The association between pemphigus and human herpesvirus (HHV) has been debated for decades. This review comprehensively summarizes current evidence on the epidemiological links, pathogenic hypotheses, and management challenges of HHV infection in pemphigus patients. Epidemiological studies indicate a higher prevalence of HHV infections in pemphigus patients compared to healthy controls. Hypotheses on the potential role of HHV in pemphigus were categorized into three distinct types: a trigger for disease onset, a factor in exacerbation or treatment resistance, or a complication of immunosuppressive therapy. Clinically, while HHV coinfection poses challenges to clinical diagnosis, specific clinical features may facilitate timely identification. Furthermore, empirical antiviral therapies demonstrate efficacy in improving patient outcomes, but standard guidelines are lacked. A clearer understanding of this association between virus and host autoimmunity is essential for optimizing outcomes in patients with pemphigus.
Lu et al. (2026) studied this question.