Zosteriform pemphigoid after zoster: Wolf's isotopic response

Area of Science:

• Dermatology
• Immunodermatology
• Pathophysiology

Background:

• The Wolf isotopic response describes a new disease emerging at a prior healed disease site.
• Herpes zoster (shingles) and herpes simplex are common preceding conditions.

Observation:

• A 79-year-old woman presented with a bullous pemphigoid (BP) eruption.
• The BP exhibited a dermatomal distribution.
• The eruption localized to an area of previous herpes zoster scarring.

Findings:

• Clinical, histological, and immunofluorescence studies confirmed localized bullous pemphigoid.
• This represents the first reported instance of bullous pemphigoid developing at a herpes zoster site.

Implications:

• Recognizing this Wolf isotopic response is crucial for accurate diagnosis.
• This phenomenon may offer insights into the pathophysiology of autoimmune skin diseases.
• Understanding localized BP post-herpes zoster can refine patient management.