Chinese Journal of Dermatology ›› 2023, Vol. 56 ›› Issue (3): 229-233.doi: 10.35541/cjd.20220451

• Original Articles • Previous Articles     Next Articles

Clinical characteristics and treatment of eight cases of pemphigus/bullous pemphigoid complicated by herpes simplex virus infection

Wan Li, Hu Bin, Luo Hongyu, Fang Meizhen, Han Lijuan, Chen Qiang, Zhou Xiaoyong, Chen Liuqing, Chen Jinbo   

  1. Department of Dermatology, Wuhan No.1 Hospital, Wuhan 430022, China The first author is working at Dermatology Hospital of Southern Medical University, Guangzhou 510515, China
  • Received:2022-06-23 Revised:2022-12-21 Online:2023-03-15 Published:2023-03-06
  • Contact: Chen Jinbo; Chen Liuqing;
  • Supported by:
    2018 Milstein Medical Asian American Partnership Foundation Research Project Award in Dermatology (MMAAP, 2018); Health Commission of Hubei Province Scientific Research Project (WJ2021M002)

Abstract: 【Abstract】 Objective To retrospectively analyze clinical characteristics and treatment of pemphigus/bullous pemphigoid (BP) complicated by herpes simplex virus (HSV) infection. Methods Inpatients with pemphigus/BP complicated by HSV infection were collected from Wuhan No.1 Hospital from 2016 to 2021, and their clinical characteristics, treatment and follow-up results were retrospectively analyzed. Results Among the 8 patients with pemphigus/BP complicated by HSV infection, there were 2 males and 6 females, and their age was 50.6 ± 8.3 years. Five of them were diagnosed with pemphigus vulgaris (PV), 1 with pemphigus foliaceus (PF), and 2 with BP. Seven were infected with HSV-1, and 1 with HSV-2. All the 8 patients were given systemic glucocorticoids and immunosuppressive agents for the treatment of pemphigus or BP, and were admitted to the hospital due to resistance to the treatment. Seven patients presented with exacerbation or recurrence of primary lesions, and 1 presented with enlarged lesions all over the body. HSV infection-induced lesions were located on the trunk in 4 cases, on the oral mucosa in 4, on the scalp in 3, and on the face in 2; lesions mainly manifested as irregular erosions with blood crusts, and some centrally umbilicated pustules; 7 patients had obvious pain at the lesional sites. During HSV infection, anti-desmoglein 1 antibody levels decreased in all the 6 patients with pemphigus, and anti-desmoglein 3 antibody levels decreased in 4 of the 5 patients with pemphigus vulgaris; anti-BP180 antibody levels decreased in 1 patient with BP, but increased in the other one with BP. After antiviral therapy at adequate doses for adequate durations (7- to 14-day treatment with valacyclovir alone or in combination with ganciclovir), HSV infection was controlled, the autoimmune bullous skin disorder intensity scores decreased compared with those before the antiviral therapy, and pain was significantly relieved in all the patients. No dose adjustment of glucocorticoids or other immunosuppressive agents was made during antiviral therapy in all patients. Conclusion HSV infection should be considered when patients with pemphigus/BP suffer from recurrence or exacerbation and poorly respond to conventional treatment; for patients with pemphigus/BP complicated by HSV infection, systemic antiviral therapy at adequate doses can be used to control the disease condition without modifying the conventional immunosuppressive regimen.

Key words: Pemphigus, Pemphigoid, bullous, Herpesvirus 1, human, Herpesvirus 2, human, Skin manifestation, Treatment outcome