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Herpes zoster in psoriasis patients undergoing treatment with biological agents: prevalence, impact, and management challenges

Authors el Hayderi L, Colson F, Dezfoulian B, Nikkels AF

Received 29 July 2016

Accepted for publication 22 August 2016

Published 18 October 2016 Volume 2016:6 Pages 145—151

DOI https://doi.org/10.2147/PTT.S102202

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Uwe Wollina


Lara el Hayderi, Fany Colson, Bita Dezfoulian, Arjen F Nikkels

Department of Dermatology, CHU du Sart Tilman, University Hospital of Liège, Liège, Belgium

Abstract: As TNF-α is a major factor in the immune defense against herpes zoster (HZ); an increased incidence and severity of HZ cases were suspected in patients undergoing treatment with TNF antagonists. Several studies and clinical experience provided evidence that the incidence of HZ increases by twofold to threefold in this patient category. The number of severe cases of HZ, with multisegmental, disseminated cutaneous, and/or systemic involvement, is also increased. Concerning psoriasis patients under biologicals, the clinician should be more alert for an eventual HZ event, in particular during the first year of biological treatment, and be aware of the possibility of more severe HZ cases. HZ may also undergo an age-shift toward younger patients. Rapid identification of risk factors for severe HZ, such as severe prodromal pains and/or the presence of satellite lesions, is recommended. The treatment recommendations of HZ in this patient group are identical to the recently published guidelines for the management of HZ. The live attenuated viral vaccine OKA/Merck strain anti-HZ vaccination is recommended before initiating biological treatment in psoriasis patients. The new adjuvanted anti-HZ vaccine will probably also benefit patients while on biological treatment.

Keywords: herpes zoster, TNF antagonists, anti-IL17, anti-IL12/23, psoriasis, aciclovir

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