Herpes simplex risk during biologic treatment for erythrodermic psoriasis

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 <i>et al</i> 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.