title: Herpes simplex virus reactivation as a trigger of mucous lesions in pemphigus vulgaris.
abstract: BACKGROUND
  Although infectious agents have long been implicated in the induction or exacerbation of pemphigus vulgaris (PV), a convincing role for the agent in the aetiology of PV has not been established.
  
  
  OBJECTIVE
  To establish the association with PV and herpes simplex virus (HSV).
  
  
  METHODS
  We examined saliva for the presence of HSV DNA after the onset of PV initially localized to the oral lesions in addition to conventional serological tests and immunohistochemistry.
  
  
  RESULTS
  We successfully detected high levels of HSV DNA in the saliva samples from six of 16 patients with PV at the earliest stage, who had no episodes of herpes simplex. The prevalence (37·5%) of detecting HSV DNA in the patients with PV was lower than that of eczema herpeticum (56·5%), but comparable to that in patients with herpes labialis (30·0%). Copy numbers of the HSV DNA were rather higher than those with herpes labialis and with eczema herpeticum. In general, detection of HSV DNA in saliva was transient and restricted to the earliest phase of the disease. In addition, anti-HSV immunoglobulin (Ig) G titres in patients with PV were significantly higher than those in patients with virologically confirmed HSV-induced disorders. All salivary HSV DNA-positive patients with PV had run a more complex, intractable course refractory to conventional therapy.
  
  
  CONCLUSIONS
  Detection of HSV DNA in saliva is a useful and noninvasive, quantitative method for establishing the role of HSV in the pathogenesis of PV and for identifying individuals at greater risk for subsequently developing refractory PV.
authors.affiliation: Department of Dermatology, Kyorin University School of Medicine, Shinkawa, 6-20-2, Mitaka, Tokyo, 181-8611, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kurata
authors.forename: Y
authors.initials: Y
authors.lastname: Mizukawa
authors.forename: Y
authors.initials: Y
authors.lastname: Aoyama
authors.forename: T
authors.initials: T
authors.lastname: Shiohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006561:Herpes Simplex / Q000150:complications*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000276:immunology / Q000502:physiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000821:virology*; D010392:Pemphigus / Q000821:virology*; D012463:Saliva / Q000821:virology; D014775:Virus Activation / Q000502:physiology
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G