Dermatologists Should Be Aware of Herpes Zoster Risk Factors

herpes zoster
herpes zoster
Women face an especially high risk for developing herpes zoster compared with men.

Age, immunocompromising conditions, female gender, race/ethnicity, family history, and comorbidities are all risk factors for the development of herpes zoster (HZ) virus infection, according to results of a recent systematic review and meta-analysis published in Mayo Clinic Proceedings.

The investigators conducted a literature review of articles published between January 1, 2003 and February 1, 2017. Risk ratios (RRs), odds ratio (ORs), and 95% CIs were summarized with the use of a random-effects model. Of the 3450 studies screened, 84 observational studies were included in the systematic review and meta-analysis was performed in 62 studies.

The investigators found that women were at an increased risk for the development of HZ compared with men (pooled adjusted RR 1.31; 95% CI, 1.27-1.34). The risk for HZ in black individuals was almost half that in white individuals (pooled RR 0.54; 95% CI, 0.47-0.63). Family history was also a risk factor for HZ (pooled OR 3.59; 95% CI, 2.39-5.40). Autoimmune disorders, including rheumatoid arthritis (pooled RR 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR 2.10; 95% CI, 1.40-3.15) were also associated with an increased risk for HZ.

Other comorbidities were found to be linked to an elevated risk for HZ, including asthma (pooled RR 1.25; 95% CI, 1.13-1.39), diabetes mellitus (pooled RR 1.30; 95% CI, 1.17-1.45), chronic obstructive pulmonary disease (pooled RR 1.31; 95% CI, 1.22-1.41), inflammatory bowel disease (pooled RR 1.35; 95% CI, 1.28-1.42), and chronic kidney disease (pooled RR 1.28; 95% CI, 1.14-1.42).

Depression was also associated with an increased risk for HZ (pooled RR 1.36; 95% CI, 1.15-1.61). In addition, physical trauma (pooled RR 2.56; 95% CI, 1.97-3.33) and statin use (pooled RR 1.14; 95% CI, 1.11-1.17) were both associated with an increased risk for HZ.

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The investigators concluded that based on the findings of this systematic review and meta-analysis, healthcare professionals should consider the HZ vaccine for all adults age 50 or older, in particular individuals at an increased risk for HZ. Greater efforts are needed to encourage the use of both current and new HZ vaccines.


Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92(12):1806-1821.