Darsha Adrija, Oldenburg Reid, Hinds Brian, Paravar Taraneh
Department of Dermatology, University of California San Diego, San Diego, California, USA.
Dermatol Online J. 2022 Dec 15;28(6). doi: 10.5070/D328659741.
Wolf isotopic response represents the development of skin lesions of one particular morphology occurring at the same site as another morphologically distinct and unrelated skin lesion. Cutaneous lupus erythematosus (CLE) is an autoimmune connective tissue disorder encompassing a wide range of phenotypes that may be associated with systemic involvement. Although CLE is a well-described entity with a broad spectrum, the occurrence of lesions manifesting as an isotopic response is rare. We present a patient with systemic lupus erythematosus who developed CLE in a dermatomal distribution following herpes zoster. When CLE lesions present in a dermatomal distribution, these cases may be difficult to distinguish from recurrent herpes zoster infection in an immunosuppressed patient. Therefore, they pose a diagnostic challenge and require balancing antiviral therapy with immunosuppression to sufficiently maintain adequate control of the autoimmune disease while addressing possible infections. To avoid treatment delay, clinicians should have elevated suspicion for an isotopic response when disparate lesions erupt in areas previously affected by herpes zoster or in cases of persistent eruptions at sites of prior herpes zoster. We discuss this case within the context of Wolf isotopic response and review the literature for similar cases.
沃尔夫同形反应表现为一种特定形态的皮肤病变在与另一种形态不同且不相关的皮肤病变相同的部位出现。皮肤红斑狼疮（CLE）是一种自身免疫性结缔组织疾病，涵盖多种可能与全身受累相关的表型。虽然CLE是一个已被充分描述的具有广泛谱系的疾病，但表现为同形反应的病变却很少见。我们报告了一名系统性红斑狼疮患者，其在带状疱疹后出现了沿皮节分布的CLE。当CLE病变呈皮节分布时，这些病例可能难以与免疫抑制患者的复发性带状疱疹感染相区分。因此，它们构成了诊断挑战，需要在抗病毒治疗和免疫抑制之间进行平衡，以在应对可能的感染时充分维持对自身免疫性疾病的适当控制。为避免治疗延误，当在先前受带状疱疹影响的区域出现不同的病变或在先前带状疱疹部位持续出现皮疹时，临床医生应提高对同形反应的怀疑。我们在沃尔夫同形反应的背景下讨论该病例，并回顾类似病例的文献。
