Elsevier

Clinics in Dermatology

Volume 32, Issue 5, September–October 2014, Pages 557-560
Clinics in Dermatology

Wolf’s isotopic response: The first attempt to introduce the concept of vulnerable areas in dermatology

https://doi.org/10.1016/j.clindermatol.2014.04.002Get rights and content

Abstract

The term isotopic response was coined in 19951 to describe the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease. That publication paved the way to recognition of this phenomenon by the medical community worldwide with multiple reports describing it under a variety of conditions.

The term isotopic response, however, turned out to be unsuitable for a Medline search, because it generated hundreds of references linked with radioactive isotopes. To facilitate Medline searches for this dermatologic phenomenon by avoiding unnecessarily time-consuming sifting through so many unrelated references, it was suggested that the name Wolf be added. The name Wolf’s isotopic response has since been generally accepted and even included in Stedman’s Illustrated Dictionary of Dermatology Eponyms.

Although the concept of the isotopic response was conceived as being analogous to Köbner’s isomorphic response, and despite the similarities between the two terms, the similarities are only “skin deep,” and there is a major difference between the two. Isomorphic response means “the same morphology” (as that of the existing disease) and describes the appearance of the same disease at another location. The term isotopic response describes the appearance of an altogether different disease at the site of an already healed skin disease. We describe this entity and present representative clinical examples. Some problems in the definition of Wolf’s isotopic response are provided, with special emphasis on its overlapping with Köbner’s isomorphic response.

The description of Wolf’s isotopic response, which is analogous but not identical to the isomorphic response described some 120 years ago by Köbner, illustrates the contribution of morphologic findings and original ideas in keeping up with the ongoing progress in the field of dermatology.

Section snippets

Definition and history

The term isotopic response was coined in 19951 to describe the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease.

The first report of such a case dates back to 1929, when Gougerot and Filliot2 described a case of lichen planus that developed in a scar of a herpes zoster eruption of 2 months’ duration. Another report appeared in 1938,3 describing a case in which lichen planus developed in a herpes zoster site 3 years after the original zoster

Reported cases of Wolf’s isotopic response in which the first disease is not herpes

Although the first disease is a herpes (zoster or simplex) infection in the vast majority of cases of Wolf’s isotopic response, there are a number of reports on other skin disorders preceding it on the same site.[11], [12], [13], [14], [15], [16] We believe that there are many other unreported cases and that herpes zoster is overrepresented in the literature, because its localization is easy to remember and the appearance of a second disease in a dermatomal location is unlikely to be ignored.

Isotopic versus isomorphic response: Two different phenomena with some overlap

Although the concept of the isotopic response was conceived as being analogous to Köbner’s isomorphic response, despite the similarities between the two terms, the similarities between the conditions are only “skin deep” and there is a major difference between the two. The term isomorphic response means “the same morphology” (as that of the existing disease) and describes the appearance of the same disease at another location. The term isotopic response describes the appearance of an altogether

The isotopic response: Another example of the value of descriptive dermatology in an evidence-based world22

The description of Wolf’s isotopic response, which is analogous but not identical to the isomorphic response described some 120 years ago by Köbner, illustrates the contribution of morphologic findings and original ideas in keeping up with the ongoing progress in the field of dermatology. It demonstrates once again that the most important instrument in dermatology is, as it has always been, the naked eye, even in an era in which diagnostic investigations are multiplying rapidly and are becoming

From the isotopic response to the introduction of the concept of “vulnerable areas in dermatology”

As Charles Darwin put it, “Science consists of grouping facts so that general laws or conclusions may be drawn from them.”24 This is exactly what the present issue strives to do. It is no less important, however, to preserve the integrity of the individual disease entity so that it is not obscured by others with which it shares a common pathomechanism.

As regards the isotopic response, it has maintained its integrity over time and, what is more, has paved the way for the development of a novel

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      Citation Excerpt :

      Our answer to that question is as follows: If the patient never had had the second disease and if the second disease (no matter which one) appeared for the first time solely at the precise site of another unrelated healed disease, it meets the criteria to be considered an isotopic response. Although the first disease in the majority of cases of Wolf’s isotopic response is a herpes (zoster or simplex) infection, there are a significant number of cases in which other skin disorders precede the second disease.8,10 We also believe that there are many other unreported cases, and that herpes zoster is overrepresented in the literature because its localization is easy to remember and the appearance of a second disease in the same dermatomal location is unlikely not to be noted.

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