Chronic Inflammatory Skin Diseases and Shingles Risk

Identified risk factors for developing herpes zoster (HZ) range from age and gender to race and overall general health. These factors may also contribute to a longer shingles infection period and the likelihood of complications.

A new study published in the Journal of the American Academy of Dermatology concluded that many chronic inflammatory skin diseases (CISD) may also lead to an increased risk for HZ and subsequent hospitalization.

The study’s authors—Raj Chovatiya, MD, PhD, and Jonathan I. Silverberg, MD, PhD—analyzed data from the 2002 to 2012 Nationwide Inpatient Sample, which provides a representative cohort of hospitalizations in the United States. They concluded that hospitalization for shingles was significantly associated with several CISDs, including atopic dermatitis (AD), and that there was a greater length of stay for those patients

“Nearly one in three people in the US will develop herpes zoster in their lifetime, with approximately 1 million cases annually and a 3% hospitalization rate,” the authors wrote in the study. “Patients with chronic inflammatory skin diseases have potential risk factors for HZ, including long-term use of systematic immunosuppressants and immune dysregulation in the skin and periphery.”

The authors also reported that HZ hospitalization was associated with the female sex and extensive use of corticosteroids, and inversely associated with an increased number of chronic conditions and early adult age. They concluded that additional studies are needed to establish CISD-specific vaccination guidelines, particularly for individuals who are younger than the age recommended for HZ vaccination.

AD is the most common, chronic, and severe type of eczema, a non-contagious group of dermatologic conditions that cause red, irritated, itchy and/or inflamed skin. Statistics from the National Eczema Associationindicate that AD affects 18 million people in the US, with nearly 40% suffering from a moderate or severe form of the disease. It is more common in adult females than males, and multiracial and white adults tend to have the highest prevalence of AD.

In its earliest stages, shingles can be mistaken for other skin conditions that are similar in appearance and share symptoms like itching, burning, and stinging, but emerging patterns differ. For example, the shingles rash first appears as small raised dots in a band along one side of the body, often on the torso. The eczema rash, on the other hand, can emerge anywhere on the body, including arms and legs.

Two other important differences that set the shingles rash apart from other rashes are that shingles is typically much more painful, and it clears up within a few weeks. By comparison, eczema is a chronic condition that can stretch from childhood to adulthood.

Since the distribution of Zostavax in the US was discontinued by Merck in July 2020, Shingrix is the only vaccine to prevent shingles. The recombinant zoster vaccine was licensed by the FDA in 2017 and is recommended by the CDC for adults age 50 years and older.

Shingrix’s efficacy in preventing shingles has been reported to be as high as 97% in individuals 70 and older, and its efficacy for the prevention of the shingles complication postherpetic neuralgia has been 88% for the same age group. 

Reference

Chovatiya R, Silverberg JI. Association of herpes zoster and chronic inflammatory skin disease in US inpatients. Journal of the American Academy of Dermatology. 2020. Doi: 10.1016/j.jaad.2019.12.073