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Eighteen-year-old female patient with with red scaly plaques on her forearms, legs and scalp, was referred to our out-patient clinic (Figure 1). The disease duration was over 10 years. The female patient was previously diagnosed as psoriasis. She was treated with various topical anti-psoriatic agents unsuccessfully. The lesions were not completely cleared. The patient was evaluated and clinical differential diagnosis included a number of erythematosquamous skin diseases. Due to the shape and arrangement of lesions , the diagnosis of seborrheic dermatitis, pityriasis rosea, lichen planus, pityriasis lichenoides et varioliformis acuta, pityriasis lichenoides chronica and parapsoriasis were excluded. And preliminary diagnosis of pityriasis rubra pilaris (PRP) and psoriasis were concluded. Skin punch biopsy was performed from her left forearm. Histopathological examination showed parakeratosis, loss of granular layer limited to small foci with diffuse hypergranulosis, and perivascular lymphocyte, histiocytes and extravasated erythrocytes in upper dermis (Haematoxylin-Eosin, original magnification x100) (Figure 2). These histopathological features were not fully consistent with psoriasis and did not exclude the diagnosis of PRP. Later, we performed dermoscopic examination on erythematous plaques and it revealed round/ oval yellowish areas surrounded by vessels of mixed linear and dotted morphology

The term Wolf's isotopic response refers to the appearance of a new skin disease at the site of an already healed, unrelated disease. In most cases, the initial disease is herpes zoster. Different diseases may subsequently develop on the same site. The most common isotopic responses are granulomatous and lichenoid reactions, Discoid lupus erythematosus (DLE) is the most common form of cutaneous lupus erythematosus. It is a chronic inflammatory skin disease that typically manifests as erythematous, indurated, scaly plaques that have the potential to cause permanent scarring and dyspigmentation. In May 2013, the patient presented papular and vesicular eruption that appeared at first on her right face, scalp skin and spreaded to the right arm. The patient was diagnosed as herpes zoster. After two months, she developed atrophic, scaly, erythematous papules and plaques confined to the same sites and referred to our outpatient clinic. Here we report this 62-year-old-female patient with DLE due to Wolf s isotopic response.