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Case Report
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| More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's isotopic response in an Asian female |
| Natalia Fijalkowski1, Ashley Wysong2, Phuong Khuu2, Anne Lynn S Chang2 |
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1Stanford School of Medicine, Stanford, CA USA.
2Department of Dermatology, Stanford University, Redwood City, CA. |
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doi:10.5348/ijcri-2012-02-92-CR-6
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Address correspondence to: Anne Lynn S Chang Instructor, Dept. of Dermatology Stanford University School of Medicine 450 Broadway- Pavilion C 2nd floor Redwood City CA 94063 Phone: 650 721-7151 Fax: 650 721-3464 Email: alschang@stanford.edu |
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| How to cite this article: |
| Fijalkowski N, Wysong A, Khuu P, Chang ALS. More than just a coincidence: Herpes zoster and acne rosacea appearing together as wolf's isotopic response in an asian female. International Journal of Case Reports and Images 2012;3(2):24-27. |
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Abstract
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Introduction:
Wolf's isotopic response is a rare dermatologic phenomenon defined as the occurrence of a new, unrelated disease at the site of healed lesions of some other disease. We report the first case of Wolf's isotopic response in a female presenting with rosacea localized to the site of healing zoster lesions.
Case Report: A 35-year-old previously healthy Filipino-American woman with no prior history of a dermatologic condition presented to our clinic with a 9-month history of a painful and pruritic unilateral erythematous papular eruption on her right upper cutaneous lip and cheek that respected the midline. At initial presentation she was started on 800 mg acyclovir five times daily for one week for presumed zoster. Four days into her seven-day acyclovir course, her primary care physician obtained cultures for VZV and HSV, but these tests were negative. The vesicular eruptions completely resolved following treatment with acyclovir, leaving only hyperpigmented scars in the unilateral maxillary distribution. Two months after the completion of her acyclovir treatment, she noticed pink dots, which had a prickly and itchy sensation located in the same unilateral distribution as her previous eruptions. Her condition was refractory to a myriad of topical treatments and a skin biopsy was performed which suggested acne rosacea. She was started on isotretinoin and continued for five months with almost complete resolution of papules and symptoms. Conclusion: The pathogenesis of Wolf's isotopic response is unknown. We review the various etiologies that have been postulated including direct action of viral, particles, immune activation, alterations in neurologic system and vascular changes. Early recognition of Wolf's isotopic response may result in more timely and effective treatment for patients. Further studies are needed to define the pathogenesis of isotopic response. | |
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Key Words:
Wolf's isotopic response, Rosacea, Herpes zoster
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Author Contributions:
Natalia Fijalkowski - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Ashley Wysong - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Phuong Khuu - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Anne Lynn S. Chang - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Natalia Fijalkowski et al. 2012; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see http://www.ijcasereportsandimages.com/copyright-policy.php for more information.) |
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