A Postherpetic Isotopic Response Presenting as a Granuloma Annulare-Like Inflammatory Reaction

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Haley D Heibel
Clay J Cockerell


isotopic response, Wolf’s isotopic response, granuloma annulare


Isotopic response refers to the occurrence of a new, unrelated cutaneous disease occurring at the same location of a previous healed disease.  The etiology of isotopic responses is still not completely understood.  Theories have included that viral particles may lead to the development of the second disease, the destruction of nerve fibers by herpes zoster may lead to an indirect influence on the immune system, an alteration of microcirculation from inflammation that causes future insults to localize to the same site, and an exaggerated and atypical hypersensitivity reaction to tissue antigens, viral antigens, or immune complex deposition.  A wide variety of disease processes have been reported as the second disease in an isotopic response.

Here, we discuss a case of an isotopic response following herpes zoster in which the second disease involved a granuloma annulare (GA)-like inflammatory reaction that resolved and recurred.  These findings support the theory that the skin affected by herpes zoster is affected in a way that makes it a focus for the manifestation of further skin diseases.


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