Surreal illustration of the immune system attacking skin cells, symbolizing the connection between viral infections and autoimmune diseases like pemphigus.

Pemphigus and Viral Infections: Understanding the Link and Protecting Your Health

Reese Marlowe monogram
Reese Marlowe in Health & Wellness November 2026 • 4 min read.

"Is there a connection between pemphigus, a rare autoimmune skin condition, and common viral infections like hepatitis B and C? New research explores the potential links and what they mean for your health."


Pemphigus is a rare autoimmune disease affecting the skin and mucous membranes, causing blisters and sores that can be painful and debilitating. While the exact cause of pemphigus remains elusive, researchers have long suspected that certain triggers may play a role in its development, particularly in individuals with a genetic predisposition. Among these potential triggers, viral infections have garnered significant attention.

Viruses like hepatitis B (HBV) and hepatitis C (HCV) have been implicated in the development of various autoimmune disorders, suggesting a possible connection between viral infections and the immune system's tendency to attack its own tissues. In the context of pemphigus, the question arises: Could these common viral infections be contributing factors in the onset or progression of the disease?

A recent study has investigated the relationship between pemphigus and HBV and HCV infections. The study aimed to determine if there is a higher prevalence of these viral infections among pemphigus patients compared to a healthy control group. By examining the serological markers of HBV and HCV in both groups, the researchers sought to shed light on the potential association between these infections and the development of pemphigus.

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Viral Hepatitis Surveillance and Burden

The CDC's HepTracker dashboard provides case-surveillance and viral-hepatitis-related mortality data for hepatitis A, hepatitis B, and hepatitis C. The CDC's 2022 National Profile uses data available through MMWR Week 1 of 2024 and supersedes earlier publications. Globally, the WHO's Global Hepatitis Report 2026 states that hepatitis B and hepatitis C together account for more than 95% of deaths related to viral hepatitis.

Guidelines, Monitoring, and Testing Limits

Pemphigus management recommendations come from an international expert Delphi consensus based on European Dermatology Forum and European Academy of Dermatology and Venereology guidance. When pemphigus is extensive, initial management usually requires hospitalization until the bullous eruption is clinically controlled, while limited disease may be monitored in inpatient or outpatient settings. Hepatitis B testing can be difficult to interpret after intravenous immunoglobulin therapy, as illustrated by reports involving patients with autoimmune skin diseases.

A Developing Clinical Perspective

The relationship between pemphigus, viral infection, and immunosuppressive treatment has developed through clinical recommendations and reported patient experiences. Because no source material was provided for this historical subsection, specific milestones and dates cannot be established here. The broader perspective should therefore remain cautious rather than presenting an unsupported discovery timeline.

Unpacking the Research: Hepatitis and Pemphigus

Surreal illustration of the immune system attacking skin cells, symbolizing the connection between viral infections and autoimmune diseases like pemphigus.

The study involved 62 pemphigus patients and 50 healthy controls. Researchers tested for Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb), and anti-HCV antibodies in both groups. The goal was to determine if pemphigus patients had a higher rate of Hepatitis B and/or C infections compared to the control group.

The findings indicated that Hepatitis C virus antibody was negative in all pemphigus patients. Two (4.3%) of the 44 pemphigus patients who were tested for Hepatitis B were positive for HBsAg, indicating a current HBV infection. Only 1 (2%) patient in the control group tested positive for HBsAg. This means, relatively low rate of HBV and HCV infections found in pemphigus patients and control groups.

The results of the study suggest that there is not a statistically significant difference in the prevalence of hepatitis B and C virus infections between pemphigus patients and healthy controls. Here's what to consider:
  • HCV: No pemphigus patients tested positive for Hepatitis C antibodies.
  • HBV: 4.3% of pemphigus patients tested positive for HBsAg (Hepatitis B surface antigen), indicating an active HBV infection.
  • Control Group: Only 2% of the control group tested positive for HBsAg.
  • Statistical Significance: The difference in HBV and HCV infection rates between the two groups was not statistically significant.
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Current Research Landscape

Recent research on pemphigus and viral infections continues to evolve, with attention to immune mechanisms, infection risk, and treatment safety. Without source material for this subsection, no particular study, therapy, or outcome can be identified reliably. Any conclusions about the latest evidence should therefore be treated as provisional until supported by specific reviews or studies.

Limits of the Evidence

The available source material does not establish a complete or uniform explanation for how viral infections relate to pemphigus. It also does not provide enough evidence to quantify treatment failure, disagreement among studies, or the frequency of unsuccessful prevention strategies. Claims in this area should therefore distinguish documented cases from broader conclusions.

Pemphigus Treatments and Reactivation Risk

A 2022 report states that patients with chronic infections may remain at risk of reactivation when exposed to immunosuppressive treatments, even as pemphigus and pemphigoid therapies have become safer. Rituximab, a monoclonal antibody against CD20, is increasingly used for pemphigus patients who do not respond to conventional therapies, but a reported case involved acute liver failure from hepatitis B reactivation after treatment. A 2025 review contrasts these treatment patterns with bullous pemphigoid, reporting strong efficacy for B-cell- and IgG-targeting biologics in pemphigus and greater emphasis on type 2 inflammation and IgE pathways in bullous pemphigoid.

While the study did not find a statistically significant association between HBV and HCV infections and pemphigus, it's essential to interpret these findings with caution. The researchers themselves acknowledge that the relatively small sample size may have limited their ability to detect subtle differences between the groups. Further research with larger cohorts is needed to confirm or refute these findings.

The Ongoing Quest: More Research Needed

The study provides valuable insights into the complex relationship between pemphigus and viral infections. While the results do not support a strong association between hepatitis B and C virus infections and the development of pemphigus, they do highlight the need for continued research in this area. Large-scale studies with diverse populations are essential to unravel the potential role of viral infections and other environmental factors in triggering autoimmune responses like pemphigus.

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A Cautious Clinical Synthesis

Pemphigus and viral hepatitis can intersect through the need to balance autoimmune disease control with infection-related risks. The evidence provided here supports careful interpretation of testing and individualized monitoring, but it does not justify assuming that every patient with pemphigus has viral hepatitis or that every viral infection causes pemphigus. Expert conclusions should remain proportional to the available clinical evidence.

Surveillance and New Hepatitis B Therapies

The CDC's 2026 Viral Hepatitis National Progress Report points users toward surveillance reports, guidelines, national progress information, and the HepTracker dashboard for hepatitis A, B, and C data. A 2025 horizon-scanning review examines emerging hepatitis B therapies and their potential to achieve functional or complete cures. The BMJ reports that hepatitis B remains a global health challenge affecting an estimated 254 million people and reviews its epidemiology and clinical spectrum, while other research is examining cirrhosis burden and mortality trends among adolescents and young adults aged 15 to 39 using the 2021 Global Burden of Disease database.

Challenges Beyond Individual Care

The broader systemic issues linking pemphigus and viral infections include the need to coordinate autoimmune treatment with infection surveillance and risk assessment. No source material was provided for this subsection, so the relative effects of healthcare access, screening systems, treatment cost, or public-health policy cannot be specified. These factors should be investigated rather than inferred.

Serious Consequences of Reactivation

Case reports describe hepatitis B reactivation in people with pemphigus vulgaris after immunosuppressive therapy that included rituximab. In one reported case, acute liver failure led to emergency liver transplantation; although serum HBV DNA fell to 77 IU/L, the patient died of septicemia five months after transplantation. These reports illustrate why treatment decisions and monitoring can have consequences extending beyond control of skin disease, while database research has specifically examined associations between pemphigus and chronic hepatitis B and hepatitis C.

How far this comparison can carry the claim

Observational study (level 4 of 8)

The groups were modest in size, and the study’s conclusion is limited to the people assessed rather than proof that the relationship is absent in all populations.[1] [2]

What these test patterns do and do not show

Taken together, the findings do not show a clear excess of hepatitis infection among the pemphigus patients in this sample; they are evidence about measured infection markers, not a cause-and-effect test.[1] [2]

The HCV-positive controls were also RNA-positive, while no pemphigus patient had HCV infection, making the control findings a useful contrast rather than evidence of a pemphigus-specific link.[1]

Where the study's evidence is constrained

  • HBV screening covered only a subset of the pemphigus group because technical problems prevented testing everyone.[2]
  • The authors considered the small group sizes a possible reason their estimates differed from population prevalence.[2]
  • The investigators did not identify the usual risk factors in the two pemphigus patients with HBV, so those cases do not clarify how infection arose.[1]

The study at a glance

Study designObservational study[2]
Sample size62 pemphigus patients and 50 controls[2]
Comparison50 age- and gender-matched healthy controls[2]
Times cited6[2]

How this case-control result fits related evidence

The paper contrasts its findings with a broader autoimmune-disease study, where HCV infection was more frequent among autoimmune patients than controls; that comparison is not specific to pemphigus.[1]

A later review notes that cross-sectional designs cannot establish event order and that virus-detection methods and sample types vary, limiting direct comparisons across studies.[3]

The study also describes its own clinical setting: patients were screened for hepatitis markers before immunosuppressive therapy because such treatment can exacerbate viral infections. This is context for the testing, not a result showing that pemphigus causes infection.[2]

Questions left by the hepatitis comparison

  • Would a larger comparison using the same testing approach find a reproducible difference in hepatitis markers between pemphigus patients and controls?[1] [2] [3]
  • How would estimates change if all pemphigus participants received HBV screening, rather than only those tested in this study?[2]

Terms used in the study

HBsAg
Hepatitis B surface antigen, a marker the study assessed as part of HBV screening.[2]
HCV-RNA
The viral RNA test result used in the study to confirm HCV infection in antibody-positive controls.[1]

Sources

  1. Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus (Europe PMC, 2014)
  2. Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus (FapUNIFESP (SciELO), 2014)
  3. Viral infections as triggers in autoimmune blistering diseases: A systematic review of associations and mechanisms (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1590/abd1806-4841.20142566, Alternate LINK

Title: Hepatitis C And Hepatitis B Virus Infections In The Etiopathogenesis Of Pemphigus

Subject: Dermatology

Journal: Anais Brasileiros de Dermatologia

Publisher: FapUNIFESP (SciELO)

Authors: Gulsen Tukenmez Demirci, Ikbal Esen Aydingoz, Ayse Tulin Mansur, Guldehan Atis, Ilknur Kivanc Altunay

Published: 2014-06-01

Everything You Need To Know

1

What is pemphigus and what are its primary symptoms?

Pemphigus is a rare autoimmune disease that affects the skin and mucous membranes. Its primary symptoms include the formation of painful and debilitating blisters and sores on the skin and in the mouth or other mucous membranes. The exact cause remains elusive, but it's thought to be triggered by factors in individuals with a genetic predisposition. Viral infections are suspected as potential triggers. Distinguishing pemphigus from other blistering diseases often involves a biopsy and specific antibody testing.

2

Do hepatitis B and C infections directly cause pemphigus?

The study explored the relationship between Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections and pemphigus. The study found no statistically significant difference in the prevalence of HBV and HCV infections between pemphigus patients and healthy controls. The absence of statistical significance does not definitively rule out a connection; larger studies may reveal a subtle association, as the current research acknowledges limitations due to sample size.

3

What did the research study specifically investigate regarding pemphigus, hepatitis B, and hepatitis C?

The research study investigated the prevalence of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections among pemphigus patients compared to a healthy control group. Researchers examined serological markers, specifically Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb), and anti-HCV antibodies, in both groups. The study aimed to determine if pemphigus patients exhibited a higher rate of HBV and/or HCV infections, suggesting a potential link between these viral infections and the autoimmune disease.

4

What are the implications of the study's findings for individuals with pemphigus or those at risk of developing it?

Given the study's finding of no statistically significant association between Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) infections, and pemphigus, it suggests that routine screening for these viruses in pemphigus patients may not be warranted based solely on this study. However, it's important to note that the study highlights the complexity of autoimmune diseases and the need for ongoing research to explore potential environmental triggers, including viral infections. Those at risk should focus on overall immune health and consult with healthcare professionals for personalized advice.

5

What are the limitations of this research, and what further studies are needed to better understand the relationship between viral infections and pemphigus?

The study acknowledges that its relatively small sample size is a significant limitation, potentially hindering its ability to detect subtle differences in Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection rates between pemphigus patients and the control group. To gain a more comprehensive understanding, future research should involve larger, more diverse cohorts. These studies should also explore other potential environmental and genetic factors that may contribute to the development of pemphigus, as well as investigate the molecular mechanisms by which viral infections might trigger or exacerbate autoimmune responses in susceptible individuals. Longitudinal studies tracking individuals over time could also provide valuable insights into the temporal relationship between viral infections and the onset of pemphigus.

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