Cutaneous Lupus After Herpes Zoster: Isomorphic, Isotopic, or Both?


  • Drs. Nicole Y. Lee, Alyssa S. Daniel, David A. Dasher, and Dean S. Morrell had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • We are indebted to Dr. Leonard Stein for referral of this patient and to Dr. Daniel Zedek for providing the pathological micrograph of this patient.

Address correspondence to Nicole Y. Lee, M.D., M.P.H., Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, 211 Columbia Place West, Chapel Hill, NC 27516, or e-mail:


Abstract:  Koebner isomorphic response describes the phenomenon of histopathologically identical skin lesions of a preceding cutaneous disease appearing in sites of trauma. Wolf isotopic response describes the phenomenon of a new skin disease appearing in the site of an unrelated cutaneous disease. Neither of the phenomena has been reported in relation to systemic lupus erythematosus. This report describes a 17-year-old girl with systemic lupus erythematosus exhibiting particularly severe cutaneous involvement confined primarily to sun-exposed areas presenting with a dermatomal band of atrophic, scaling, erythematous papules, and plaques on her left shoulder extending down her left arm after herpes zoster eruption. The histopathologil result showed lupus erythematosus. This phenomenon is best considered as a Koebner isomorphic response, although Wolf isotopic response has some clinical relevance as well. Koebner isomorphic and Wolf isotopic responses are discussed as related to this case.