Hailey-Hailey Disease Complicated by Herpes Simplex Viral Infection

Abstract

Eczema herpeticum refers to a disseminated HSV infection in areas of impaired skin barrier, most commonly in the setting of atopic dermatitis. It has rarely been reported in the literature in Hailey-Hailey disease patients. When recognized early, eczema herpeticum is easily and effectively treated with antiviral medications.A 51-year-old man with a history of HaileyHailey disease and recurrent MRSA cutaneous infections presented with a rash in his groin persisting for two weeks. This flare was more painful than usual and felt "like ants under (his) skin". He had been treated without improvement at an outside facility for presumed staphylococcal and yeast infections with low-dose prednisone, IV daptomycin, and topical nystatin. Gold Bond powder was also unhelpful. On physical exam, macerated erythematous thin plaques were present with superimposed grouped punched-out ulcers in the inguinal folds and on the scrotum. There were also crusted small red papules scattered over the central chest, upper back, axillary vaults and posterior neck. Biopsy from the upper back showed extensive suprabasal acantholysis consistent with Hailey-Hailey disease. Secondary infection in the groin with herpes simplex virus (HSV) was suspected; a viral culture from the ABSTRACT A 51-year-old man with a history of Hailey-Hailey disease presented to clinic due to worsening discomfort from a rash in his groin. Physical examination of the inguinal area and scrotum revealed grouped, punched-out ulcers on a base of macerated, erythematous plaques. Viral culture from the ulcers was positive for HSV -2. The patient had no known history of Herpesvirus infection. Treatment with oral valacyclovir resulted in marked clinical improvement. Although cases of HaileyHailey herpeticum are much less common than the better-studied eczema herpeticum, it is important for physicians to be aware that any disease that disrupts the stratum corneum increases the risk of superimposed HSV infection, which constitutes a medical emergency. Prompt treatment with antiviral agents can hasten patient recovery and optimize outcomes.