Reply to Happle R. And al. Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Abstract

We read with interest the issues raised by Happle and Kluger. The Koebner phenomenon is well-established and the number of diseases apparently showing this phenomenon has grown so much that a classification of subtypes exists. The concept of locus minoris resistentiae (lmr), which helps us explain why certain disorders occur in certain locations, appears to underlie both Koebner phenomenon and Wolf isotopic response. The isotopic response was initially defined as "the occurrence of a new disorder at the site of another, unrelated and already healed skin disease". Wolf himself cited lmr as a putative explanation for the occurrence of the isotopic response. Certain questions arise from the initial definition by Wolf and the ever growing extensions of the isotopic response we see today.

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