In patients with pemphigus vulgaris, the presence of fissures, hemorrhagic crusts, linear erosions, erosions with angulated margins, and raised erythrocyte sedimentation rate may be indicative of herpes simplex virus (HSV), according to study results published in the Journal of the American Academy of Dermatology.

A total of 60 consecutive patients with pemphigus vulgaris with active skin or mucosal lesions were recruited from the dermatology department of a single hospital in India. The investigators examined the skin and mucosae for the presence or absence of grouped vesicles, polycyclic margins of the erosions, linear erosions, erosions with angulated margins, periorbital edema, fissures, pustules, and hypopyon. Clinical and laboratory features of patients with documented HSV infection were then compared with those of patients without HSV infection.

More than one-third of patients (38.33%) had a clinically confirmed HSV infection. After ten days of acyclovir therapy, the mean Pemphigus Disease Area Index of the patients infected with HSV was reduced from 46.74±21.92 to 35.44±17.95 (P =.003).

According to the univariate analysis, factors associated with HSV infection included male gender (P =.03), presence of fissures (P =.001), hemorrhagic crusts (P =.003), erosions with angulated margins (P =.024), linear erosions (P =.001), and raised erythrocyte sedimentation rate (ESR) (P =.015). The only independent predictors of HSV infection in the multivariate analysis, however, were the presence of hemorrhagic crusts (P =.015) and linear erosions (P =.008).

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Study limitations include its small sample size, as well as the inclusion of patients from a single hospital in India.

Based on their findings, the researchers concluded that “the physician may prescribe prophylactic acyclovir in a patient of severe pemphigus on long-term immunosuppressive therapy having fissures, haemorrhagic crusts, linear erosions, erosions with angulated margins, and raised ESR.”

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Reference

Konda D, Chandrashekar L, Dhodapkar R, Ganesh RN, Thappa DM. Clinical markers of herpes simplex virus infection in patients with pemphigus vulgaris [published online June 10, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.06.002