| BackgroundHerpes zoster(HZ)is an infectious skin disease caused by the reactivation of varicella-zoster virus(VZV).Isotopic response refers to a new skin disease(secondary disease)occurring in the same place as another healed and unrelated skin disease(primary disease).Wolf's isotopic response of herpes zoster corresponds to the phenomenon that a new skin disorder occurs at the same site of a previous and already healed(scarring or pigmentation changes included)herpes zoster eruption.At present,few case reports and analyses of clinical features regarding this phenomenon are available.ObjectiveWe aim to improve the recognition to this phenomenon and decrease the possibility of misdiagnosis by reporting cases and analysing the clinical features.MethodsCases with Wolf's isotopic response of herpes zoster admitted to the dermatology department of Qilu Hospital of Shandong University from September 2016 to December 2018 were reported.Relevant literatures were searched and then screened through CNKI,Wanfang Database and PUBMED,individual patient data(IPD)were extracted from the literatures,and the patients with Wolf's isotopic response of herpes zoster in our hospital were summarized.Patients' clinical data,including:age,gender,underlying diseases,secondary disease,herpes zoster,time interval between HZ and the secondary disease,whether skin histopathological examination was performed,VZV polymerase chain reaction(PCR),location,whether scarring occurred after healing of HZ and zoster-associated pain(ZAP).SPSS 25.0 and Graphpad Prism 6.0 were used for statistical analysis and graphing.P<0.05 was considered statistically significant.ResultsPart ?:Report of 3 casesFive cases diagnosed with Wolfs isotopic reaction of herpes zoster were admitted in Qilu hospital of Shangdong University from September 2016 to December 2018,among which 2 cases were excluded for unclear diagnosis,and 3 cases were included in this study.Brief clinical data of 3 cases admitted to our hospital are as follows:Case 1:Male 65 years old(ys).He suffered from HZ on his right chest and back,and 20 days after healing,papulovesicles and vesicles appeared at the same site with pruritus.The diagnosis is eczema(Wolfs isotopic response of herpes zoster).Case 2:Female,82ys.She had HZ on her left abdomen and lumbar,and 1 year after its healing,oval depigmented macules appeared at the same site.The diagnosis is morphea(Wolfs isotopic response of herpes zoster).Case 3:Female,60ys,She had HZ on her left abdomen,and 60 days after its healing,she presented with dark red patches,on which were clustered red papules.The diagnosis is lymphocytic infiltration of skin(Wolfs isotopic response of herpes zoster).Part ?:Literature review and analysesA total of 114 cases of Wolfs isotopic response of herpes zoster reported in 86 case report or case series during 1978 and 2018 were included through literature search.In combination with 3 cases in our hospital,IPD of 117 cases were extractedand analysed.1.Gender and age:56 male patients and 61 female patients were included,and the ratio of male to female was 1:1.1.Age ranged from 4ys to 83ys with a median age of 57.0(43.0,67.0)ys.The number of patients aged more than 50ys was 76,accounting for 65.0%of the total.The median age of male patients was 57.0(38.5,67.8)ys and the median age of female patients was 57.0(46.5,67.0)ys.The age composition difference between male and female patients was not statistically significant(P=0.63).2.Underlying diseases:39 patients(33.3%)were immunocompromised for certain underlying diseases,among which patients with hematological diseases(mainly leukemia or lymphoma)were the most,with a total of 22 patients(18.8%).3.Secondary disease:Secondary diseases varied a lot,35 cases(29.9%)of noninfectious granuloma,8 cases(6.8%)of infectious diseases,17 cases(14.5%)of erythema scale diseases,13 cases(11.1%)of connective tissue disease,16 cases(13.7%)of skin appendage diseases,11 cases(9.4%)of skin tumors and related proliferative diseases,6 cases(5.1%)of eczema and dermatitis diseases,and 11 cases(9.4%)of other diseases were reported.Granuloma annulare(GA)(17 cases,14.5%)and acne(12 cases,10.3%)were the most commonly reported diseases.4.Interval between HZ and secondary diseases:The shortest time interval was 2 days(d),the longest was 4745ds,and the median time interval was 60(28,180)ds.5.VZV PCR at skin lesions of secondary diseases:Among the 22 patients who underwent this examination,21 were negative.6.Location:Patients with different involved regions were counted.The trigeminal,cervical,intercostal,and lumbosacral region involved patients were I18,19,50,and 18,accounting for 17.1%,18.1%,47.6%,and 17.1%,respectively.There was no statistically significant difference between the locations of Wolfs isotopic response of herpes zoster and herpes zoster(P=0.20).7.Secondary diseases and age:The median age of patients with noninfectious granuloma,infectious diseases,erythema scale diseases,connective tissue diseases,skin appendage diseases,skin tumors and related proliferative diseases,eczema and dermatitis and other diseases was 59.0(53.0,71.0)ys,48.5(32.5,69.0)ys,43.0(35.5,65.5)ys,47.0(21.0,66.0)ys,50.0(38.5,58.75)ys,58.0(43.0,71.0)ys old,54.0(40.8,66.3)ys and 67.0(59.0,71.0)ys respectively.The age composition of secondary diseases was different(P=0.03).Older ages were seen in the noninfectious granuloma and other disease groups.8.Secondary diseases and immunocompromising underlying diseases:The number of patients with immunocompromising underlying diseases in different secondary disease groups was 19,2,3,9,2,2,0 and 3,accounting for 54.3%,25.0%,17.7%,69.2%,12.5%,18.7%,0.0%and 27.3%of the corresponding disease groups respectively.The difference was statistically significant(P<0.01).Patients with noninfectious granuloma and connective tissue diseases were more likely to be associated with the immunocompromising underlying diseases.9.Secondary diseases and time interval&secondary diseases and herpes zoster scar:The overall distribution of time interval of different diseases was the same,and the difference was not statistically significant(P=0.18);The number of patients with herpes zoster scar was 10,3,1,2,1,2,2,2 and 4,accounting for 28.6%,37.5%,5.6%,15.4%,6.3%,18.2%,33.3%and 36.4%of the corresponding disease groups,respectively.The difference was not statistically significant(P=0.45).Conclusion1.Secondary diseases of Wolf's isotopic response of herpes zoster were diverse,and noninfectious granuloma diseases were the most common.2.The time interval between herpes zoster and secondary diseases was significantly different among patients,whereas 1 month to half a year were most commonly seen.3.Antiviral treatment was not necessary.4.The tendency of the occurrence site is similar to that of herpes zoster,and there is no special site tendency.5.The types of secondary diseases were related to age,and patients in noninfectious granuloma group was relatively older.Patients with noninfectious granuloma and connective tissue diseases were more likely to be associated with immunocompromising underlying diseases.The type of secondary disease was independent of the time interval and whether there were scars following herpes zoster. |
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