EXAMINATION OF NONINVOLVED SKIN, PREVIOUSLY INVOLVED SKIN, AND PERIPHERAL-BLOOD FOR HERPES-SIMPLEX VIRUS-DNA IN PATIENTS WITH RECURRENT HERPES-ASSOCIATED ERYTHEMA MULTIFORME

The association between infection with HSV and the subsequent developm ent of erythema multiforme is well established, although the role that the virus plays in the pathogenesis of this disorder is not known. HS V DNA has been detected in cutaneous lesions of herpes-associated eryt hema multiforme (HAEM), and it has been suggested that the tissue dama ge seen in these lesions is virus-specific. In the current, prospectiv e study, we examined biopsies of lesional, non-involved, and previousl y involved but healed skin, in addition to specimens of peripheral blo od, from patients with HAEM, for HSV DNA by using the polymerase chain reaction. HSV DNA was detected in lesional skin of 10 of 11 patients compared to 2 of 11 non-involved skin biopsies obtained at the same ti me. HSV was present in 4 of 6 blood specimens obtained during the acut e episode. Five patients returned 3 months after the acute episode res olved for biopsies of previously involved skin. HSV was detected in 4 of these 5 biopsies. Thus, the presence of HSV DNA in the skin of pati ents with HAEM appears to be predominantly in areas of clinical involv ement; the virus remains in those cutaneous sites for up to 3 months w ithout evidence of clinical disease; and HSV DNA may be detected in th e peripheral blood cells during acute HAEM. Based on these findings, w e suggest that the virus plays a role in lesion development, that the skin may function as a site of viral persistence, and that hematogenou s spread of viral DNA may be an important factor in the development of HAEM.