Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 4327  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 5  |  Page : 411
Zosteriform morphea in an immunocompetent patient


1 Department of Dermatology, Complejo Hospitalario de Jaén, Motril, Spain
2 Department of Internal Medicine, Hospital Santa Ana, Motril, Spain

Date of Web Publication30-Aug-2013

Correspondence Address:
Ricardo Ruiz-Villaverde
Department of Dermatology, Complejo Hospitalario de Jaén, Motril
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.117368

Rights and Permissions



How to cite this article:
Ruiz-Villaverde R, Sánchez-Cano D. Zosteriform morphea in an immunocompetent patient. Indian J Dermatol 2013;58:411

How to cite this URL:
Ruiz-Villaverde R, Sánchez-Cano D. Zosteriform morphea in an immunocompetent patient. Indian J Dermatol [serial online] 2013 [cited 2020 Jul 14];58:411. Available from: http://www.e-ijd.org/text.asp?2013/58/5/411/117368


Sir,

A 19-year-old female attended to our dermatological clinic with atrophic indurated hyperpigmented patches in a zosteriform distribution located on her left submammary [Figure 1] and back region [Figure 2]. There was no erythema in and around the lesions. The patient reported no personal or familiar medical history of interest except for an episode of herpes zoster in the same location two years before. Clinical examination did not reveal another cutaneous lesions. Blood cell count, general biochemistry, urinanalysis, thyroid profile, antinuclear antibodies, ESR (erytrocite sedimentation rate), CPR (C reactive protein), chest X-ray, and serologic test for Borrelia Burgdoferi showed no abnormalities. Serology for varicella-zoster virus showed negative IgM and positive IgG.
Figure 1: Hyperpigmented patch in zosteriform distribution on submmamary region in our patient

Click here to view
Figure 2: Morphea lesions on the back completing the zosteriform pattern

Click here to view


Histolopathologic examination showed thick bundles of collagen in reticular dermis orientated parallel to the skin surface. Cutaneous appendages were reduced. A perivascular inflammatory infiltrate composed of plasma cells and lymphocites was also observed. Our case was consistent with zosteriform morphea as an expression of isotopic Wolf response after the episode of herpes zoster. We began treatment with calcipotriol/betamethasone gel with mild therapeutic response.

The term "zosteriform" is commonly used to describe the morphological pattern of a skin dermatosis resembling the distribution of herpes zoster. Lichen planus, porokeratosis, common warts, fungal infections, naevus, skin metastases are some of the diseases that have been described following this pattern. In other terms, several types of cutaneous lesions have previously been described at the sites of herpes zoster scars. [1] This phenomenon that characterizes the occurrence of a new skin disease at the site of another has been termed as isotopic response by Wolf et al. [2] Although the cutaneous eruptions described in herpes zoster scars are variable, granuloma annulare and other types of granulomatous disorders are the most commonly reported reactions. Zosteriform morphea has been rarely described after herpes zoster in immunosuppressed [3],[4] or immunocompetent [5] patients. It has been hypothesized that the viral infection changes the local immunity inducing a delayed-type hypersensitivity reaction to herpes zoster viral antigen or immune suppression. We coincide with Lopez et al, [6] that regarding the cytokine pattern of the inflammatory response a different dermatosis can be expressed, but in other way we cannot forget that other cases, as zosteriform lichen planus mainly, have been interpreted as a manifestation of Koebner's phenomenon. This pattern would be an expression of a viscerocutaneous reflex mechanism within the affected segments as a radicular irritation caused by abnormalities of the vertebral column. Nevertheless further studies are needed to perform a better interpretation of isotopic Wolf response.

 
   References Top

1.Requena L, Kutzner H, Escalonilla P, Ortiz S, Schaller J, Rohwedder A. Cutaneous reactions at sites of herpes zoster scars: An expanded spectrum. Br J Dermatol 1998;138:161-8.  Back to cited text no. 1
[PUBMED]    
2.Wolf R, Brenner S, Ruocco V, Filioli FG. Isotopic response. Int J Dermatol 1995;34:341-8.  Back to cited text no. 2
[PUBMED]    
3.Zimmermann H. Zoster als Prämorbid einer zirkumskripten sklerodermie. Dermatol Wochenschr 1964;150:112-6.  Back to cited text no. 3
[PUBMED]    
4.Forschner A, Metzler G, Rassner G, Fierlbeck G. Morphea with features of lichen sclerosus et atrophicus at the site of a herpes zoster scar: Another case of an isotopic response. Int J Dermatol 2005;44:524-5.  Back to cited text no. 4
[PUBMED]    
5.Joshi A, Al-Mutairi N. Zosteriform morphea: A new pattern. Acta Derm Venereol 2005;85:279-80.  Back to cited text no. 5
[PUBMED]    
6.López N, Alcaraz I, Cid-Mañas J, Camacho E, Herrera-Acosta E, Matilla A, et al. Wolf's isotopic response: Zosteriform morphea appearing at the site of healed herpes zoster in a HIV patient. J Eur Acad Dermatol Venereol 2009;23:90-2.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Congenital vulnerability of cutaneous segments arising from skin mosaicism: A genetic basis for locus minoris resistentiae
Rami N. Al-Rohil,David Leung,J. Andrew Carlson
Clinics in Dermatology. 2014; 32(5): 577
[Pubmed] | [DOI]
2 Wolf’s post-herpetic isotopic response: Infections, tumors, and immune disorders arising on the site of healed herpetic infection
Vincenzo Ruocco,Eleonora Ruocco,Giampiero Brunetti,Teresa Russo,Alessio Gambardella,Ronni Wolf
Clinics in Dermatology. 2014; 32(5): 561
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (769 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2177    
    Printed22    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    
    Cited by others 2    

Recommend this journal