Pemphigus is a group of autoimmune blistering diseases of the skin and/or mucous membranes caused by the presence of antibodies against adhesion molecules on the cell surface of keratinocytes. [1] Most cases are localized to the face and trunk and are characterized by recurrent crops of flaccid bullae that readily rupture, resulting in shallow crusted erosions which heal leaving behind hyperpigmentation. Rarely can it also present as erythroderma. [2] Management requires immunosuppressive therapy. In rare cases, herpes simplex virus infection can develop as a consequence of immunosuppressive therapy in these patients and cause a clinical diagnostic dilemma. Definite diagnosis is essential as the management then requires immunosuppressive therapy with antiviral drugs.
Pemphigus foliaceus is an autoimmune disease having a chronic generalized course or may rarely present as an exfoliative dermatitis. Presence of occult HSV infection is involved in development of pemphigus and immunosuppressive therapy for pemphigus results in flare of typical or atypical herpetic lesions. We herein report of a case of a 48 year old male on immunosuppressive therapy for pemphigus foilaceous resulting in flare of herpetic infection.
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