World J Clin Cases. Jan 16, 2026; 14(2): 116933 Published online Jan 16, 2026. doi: 10.12998/wjcc.v14.i2.116933
Herpes simplex risk during biologic treatment for erythrodermic psoriasis
Shree V Dhotre, Pradnya S Dhotre, Basavraj S Nagoba
Shree V Dhotre, Department of Microbiology, Ashwini Rural Medical College, Hospital and Research Centre, Solapur 413006, Maharashtra, India
Pradnya S Dhotre, Department of Biochemistry, Ashwini Rural Medical College, Hospital and Research Centre, Solapur 413001, Maharashtra, India
Basavraj S Nagoba, Department of Microbiology, MIMSR Medical College, Latur 413531, Maharashtra, India
Author contributions: Dhotre SV conceived the correspondence, coordinated manuscript preparation, and led drafting; Dhotre PS and Nagoba BS contributed to literature interpretation and critical discussion; Dhotre SV and Nagoba BS performed literature review and manuscript revision; all authors approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Corresponding author: Shree V Dhotre, Associate Professor, Department of Microbiology, Ashwini Rural Medical College, Hospital and Research Centre, At post-Kumbhari, Solapur 413006, Maharashtra, India. shree_v_dhotre@yahoo.co.in
Received: November 25, 2025 Revised: December 29, 2025 Accepted: January 14, 2026 Published online: January 16, 2026 Processing time: 52 Days and 17.5 Hours
Abstract
Disseminated herpes simplex virus infection in erythrodermic psoriasis remains exceedingly uncommon, yet it poses substantial diagnostic and therapeutic challenges in patients receiving biologic therapy. The recent case by Berjawi et al illustrates an atypical presentation of widespread herpes simplex virus-1 in a patient undergoing treatment with ixekizumab and topical corticosteroids, highlighting diagnostic uncertainty, cumulative immunosuppression, and therapeutic decision-making in severe psoriasis. This correspondence aims to emphasize the challenges of early herpes simplex virus recognition, discuss the potential but associative role of interleukin-17 inhibition in antiviral defence, and underscore the lack of clinical guidance regarding interruption and safe reintroduction of biologic therapy following viral clearance.
Core Tip: Disseminated herpes simplex virus-1 is a rare but potentially life-threatening complication in erythrodermic psoriasis treated with biologics. This case highlights diagnostic ambiguity in inflamed skin, the impact of cumulative immunosuppression, and the absence of standardized guidance on when and how to safely reintroduce biologic therapy after viral resolution.
