10.5826/dpc.1401a55
text/xml
2160-9381
3627
en
Luis Javier Del Pozo Hernando
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Reverse Isotopic Phenomenon in Acute Drug Eruption
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-06-21
2024-01-31
2024-02-21
e2024055
Dermatol Pract Concept
Luis Javier Del Pozo Hernando
2024/01/31
10.5826/dpc.1401a55
e2024055
Department of Dermatology, Hospital Universitari Son Espases, Palma, Spain
2160-9381
en
e2024055
Jaka-Moreno A, López-Pestaña A, López-Núñez M, Ormaechea-Pérez N, Vildosola-Esturo S, Tuneu-Valls A, Lobo-Morán C. Wolf's isotopic response: a series of 9 cases. Actas Dermosifiliogr. 2012 Nov;103(9):798-805. English, Spanish. doi: 10.1016/j.ad.2012.02.007. Epub 2012 Jun 6. PMID: 22681715.
Reverse Isotopic Phenomenon in Acute Drug Eruption
https://dpcj.org/index.php/dpc/article/download/3627/2551
                             Reverse Isotopic Phenomenon
                                in Acute Drug Eruption
                  Carlos Manuel Martorell Moreau1, Luis Javier Del Pozo Hernando1


1 Department of Dermatology, Hospital Universitari Son Espases, Palma, Spain



Citation: Martorell Moreau CM, Del Pozo Hernando LJ. Reverse Isotopic Phenomenon in Acute Drug Eruption. Dermatol Pract Concept.
2024;14(1):e2024055. DOI: https://doi.org/10.5826/dpc.1401a55
Accepted: July 9, 2023; Published: January 2024
Copyright: ©2024 Martorell Moreau et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: Both the authors have contributed significantly to this publication.
Corresponding Author: Carlos Manuel Martorell Moreau, Department of Dermatology, Hospital Universitari Son Espases, Valldemossa,
79, 07120 Palma, Illes Balears, Palma, Spain. E-mail: cmartorell15@gmail.com




Case Presentation                                                       an unspecific erosion that tested negative for herpes virus
                                                                        1 and 2. The periphery of the biopsy showed a moderate
A 90-year-old patient was brought to the emergency depart-              dermal inflammatory infiltrate with eosinophils (Figures 1,
ment with a 3-day history of a progressively worsening er-              C and D). In between those areas, there was a zone with
ythematous rash on the trunk and abdomen. She had been                  minimal changes corresponding to the spared skin. A diag-
taking valacyclovir and metamizol for 4 days after develop-             nosis of acute drug eruption with reverse isotopic phenom-
ing herpes zoster on the upper left flank prior to onset of             enon over healing herpes zoster lesions was made. The rash
symptoms. Physical examination revealed a maculopapular                 disappeared shortly after discontinuing all medication and
erythematous rash over the trunk, abdomen and proximal                  receiving a short course of systemic corticosteroids. The pa-
extremities. The rash spared crusts and erosions that fol-              tient declined further testing, including drug patch testing.
lowed a dermatomal distribution suggestive of herpes zos-
ter infection (Figure 1A). On dermoscopy, individual lesions
                                                                        Teaching Point
were composed of a central reddish crust surrounded by a
white halo with shiny white lines, and perilesional erythema            Reverse isotopic phenomenon or isotopic non-response de-
with linear and dotted vessels (Figure 1B).                             scribes the absence of a skin disease in an area previously
    A skin biopsy was performed, including a crust, rash,               affected by another dermatosis. This sparing effect is thought
and unaffected skin. The biopsy revealed three histopatho-              to be related to dysfunction of antigen-presenting cells, par-
logically distinct zones. In the center of the biopsy, there was        ticularly Langerhans cells [1,2].




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024055                                                                              1
                      Figure 1. (A) Maculopapular erythematous rash over the trunk, which spared the h      ­ erpes
                      zoster lesions. (B) Central reddish crust surrounded by a white halo with shiny white
                      lines, and perilesional erythema with linear and dotted vessels. (C) On the right side of the
                      skin ­biopsy, a denser dermal inflammatory infiltrate corresponding to the affected skin as
                      ­opposed to the spared skin on the left. (D) Dermal edema with perivascular and interstitial
                       infiltrate of lymphocytes, plasma cells, and eosinophils.




References                                                             2. Jaka-Moreno A, López-Pestaña A, López-Núñez M, et al. Wolf’s
                                                                          isotopic response: a series of 9 cases. Actas Dermosifiliogr.
1. Kannangara AP, Fleischer AB Jr, Yosipovitch G, Ragunathan RW.          2012;103(9):798-805. DOI: 10.1016/j.ad.2012.02.007. PMID:
   Herpes zoster virus associated ‘sparing phenomenon’: is it an          22681715
   innate possess of HZV or keratinocyte cytokine(s) mediated
   or combination? J Eur Acad Dermatol Venereol. 2008;22(11):
   1373-1375. DOI: 10.1111/j.1468-3083.2008.02627.x. PMID:
   18422536.




2                                                                             Image Letter | Dermatol Pract Concept. 2024;14(1):e2024055
