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LETTERS IN RESPONSE TO PREVIOUS PUBLICATION IN IJD®
Year : 2016  |  Volume : 61  |  Issue : 5  |  Page : 565-566
Pustular psoriasis occurring on the striae distensae: An umpteenth example of immunocompromised cutaneous district


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

Date of Web Publication9-Sep-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: 10.4103/0019-5154.190106

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How to cite this article:
Caccavale S, Caccavale T, La Montagna M. Pustular psoriasis occurring on the striae distensae: An umpteenth example of immunocompromised cutaneous district. Indian J Dermatol 2016;61:565-6

How to cite this URL:
Caccavale S, Caccavale T, La Montagna M. Pustular psoriasis occurring on the striae distensae: An umpteenth example of immunocompromised cutaneous district. Indian J Dermatol [serial online] 2016 [cited 2021 Apr 20];61:565-6. Available from: https://www.e-ijd.org/text.asp?2016/61/5/565/190106




Sir,

We read with great interest the report recently published in the Indian Journal of Dermatology by Balasubramanian and Srinivas [1] which describes a patient with pustular psoriasis occurring on the striae distensae.[1] The patient complained recurrent episodes of generalized pustular eruptions since the age of 15 years. Since the disease was recalcitrant, the patient had assumed systemic steroids during an acute exacerbation, developing steroid-induced striae distensae over the anterior abdomen, arms, and thighs. The authors reported that the current episode of pustular psoriasis was characterized by the striking occurrence of pustular eruptions on the striae.[1]

We speculate that Balasubramanian's report is no more than a further mere example of “immunocompromised cutaneous district” (ICD).[2] The injuring events capable of rendering a skin region a potential ICD are various, numerous, and most of the times identifiable using a careful clinical history.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] An ample documentation of multifarious disorders appearing in ICDs was delineated by Ruocco et al . in 2009.[2] In the following 8 years, this concept has been extended to an enlarging variety of clinical conditions. A recent classification 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.[16],[17],[18],[19],[20],[21] The report of Balasubramanian and Srinivas can be seen as an example of isomorphic response or Köbner phenomenon (a preexisting disease that appears at site of injury), and neither an isotopic response (a new skin disease that appears at site of previously diseased or injured), nor an isoscartopic response, since the pustular psoriasis was preexistent to the development of striae distansae.[1],[19] Disruption of lymph microcirculation and damage to peripheral nerve endings could obviously have been occurred in the patient's scared skin, thus altering the local interplay between immune cells conveyed by lymph vessels and neuromediators running along peripheral nerve fibers. 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 [2] (as pustular psoriasis).[22]

We thank the authors for giving us the opportunity to discuss such a complex and interesting topic.

Financial support and sponsorship

Nil.

Conflflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Balasubramanian P, Srinivas CR. Pustular Psoriasis Occurring on the Striae Distensae: Isotopic Phenomenon/Koebner's Phenomenon. Indian J Dermatol 2016;61:239.  Back to cited text no. 1
[PUBMED]  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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]    
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
[PUBMED]  Medknow Journal  
16.
Caccavale S, Squillace L, Ruocco E. Tattoo-induced psoriasis: An umpteenth example of immunocompromised district. Int J Dermatol (in press).  Back to cited text no. 16
    
17.
Caccavale S, La Montagna M, Caccavale T. Isoscartopic Response: Another Facet of the Immunocompromised Cutaneous District. Indian J Dermatol 2016;61:219-20.  Back to cited text no. 17
[PUBMED]  Medknow Journal  
18.
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 2016;82:227-9.  Back to cited text no. 18
[PUBMED]  Medknow Journal  
19.
Caccavale S, Kannangara AP, Ruocco E. Categorization of and comments on isomorphic and isotopic skin reactions. Clin Dermatol (in press).  Back to cited text no. 19
    
20.
Caccavale S, Caccavale T, La Montagna M. Varicella within a prior immunization reaction site: Another example of “isovaccinetopic response”. Pediatr Dermatol (in press).  Back to cited text no. 20
    
21.
Caccavale S, Caccavale T, La Montagna M. Facial flat warts in a young patient with a previous trauma: An example of isotraumatopic response. Int J Dermatol (in press).  Back to cited text no. 21
    
22.
Lo Schiavo A, Brancaccio G, Puca RV, Caccavale S. Etanercept in the treatment of generalized annular pustular psoriasis. Ann Dermatol 2012;24:233-4.  Back to cited text no. 22
[PUBMED]    




 

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