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CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 2  |  Page : 219-220
Isoscartopic response: Another facet of the immunocompromised cutaneous district


1 Department of Dermatology, Second University of Naples, Naples, Italy
2 Department of Psychiatry, University of Foggia, Foggia, Italy
3 Department of Cardiovascular Surgery and Transplant, Second University of Naples, Naples, Italy

Date of Web Publication1-Mar-2016

Correspondence Address:
Stefano Caccavale
Department of Dermatology, Second University of Naples, Naples
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.177770

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How to cite this article:
Caccavale S, La Montagna M, Caccavale T. Isoscartopic response: Another facet of the immunocompromised cutaneous district. Indian J Dermatol 2016;61:219-20

How to cite this URL:
Caccavale S, La Montagna M, Caccavale T. Isoscartopic response: Another facet of the immunocompromised cutaneous district. Indian J Dermatol [serial online] 2016 [cited 2021 Oct 25];61:219-20. Available from: https://www.e-ijd.org/text.asp?2016/61/2/219/177770


Sir,

We read with great interest the report recently published in the Indian Journal of Dermatology by Kumar et al., which describes a patient with lichen planus pemphigoides presenting over preexisting atrophic scars.[1] The report drew our attention due to the peculiar distribution of the lesions. Kumar et al.[1] note that the case is an extremely rare instance of the isotopic phenomenon. The authors try to clarify the pathomechanism involved in the development of lichen planus pemphigoides at the scarring sites (due to painful ulcers caused by pyoderma gangrenosum). They state that the predilection of the blisters to develop on the lower extremities could be explained by sluggish circulation in those regions. According to their opinion, scars involving the dermis and subcutaneous tissue with largely unaffected epidermis might alter the blood circulation in that particular area, leading to the preferential deposition of immunoglobulins in the scar area and subsequent bulla formation.[1]

We think that Kumar's report is no more than a further mere example of “immunocompromised cutaneous district” (ICD).[2] This concept refers to a skin site of loco-regional immune dysregulation due to an obstacle to the normal trafficking of immunocompetent cells through lymphatic channels, and/or interference with the signals that the neuropeptides and neurotransmitters, related to peripheral nerves, send to cell membrane receptors of immunocompetent cells.[2] Disruption of lymph microcirculation and damage to peripheral nerve endings can obviously occur in scarred skin, thus altering the local interplay between immune cells conveyed by lymph vessels and neuromediators running along peripheral nerve fibers.[2] Depending on which of the neurotransmitters and immune cells are involved, this destabilization can be either defective, thus predisposing to infections and tumors, or excessive, thus favoring the occurrence of some immune disorders or dysimmune reactions such as lichen planus pemphigoides. The injuring events capable of rendering a skin region a potential ICD are various.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] A recent classification of isomorphic and isotopic skin reactions has proposed a newly coined terminology to indicate each specific cause responsible for the occurrence of an ICD and has encompassed additional conditions that had not been defined previously.[18] The report of Kumar et al. could be seen as an example of “isoscartopic response” (a clinical condition that had not been defined yet). We thank the authors for giving us the opportunity to discuss such a complex and interesting topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kumar P, Savant SS, Das A, Hassan S, Barman PD. Lichen planus pemphigoides presenting preferentially over preexisting scars: A rare instance of isotopic phenomenon. Indian J Dermatol 2015;60:596-9.  Back to cited text no. 1
  Medknow Journal  
2.
Ruocco V, Brunetti G, Puca RV, Ruocco E. The immunocompromised district: A unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites. J Eur Acad Dermatol Venereol 2009;23:1364-73.  Back to cited text no. 2
    
3.
Lo Schiavo A, Brancaccio G, Romano F, Caccavale S. Nerve injury and localized skin lesions: An instance of immunocompromised district. Skinmed 2012;10:260-1.  Back to cited text no. 3
    
4.
Ruocco E, Brunetti G, Sangiuliano S, Caccavale S, Lo Schiavo A. Discoid lupus erythematosus at a site of previous injury. Australas J Dermatol 2013;54:e16-8.  Back to cited text no. 4
    
5.
Bove D, Lupoli A, Caccavale S, Piccolo V, Ruocco E. Dermatological and immunological conditions due to nerve lesions. Funct Neurol 2013;28:83-91.  Back to cited text no. 5
[PUBMED]    
6.
Lo Schiavo A, Caccavale S, Alfano R, Gambardella A, Cozzi R. Bullous pemphigoid initially localized around the surgical wound of an arthroprothesis for coxarthrosis. Int J Dermatol 2014;53:e289-90.  Back to cited text no. 6
    
7.
Lo Schiavo A, Brancaccio G, Romano F, Caccavale S. Lymphangiomas arising on lymphedema:First step of malignant development. G Ital Dermatol Venereol 2014;149:372-4.  Back to cited text no. 7
    
8.
Ruocco E, Lo Schiavo A, Caccavale S. Pemphigus induced by radiotherapy for breast cancer: An instance of immunocompromised district. Eur J Dermatol 2014;24:278-9.  Back to cited text no. 8
    
9.
Ruocco E, Di Maio R, Caccavale S, Siano M, Lo Schiavo A. Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district. Clin Dermatol 2014;32:660-9.  Back to cited text no. 9
    
10.
Lo Schiavo A, Caccavale S, La Montagna M, Caccavale T, Gambardella A. The role of lymphatic stasis in Kaposi's sarcoma onset. G Ital Dermatol Venereol 2014;149:731-3.  Back to cited text no. 10
    
11.
Ruocco E, Caccavale S, Siano M, Lo Schiavo A. Radiation port cutaneous metastases: A further example of immunocompromised district. Indian J Dermatol 2014;59:302-3.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Lo Schiavo A, Peccerillo F, Mascolo M, La Montagna M, Caccavale T, Gambardella A, et al. Inverse notalgia paresthetica: A strange case of professional disease. Int J Dermatol 2015;54:e49-51.  Back to cited text no. 12
    
13.
Caccavale S, Gambardella A. Reactive angioendotheliomatosis following implantation of a knee metallic device: An instance of immunocompromised district. Int J Dermatol 2015;54:e372-3.  Back to cited text no. 13
    
14.
Caccavale S, La Montagna M. Uncommon superficial angiomyxoma of the vulva complicated with condyloma acuminatum and Staphylococcus hominis infection: A mere example of gynecological immunocompromised district. Int J Dermatol 2015;54:e505-6.  Back to cited text no. 14
    
15.
Caccavale S, Caccavale T, La Montagna M. Post herpes zoster trigeminal trophic syndrome in a child: An example of immunocompromised district. Indian J Dermatol 2016;61:124.  Back to cited text no. 15
  Medknow Journal  
16.
Caccavale S, Kannangara AP, Ruocco E. The immunocompromised cutaneous district and the necessity of a new classification of its disparate causes. Indian J Dermatol Venereol Leprol. [Epub ahead of print].  Back to cited text no. 16
    
17.
Caccavale S, Squillace L, Ruocco E. Tattoo-induced psoriasis: An umpteenth example of immunocompromised district. Int J Dermatol. [Epub ahead of print].  Back to cited text no. 17
    
18.
Caccavale S, Kannangara AP, Ruocco E. Categorization of and comments on isomorphic and isotopic skin reactions. Clin Dermatol. [Epub ahead of print].  Back to cited text no. 18
    




 

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