Clinical markers of herpes simplex virus infection in patients with pemphigus vulgaris.

BACKGROUND: Herpes simplex virus (HSV) is known to influence the course of pemphigus vulgaris. Relapse, exacerbation, and treatment resistance in patients with pemphigus vulgaris can be due to HSV infection.

OBJECTIVES: To characterize the clinical markers of HSV infection among patients with pemphigus.

METHODS: This was a hospital-based, descriptive study performed with 60 consecutive patients with pemphigus vulgaris. The clinical and laboratory features of patients with documented HSV infection were then compared with those of patients without infection.

RESULTS: HSV infection was confirmed in 23 (38.33%) patients. On univariate analysis, it was noted that male sex (P = .03); presence of fissures (P = .001), hemorrhagic crusts (P = .003), erosions with angulated margins (P = .024), and linear erosions (P = .001); and raised erythrocyte sedimentation rate (P = .015) were found to be significantly associated with HSV infection. In a multivariate analysis, hemorrhagic crusts (P = .015) and linear erosions (P = .008) were found to be independent predictors of HSV infection.

LIMITATIONS: We did not use polymerase chain reaction to detect HSV infection, which could have yielded more cases of HSV infection.

CONCLUSION: In the clinical setting of pemphigus vulgaris, the presence of fissures, hemorrhagic crusts, linear erosions, erosions with angulated margins and raised erythrocyte sedimentation rate must alert the clinician to the possibility of HSV superinfection.