Generalized Hailey–Hailey Disease Complicated by MRSA Infection: A Case Report of Management with Systemic Corticosteroids and Targeted Anti-Infective Therapy

Changlin Sui,1,* Jintao Chuan,2,* Yanjie Wei,2 Xue Li,1 Lu Zhang1,31Department of Dermatology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China; 2Department of Dermatology, The First Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China; 3Department of Dermatology, Qishan Hospital of Yantai, Yantai, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lu Zhang, Department of Dermatology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China, Email [email protected]: Generalized cutaneous involvement is an uncommon presentation of Hailey–Hailey disease (HHD), and secondary bacterial infection may further complicate its management. We report a case of generalized HHD complicated by methicillin-resistant Staphylococcus aureus (MRSA) infection.Patients and Methods: A 38-year-old man presented with a five-year history of recurrent flexural eruptions and a generalized exacerbation during the preceding two weeks. The clinical presentation and histopathological findings of acantholysis with intraepidermal blister formation supported the diagnosis of HHD. Direct immunofluorescence was negative for IgG and C3. Genetic testing was not performed. Cultures of skin exudates from multiple lesions revealed growth of MRSA. Treatment included systemic corticosteroids, oral moxifloxacin, topical agents, and local skin care. Moxifloxacin was selected according to the antimicrobial susceptibility results.Results: After 12 days of treatment, the lesions showed marked improvement. The crusts detached, and some lesions resolved, leaving light-brown post-inflammatory hyperpigmentation.Conclusion: In this patient with generalized HHD, secondary MRSA infection was identified and treated as part of the combined regimen. Clinical improvement was observed during combined treatment; however, the relative contribution of each intervention and the durability of the response cannot be determined from a single case with short-term follow-up.Keywords: Hailey–Hailey disease, anti-infective therapy, skin care, MRSA