réaction est différente des réactions isomorphiques de type Koebner, où il s’agit de l’apparition d’une dermatose déjà connue sur le lieu d’un traumatisme, et non d’une nouvelle dermatose.
Nous décrivons un cas, à notre connaissance jamais rapporté dans la littérature, de réaction isotopique de Wolf avec un granulome de Lever extra-facial.
Granuloma faciale (GF), or facial granuloma of Lever, is an uncommon dermatosis occurring classically on the face. We report a case of a GF on zoster scars located on the trunk, which is a highly particular isotopic response.
A 60-year-old man with a sole history of left lumbar zoster presented with a skin lesion present for two months. Clinical examination revealed a 2.5-cm papular erythematous lesion that was both infiltrated and pruritic. This lesion was situated precisely on zoster scars. Lab tests revealed no abnormalities. Histopathologic examination showed an inflammatory process without neovessels but rich in eosinophils with chronic vasculitis and polymorphic infiltrate, on which basis GF was diagnosed.
GF is a localized form of cutaneous small-vessel vasculitis. Although it usually affects the face, extra-facial locations also exist. The original character of this presentation, aside from the location, is the occurrence of this GF on a zoster scar, which corresponds to Wolf's isotopic response. This phenomenon, described by R. Wolf, comprises the occurrence of a new skin disorder at the site of another unrelated and already healed skin disease, usually herpes. The physiopathology is still unclear. This differs from isomorphic reactions such as Koebner's reaction, which consists of the appearance at an injury site of skin lesions typical of an existing dermatosis but not a new disorder.
This is a rare case of Wolf's isotopic response with GF, of which, to our knowledge, there are no reports in the literature.
Characteristics and pathogenesis of Koebner phenomenon
2023, Experimental Dermatology
Keloids After Herpes Zoster: Report of Wolf’s Isotopic Phenomenon and Literature Review
2023, Clinical, Cosmetic and Investigational Dermatology

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Dermatologic Disquisitions and Other Essays“Wolf’s isotopic response”: the originators speak their mind and set the record straight

Abstract

Section snippets

Definition and short history

Expansion of the inclusion criteria

Isotopic versus isomorphic response: Two different phenomena with some overlap

Do we need the new term “Wolf’s postherpetic isotopic response” in addition to the original “Wolf’s isotopic response”?

Conclusions

J Invest Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Clin Dermatol

Tinea in a site of healed herpes zoster (isoloci response?)

Int J Dermatol

Zur aetiologie der Psoriasis

Vjschr Dermatol

Dermatologic Disquisitions and Other Essays
“Wolf’s isotopic response”: the originators speak their mind and set the record straight