Primary cutaneous dermal mucinosis on herpes zoster scars

The term isotopic response refers to the appearance of a new skin disease at the site of another unrelated and already healed skin disorder. Often, the first disease is herpes zoster (HZ). Several cutaneous reactions have been described in a dermatome recently affected by HZ. We present the case of a 33-year-old man who developed whitish papules with a zosteriform distribution on HZ scars. Histopathologic study with hematoxylin and eosin and Alcian blue (pH 2.5) staining demonstrated abundant deposits of mucin interstitially arranged between collagen bundles of the papillary dermis. Cutaneous dermal mucinosis as a postherpetic isotopic response is rare, but it should be added to the list of cutaneous reactions arising in HZ scars.