Surgical conversion of herpes simplex from an epidermal to a dermal disease

A new post-surgical form of recurrent herpes simplex is described. It appeared as an erythematous bulla at sites of recurrent herpes from which the prior epidermal lesion had been transversely excised. Histologically, it was characterized by a lesion-free epidermis, a large subepidermal bulla, and a marked inflammatory response in the uppermost dermis, complete with diagnostic multinucleate giant cells. It is postulated that epidermal surgery leaves the area immune to future direct herpetic involvement of the epidermis because it denervates the epidermis. The possibility is raised that such dermal forms of herpes may also occur in the natural course of the disease.