Herpes Zoster in Immunocompetent Patients Raises Risk for Complications

Risk of stroke after herpes zoster in patients with autoimmune diseases
Risk of stroke after herpes zoster in patients with autoimmune diseases
The complications associated with immunocompromised patients with herpes zoster was examined.

Herpes zoster (HZ) in immunocompetent patients and the need for more population-based studies was highlighted in findings from a commentary article published in the British Journal of Dermatology. A recent retrospective matched cohort study found that immunocompetent patients with HZ were at higher risk for neurological, ocular, cutaneous, and visceral complications in the first 3 months after their diagnosis.

Health information from 178,964 immunocompetent patients with HZ and 1,799,380 immunocompetent patients without HZ matched for age, sex, and practice. The patients with HZ had an increased risk for neurological (HR 3.63, 95% CI 3.35–3.94), ocular (HR 1.99, 95% CI 1.92–2.07), cutaneous (HR 1.64, 95% CI 1.52–1.77) and visceral complications (HR 1.30, 95% CI 1.25–1.35) compared with control patients in the first 3 months after HZ diagnosis. The magnitude of relative risk for these complications was greater among patients younger than 50 years of age than among patients older than 50 years of age.

When patients with HZ were prescribed antivirals in primary care, their relative risk decreased for Ramsay Hunt syndrome (adjusted HR [aHR] 0.52, 95% CI 0.45–0.62), zoster hospitalization (aHR 0.62, 95% CI 0.50–0.78), and neurological complications (aHR 0.61, 95% CI 0.53–0.70) compared with HZ patients not prescribed antivirals.

The commentary authors emphasized the importance of antiviral prescription for patients diagnosed with HZ, “particularly in older patients with HZ.”

They also recommended using the study “in cost-effectiveness models of zoster vaccination to precisely reflect the burden of the disease.”

Disclosure: A. D. Cohen declared receiving grants and personal fees from the pharmaceutical industry. Please see the original reference for a full list of the author’s disclosures.


Kridin K, Cohen AD. The underestimated risk for complications in immunocompetent patients with herpes zoster: should we change our clinical practice? Br J Dermatol. Published online March 8, 2021. doi:10.1111/bjd.19860.