Prevalence and clinical features of herpes simplex virus infection in oral lesions of pemphigus vulgaris: A prospective, cross-sectional study

Zhang, Hanmei; Wang, Yuan; Li, Suo; Yu, Mei; Feng, Suying

doi:10.1016/j.jaad.2022.03.015

Cited by 9 publications

(12 citation statements)

References 5 publications

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“…We recently investigated the correlation of HSA infection and pemphigus vulgaris (PV), and found that the significantly elevated prevalence of HSV infection in PV patients might mainly be caused by ruptured barrier of oral mucosa ( 12 ). HSV infection in MMP patients was rarely reported ( 13 ), and its potential participation mechanism in the present MMP case is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies

Liu

Yun

et al. 2023

Front. Immunol.

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Mucous membrane pemphigoid (MMP) is a type of subepithelial autoimmune bullous disease, affecting various mucosae, occasionally with skin lesions. Both diagnosis and treatment of MMP are difficult. Although multiple autoantigens have been identified for MMP, the pathogenesis of MMP is still unclear. In this study, we presented a female MMP case with extensive oral mucosal lesions and skin lesions, particularly on the extremities. IgG and IgA autoantibodies against multiple autoantigens including BP180, laminin 332, integrinα6β4 and desmoglein 3, and IgM autoantibodies against BP180 were identified during the disease course. Compared with IgG autoantibodies, the levels of IgA autoantibodies against various autoantigens decreased more significantly with improvement of clinical features after the initiation of treatments. Our findings indicated the importance of comprehensive autoantibody screening for different immunoglobulin types and autoantigens at multiple time points for the precise diagnosis of various autoimmune bullous diseases, and the significant involvement of IgA autoantibodies into the pathogenesis of MMP.

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Section: Discussionmentioning

confidence: 99%

Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies

Liu

Yun

et al. 2023

Front. Immunol.

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“…Furthermore, HSV infection was found to be related to exacerbation of PV manifestations 10,11 . Although previous studies have reported a promising role for HSV infection and PV, this hypothesis was not evaluated using gold‐standard methods, including molecular evaluation of PV lesions , in the majority of the studies 11–13 . Furthermore, the findings of previous studies regarding the relationship between HSV and PV severity or exacerbation were contradictory 5,9–14 .…”

Section: Introductionmentioning

confidence: 99%

“…The possible relationship between HSV infection and PV lesions was suggested based on the elevated titres of HSV half IgG antibodies among PV patients 11 . Based on the detection of HSV‐specific DNA in swabs taken from PV oral lesions, it was hypothesised that antiviral therapeutic regimens could improve the disease‐related lesions 12,13 . Furthermore, HSV infection was found to be related to exacerbation of PV manifestations 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Detection of herpes simplex viruses in the oral lesions of patients with pemphigus vulgaris: Is it diagnostic or predictive of disease severity?

Kamyab

Daneshpazhooh

Zaresharifi

et al. 2023

Skin Health and Disease

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BackgroundSome studies emphasise the relationship between the herpes simplex virus (HSV) and pemphigus. Although the possible role of HSV in the pathogenesis of pemphigus and the severity of the disease is obscure, we aimed to evaluate the presence of herpes simplex viruses (HSV 1/2) in the oral lesions of patients with pemphigus vulgaris and also assess its association with disease severity and types of lesions.MethodsA retrospective study was conducted on collected data in the form of collecting paraffin blocks, slides, and relevant pathology reports and referring to patients' medical records. A questionnaire containing details on the degree of skin, scalp, and mucosal involvement (Pemphigus Disease Area Index (PDAI)) was fulfiled. The immunoassay result was also collected to check the anti‐desmoglein 3 and 1 antibodies (using ELISA technique).ResultsIn this study, 52 patients of pemphigus vulgaris with oral lesions (case) and 52 patients with oral lesions not related to the disease (control) were evaluated. HSV1 was detected in 13.5% of oral pemphigus lesions and 1.9% of the control group (p = 0.0598). There were no positive cases of HSV2 in either group. There was no significant association between the positivity of HSV1 and the site of lesions (p = 1.00) or disease severity (p = 0.28). However, we found a strong correlation between the PDAI disease severity score with the titre of the AntiDsg3 antibody (r = 0.487, p = 0.001) and AntiDsg1 antibody (r = 0.309, p = 0.026).ConclusionThis study demonstrated a significant prevalence of HSV1 in oral pemphigus lesions, and acyclovir therapy may play a significant role in managing these patients. However, HSV's role in the pathogenesis of pemphigus vulgaris cannot be clearly determined.

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“…This inconsistent relationship between anti-Dsg antibodies and disease activity among PV patients with HSV infection is consistent with our previous findings. 11 In conclusion, the possibility of HSV infection must be considered if the oral lesions of PV are treatment-refractory, especially in patients with continually decreasing anti-Dsg antibodies.…”

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confidence: 99%

Treatment of refractory pemphigus vulgaris oral lesions

Zhang

Wang

et al. 2023

J Deutsche Derma Gesell

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Dear Editors,Pemphigus vulgaris (PV) is a rare intraepidermal autoimmune bullous dermatosis mainly caused by anti-desmoglein (Dsg)3 with/without anti-Dsg1 autoantibodies. 1 This letter reports three specific PV patients with refractory oral lesions who tested negative for anti-Dsg antibodies and whose skin lesions regressed completely after immunosuppressant treatment. All refractory oral lesions in the three patients were positive for Herpes simplex virus (HSV) and healed only after anti-virus treatment.Three patients with multiple erosions and flaccid blisters on scalp, trunk, and oral mucosa (patient 3 with concomitant vulvar erosions) were diagnosed with PV by the presence of anti-Dsg autoantibodies, histopathology, and direct immunofluorescence examinations. Upon confirmation of the diagnosis, systemic immunosuppressants were prescribed to treat the disease. Patient 1 was initially treated with prednisone (40 mg/day) and ciclosporin (75 mg, thrice a day); patients 2 and 3 were initially treated with methylprednisolone(60 mg/day) and azathioprine (50 mg, twice a day), and the azathioprine was replaced by mycophenolate mofetil (1,000 mg, twice a day) in patient 2 due to a decrease in white blood cells three weeks later. Patients 2 and 3 were also treated with intravenous immunoglobulins (0.4 g/kg⋅body weight [BW]/d*5d) once during the disease. In all three patients, with the addition of immunosuppressants, all the lesions on scalp and trunk (vulva in patient 3), as well as part of the lesions on oral mucosa gradually healed and the titer of anti-Dsg autoantibodies dropped to negative (Table 1). However, part of the oral lesions remained and were resistant to therapy in the three patients (Figures 1a, b, 2a, b). Additionally, some new oral lesions appeared in patient 1. The remaining oral lesions in patients 1 and 2 were topically injected with triamcinolone acetonide but showed no improvement, with some

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Prevalence and clinical features of herpes simplex virus infection in oral lesions of pemphigus vulgaris: A prospective, cross-sectional study

Cited by 9 publications

References 5 publications

Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies

Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies

Detection of herpes simplex viruses in the oral lesions of patients with pemphigus vulgaris: Is it diagnostic or predictive of disease severity?

Treatment of refractory pemphigus vulgaris oral lesions

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