Chronic herpes simplex virus (CHSV) is defined as atypical mucocutaneous wart-like and/or ulcerative HSV infection, persisting for at least 1 month. Because of its atypical presentation, misdiagnosis is common and appropriate treatment can be delayed. A 63-year-old male came to our clinic complaining of severe pruritus on the lower back which lasted for two months. Topical agents have been prescribed under the impression of perforating dermatosis, but the symptom did not improve. Upon physical examination, multiple erythematous nodules with crusts and pustules were noted on the lower back. The patient had history of DM and HTN, and was undergoing peritoneal dialysis for end-stage renal disease. Serologic tests were negative for HIV, HBV, and VDRL. Punch biopsy from a nodule showed ballooning degeneration with few multinucleated cells in the epidermis, which led to the diagnosis of HSV infection. HSV PCR from the tissue was positive with HSV type 2. The patient was then treated with valacyclovir for two weeks and symptom relieved. The clinical polymorphism of CHSV makes recognition difficult. Such as our case, patient was clinically suspected as having perforating dermatosis, however, histopathology proved otherwise. Heightened awareness and high index of suspicion are critical for diagnosis of CHSV infection. We herein report a case of CHSV infection which was clinically misdiagnosed as a perforating dermatosis.