Herpes Simplex Virus Infection in Pemphigus Patients: A Prospective Study

This prospective study over 15 months examined 8 cases of pemphigus (PV) associated with herpes simplex virus (HSV) infection. The study found that HSV infection typically occurred around 27.5 days after the onset of PV treatment, which included oral steroids, azathioprine, and rituximab. Herpetic lesions appeared as fissures, erosions, and hemorrhagic crusts, and were confirmed with a positive Tzanck smear. All patients recovered rapidly with acyclovir/valaciclovir treatment. The study suggests that recognizing HSV infection in PV patients can prevent unnecessary changes in immunosuppressive treatment, as HSV may be a causative factor in treatment-resistant lesions due to immunosuppressive therapies and viral induction of autoimmunity.