By Gary M. White, MD

Various diseases may affect the skin in a dermatomal distribution including herpes zoster, herpes simplex, granuloma annulare in the prior site of herpes zoster, herpes zoster sine herpete (pain is the presenting symptom), and the scarring from congenital varicella.

The term Wolf's isotopic response is a related term and indicates the development of a new and seemingly unrelated skin condition at the site of another skin disorder that appears to already have healed.


Zoster Sine Herpete. Zoster Sine Herpete is the occurrence of the pain of Herpes Zoster without the cutaneous signs.


Granuloma annulare in a zoster scar [JAAD 14;765 and AD 119;788].

Zosteriform B-Cell Chronic Lymphocytic Leukemia Infiltration. A 77-year-old woman, known to have chronic lymphocytic leukemia, developed multiple red, erythematous, pruritic papules, which had suddenly appeared on her left hemithorax, along the C6 dermatome, with a 4-week duration. Dermatology Online Journal 17(9)


Herpes simplex may rarely produce vesicles in a dermatome [JAAD 23;928]. Photograph courtesy of Michael O. Murphy, MD
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Herpes Zoster
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Congenital Scars

Congenital Varicella Syndrome

Diseases Following Herpes Zoster

Various diseases have been reported to occur in the dermatome previously affected by herpes zoster including granuloma annulare, granulomatous vasculitis, pseudolymphoma, sarcoid granulomas, and tuberculoid granulomas. Note: Wolf’s isotopic response is the development of a new cutaneous condition at the location of a previous, unrelated, and already healed skin disease.

Fixed Drug Eruption [International Journal of Dermatology 2012:57:327]

Chronic Graft Vs Host Disease following herpes zoster. BJD 2015;173;1050–1053


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