Study shows atopic dermatitis increases shingles risk

People with atopic dermatitis are at increased risk of developing shingles, and the risk is not associated with mediations used to treat atopic dermatitis, according to findings reported today by British researchers in JDDG: Journal der Deutschen Dermatologischen Gesellschaft.

Other studies have shown the same association, but this study was one of the largest with researchers using a database containing 46 million primary care electronic health records.

Lead author Anna K. Schober, at the London School of Hygiene and Tropical Medicine, and her colleagues found that individuals with atopic dermatitis were 33% more likely to develop shingles than those who didn’t have atopic dermatitis. When they made statistical adjustments for other autoimmune conditions, such as ulcerative colitis and Crohn’s disease, and a number of other health conditions (heart failure, obesity, depression and several others), the elevated risk dipped slightly to 28%. The risk of shingles was also correlated with the severity of the atopic dermatitis.

Clinicians and researchers who are familiar with atopic dermatitis are likely not to be surprised by these findings, partly because of the epidemiologic studies that have found the same association but also because of evidence that people with atopic dermatitis have altered immune responses that make them more susceptible to infections.

An intriguing nuance to the findings by Schober and her co-investigators is that the risk of shingles was greater in younger age groups. Specifically, the increased risk of shingles went from 51% among individuals ages 30 to 40 to 42% among those ages 40 to 50 to 29% in those ages 50 to 60. They note that the decreasing risk with age may be a consequence of people in England who are older than 70 becoming eligible for shingles vaccination starting in 2013.

The researchers found that, overall, exposure to oral corticosteroids and conventional immunosuppressants did very little to change the risk numbers. They noted that the vast majority of the data they used in their analysis came before the Janus kinase (JAK) inhibitors started being used in clinical practice, so JAK inhibitors did not influence their findings.

Schober and her colleagues conducted their matched cohort study by combing the United Kingdom’s Clinical Practice Research Datalink Aurum database. They used a diagnostic code and two instances of prescriptions related to atopic dermatitis to identify cases of atopic dermatitis. Their overall core comparison was between 2,445,090 “AD [atopic dermatitis] exposed” and 11,636,684 “unexposed” participants. Then they sliced further and identified 329,821 shingles “events,” 76,990 among people with atopic dermatitis and 252,831 among those without it. Those two groups were matched in other respects by the researchers as they attempted to tease out a possible linkage between atopic dermatitis and shingles, which is called herpes zoster. Those large numbers lend the study some credibility from a statistical point of view, making it an addition to the evidence base showing an atopic dermatitis-shingles link even if it isn’t breaking new ground.

Although not fully spelled out, one possible implication of this study is that the shingles vaccine recommendations should be extended to people with atopic dermatitis to blunt what appears to be increased risk of developing shingles from having atopic dermatitis. The Centers for Disease Control and Prevention’s (CDC) current recommendation is that people ages 50 and older should be vaccinated against shingles with the recombinant zoster vaccine, which is sold under the brand name Shingrix. The CDC also recommends that people ages 19 or older be vaccinated against shingles if they “are or will be immunodeficient or immunosuppressed because of disease or therapy.”