Granuloma annulare occurring on preceding herpes zoster as an isotopic response = Granuloma annulare occurring on preceding herpes zoster as an isotopic response

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In 1995, Wolf et al. coined the term isotopic response to describe the occurrence of a new, unrelated disease at the site of another already healed skin disease. Most reported in the literature as original disease is herpes zoster. However, greatly varied in isotopic response including granulomatous reactions, malignant tumors, leukemic infiltrations, dysimmune reactions. A 54-year-old female presented with multiple erythematous, flat-topped papules, some coalescing, in a zosteriform distribution on the right T11 dermatome area. 6 months before, exactly the same area was involved by herpes zoster and treated with no scar formation. Histopathology showed irregular and eosinophilic collagen with moderate cellular infiltration in upper dermis. A palisades of histiocytes, lymphocytes, and multinucleated giant cells surrounding focal degenerated collagen were seen in high magnifications. From the clinical and histopathologic findings, the diagnosis of granuloma annulare as an isotopic response was made. The patient was treated with mometasone furoate cream twice a day with resolution noted in 1 month. We herein report a case of granuloma annulare occuring on preceding herpes zoster as an isotopic response.