Patients with atopic dermatitis (AD) have an increased risk for herpes zoster (HZ) virus infection independent of treatment type, according to study findings published in Dermatitis.
Researchers collected data from the Taiwan National Health Insurance Research Database (NHIRD) to evaluate the association between AD and HZ virus infection. The patients were identified from the Longitudinal Health Insurance Database (LHID) between 2000 and 2015. Follow-up began on the index date of AD and continued until HZ virus infection or the end of 2015.
The study cohort comprised 28,677 participants with AD aged 20 years and older, and the control group comprised 114,708 participants without AD. Those with AD were then categorized into 2 subgroups: participants received systemic treatment and those who did not.
The mean ages were 42.65±13.21 years in patients with AD and 42.70±13.25 years in the control group, with men and women equally represented in both groups.
Overall, the patients with AD had a significantly higher adjusted hazard ratio (aHR) for HZ virus infection of 2.303 (95% CI, 1.134-3.452; P <.001) compared with individuals without AD.
The sex- and age-stratified models showed similar findings. Men with AD had an aHR of 2.389 (95% CI, 1.178-3.575; P <.001), and women with AD had an aHR of 2.221 (95% CI, 1.096-3.329; P <.001). The participants with AD among all age subgroups had significantly increased aHRs vs those without AD.
All subgroups of participants with AD had significantly increased aHRs compared with individuals without AD, regardless of the treatment they received or the number of treatment switches. The participants with AD and without systemic treatment had an aHR of 2.356 (P <.001), and the aHR in those with AD and with systemic treatment was 2.182 (P <.001) compared with those without AD.
In the survival analysis, the mean time from the beginning of follow-up to HZ virus infection was 7.77±6.06 years in participants with AD and 7.94±6.25 years in control participants. The participants with AD, regardless of treatment type, had an increased risk for HZ virus infection vs participants without AD (P <.001). In the subgroups of participants with AD who received systemic treatment, no significant difference of HZ virus infection risk was found. Survival analysis was similar in that patients with AD had an increased risk for HZ virus infection compared with those without AD, although no differences occurred within separate treatment subgroups.
Limitations of the study include the fact that participants were enrolled from 2000 to 2015, which is before the first biologic for AD was approved by the Taiwan Food and Drug Administration; the researchers were unable to compare the risk for HZ virus infection for biologics vs other systemic treatments. The Eczema Area and Severity Index was not available in the NHIRD, and the potential for topical steroids and calcineurin inhibitors leading to HZ virus infection may be a confounding factor contributing to HZ virus infection in patients with AD.
The researchers conclude, “AD per se may act as a risk factor for HZ infection independent of disease severity. Seeing that the administration of specific biologics may predispose AD patients to HZ infections, prophylactic varicella vaccination should be considered in this population. Monitoring for possible HZ events during treatment is also indispensable to prevent serious infection.”
Wu S-E, Chen Y-H, Chung C-H, et al. Atopic dermatitis as a risk factor for herpes zoster infection independent of treatment: a nationwide population-based cohort study. Dermatitis. Published online April 19, 2023. doi:10.1089/derm.2022.0094