Wolf’s Isotopic Response in a Post Herpes Zoster Patient Forming Superficial Basal Cell Carcinoma

Basal cell carcinoma (BCC) is a common cutaneous malignancy in Caucasians but has a low incidence in Indian skin. Most commonly, BCC is found in sun-exposed areas, with intermittent ultraviolet exposure as a major risk factor. Although rarely fatal, BCC can cause tissue damage if left untreated. Varicella zoster virus affects both nerve endings and skin, thereby presenting as a rash that may resolve with persisting pain as a symptom. Wolf’s isotopic response (WIR) phenomenon is the formation of a new unrelated disease in the area of a previously healed disease. A 72-year-old housewife with a clinical history of resolved herpes zoster on the scalp presented with an erythematous, atrophic lesion with crusting and fissuring. The post-herpetic neuralgia gradually resolved, but the lesion was not responding to any form of treatment. The histopathological examination demonstrated a picture consistent with superficial basal cell carcinoma. The neurotransmitters released by the nerve endings during an episode of varicella alter the immune control process. This can be a probable cause of a second, unrelated disease, i.e., viral activation in a specific ganglion may alter local immunity, therefore triggering a neoplastic transformation.