Atopic dermatitis is associated with herpes zoster in adults – A matched cohort study using electronic health records data in England
Anna K. Schober, Sinéad M. Langan, Hywel C. Williams, Harriet Forbes, Julian MatthewmanSummary
Background and objectives
Some atopic dermatitis (AD) treatments have been linked to an increased risk of herpes zoster (HZ). Limited evidence suggests an independent association between atopic dermatitis and herpes zoster. The study aimed to investigate the association between atopic dermatitis and herpes zoster in the UK and to explore the role of treatments in this relationship.
Patients and methods
We conducted a matched cohort study using routinely collected primary care data from the UK Clinical Practice Research Datalink (CPRD) Aurum database (1997–2023) and applied Cox regression models. Age, behavioral factors, several comorbid diseases and different treatment exposures were included as covariates.
Results
Individuals with atopic dermatitis had an adjusted hazard ratio of 1.28 (95% CI: 1.27–1.29) for HZ. Adjustments for different definitions of oral corticosteroid exposure as well as other traditional immunosuppressants led to minimal reductions in the association. The risk of herpes zoster increased with AD severity (aHR for mild AD: 1.22 [95% CI: 1.20–1.23]; aHR for moderate AD: 1.28 [95% CI: 1.27–1.30]; aHR for severe AD: 2.33 [95% CI: 2.22–2.45]).
Conclusions
The risk of HZ is increased in individuals with atopic dermatitis, independent of comorbidities and the use of oral corticosteroids or immunosuppressants. This elevated baseline risk is particularly relevant because herpes zoster is also a known adverse effect of newer therapies such as Janus kinase (JAK) inhibitors. These findings may inform vaccination guidelines.