Exploring the link between herpes viruses and pemphigus vulgaris: literature review and commentary

Pemphigus vulgaris (PV) is an autoimmune skin condition characterized by the presence of circulating autoantibodies specific for a subset of cellular adhesion proteins within mucosal and/or non-mucosal epidermal surfaces. Although the presence of self-directed antibodies is well established, the exact etiology of PV is still uncertain. Environmental factors have been linked to a variety of autoimmune disorders. Specifically, viral infection has been considered to act as one contributory component in disease pathogenesis. Perhaps the most studied group of pathogens is that of herpes viruses, with considerable evidence linking the herpes simplex virus and PV. These viruses have been reported to influence the course of disease and have been associated with PV flares and clinical exacerbations. However, there are significant inconsistencies amongst published data; additional analysis is required to solidify the proposed relationship. In the following article, we critically review the literature regarding the impact of the herpes viruses on PV, providing a framework for clinical application, mechanistic pathways, and future investigation.