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Hailey–Hailey Disease With Coexistent Herpes Virus Infection

Insights Into the Diagnostic Conundrum of Herpetic/Pseudoherpetic Features in Cutaneous Acantholytic Disorders

Leitch, Claire S., MB ChB*; Panthagani, Anusha P., MB ChB, MRCP; Tidman, Michael J., MD, FRCP*; Biswas, Asok, MD, FRCPath, DipRCPath

The American Journal of Dermatopathology: October 2018 - Volume 40 - Issue 10 - p 749–753
doi: 10.1097/DAD.0000000000000902
Lessons Learned at the Microscope

Abstract: The specific histopathologic diagnosis of a primary acantholytic disorder takes into account the distribution and extent of acantholysis, presence or absence of dyskeratosis, nature of the dermal inflammatory cell infiltrate, and immunofluorescence findings. Herpes virus infection is a common cause of secondary acantholysis where distinctive viral cytopathic changes aid in making it a clear-cut diagnosis in majority of cases. We present a case of coexistence of Hailey–Hailey disease and herpes simplex virus infection to compare and contrast their histopathologic features. This is imperative because acantholytic cells from primary acantholytic disorders may occasionally show cytological features traditionally associated with herpes virus infection (pseudoherpetic changes). The objective of this article is to create a greater awareness of pseudoherpetic changes and also to explore the clinical significance of coexistence of a primary acantholytic disorder and herpes virus infection, as in this case.

*Department of Dermatology, Lauriston Building, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom;

Department of Dermatology, Royal Derby Hospital, Derby, United Kingdom; and

Department of Pathology, Western General Hospital, The University of Edinburgh, Edinburgh, United Kingdom.

Correspondence: Asok Biswas, MD, FRCPath, DipRCPath, Department of Pathology, Western General Hospital and the University of Edinburgh, Alexander Donald Building, Crewe Road, Edinburgh EH4 2XU, United Kingdom (e-mail:

The authors declare no conflicts of interest.

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