Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a significant impact on quality of life. PHN is often chronic and difficult to treat. Dermatologists have always been involved in making the diagnosis of these conditions and, most recently, teaching the need for early antiviral therapy.
Objective:
With the introduction of a new vaccine, HZ and its difficult-to-treat complication PHN can be prevented or minimized. Preventive medicine is important and has been supported by dermatologists with sun safety programs. Patients receiving biologics are at increased risk of developing zoster.
Conclusion:
Dermatologists should embrace zoster vaccination and recommend routine vaccination of immunocompetent individuals > age 60 years, as well as patients of any age who are starting immunosuppressants, including biologics. Given that individuals over age 50 years are at risk for PHN and studies have shown that the vaccine's immunogenicity and safety are maintained in individuals age 50 to 59 years, vaccination in this age group may be considered. Some dermatologists may consider vaccinating their own patients, but most will likely recommend that vaccination be performed by their patients' primary care physicians.
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References
1.
GuentherLC. Herpes zoster and postherpetic neuralgia. Expert Rev Dermatol2006;1:607–18, doi:10.1586/17469872.1.4.607.
2.
OxmanMNLevinMJJohnsonGR. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med2005;352:2271–84, doi: 10.1056/NEJMoa051016.
3.
BrissonMPellissierJMCamdenS. The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia. Hum Vaccin2008;4:238–45.
4.
BrissonMEdmundsWJLawB. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect2001;127:305–14, doi:10.1017/S0950268801005921.
5.
StrausSEOxmanMN. Varicella and herpes zoster. In: FreedbergIMEisenAZWolffK, editors, Fitzpatrick's dermatology in general medicine. 5th ed. New York: McGraw-Hill; 1999. p. 2427–50.
6.
OpsteltenWVan EssenGASchellevisF. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol2006;16: 692–5, doi: 10.1016/j.annepidem.2005.12.002.
Hope-SimpsonRE. The nature of herpes zoster: a long-term study and new hypothesis. Proc R Soc Med1965;58:9–12.
9.
ThomasSLHallAF. What does epidemiology tell us about risk factors for herpes zoster?Lancet Infect Dis2004;4:26–32, doi:10.1016/S1473-3099(03)00857-0.
10.
SchmaderKE. Epidemiology of herpes zoster. In: ArvinAMGershonAA, editors. Varicella-zoster virus. Virology and clinical management. Cambridge (UK): Cambridge University Press; 2000. p. 220–45.
11.
ButinxFWachannaRBartholomeeusenS. Is herpes zoster a marker for occult or subsequent malignancy?Br J Gen Pract2005; 55:102–7.
12.
BongartzTOrensteinR. The risk of herpes zoster: another cost of anti-TNF therapy?Nat Rev Rheumatol2009;5:361–2, doi:10.1038/nrrheum.2009.120.
13.
McDonaldJRZeringueALCaplanL. Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis2009;48:1364–71, doi:10.1086/598331.
14.
StrangfeldAListingJHerzerP. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA2009;301:737–44, doi:10.1001/jama.2009.146.
15.
RübbenABaronJMGrussendorf-ConenE-I. Routine detection of herpes simplex virus and varicella zoster virus by polymerase chain reaction reveals that initial herpes zoster is frequently misdiagnosed as herpes simplex. Br J Dermatol1997;137:259–61, doi:10.1046/j.1365-2133.1997.18161913.x.
16.
ForghaniB. Laboratory diagnosis of infection. In: ArvinAMGershonAA, editors. Varicella-zoster virus. Virology and clinical management. Cambridge (UK): Cambridge University Press; 2000. p. 351–82.
17.
MounseyALMatthewLGSlawsonDC. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician2005;72:1075–80.
18.
OxmanMN. Clinical manifestations of herpes zoster. In: ArvinAMGershonAA, editors. Varicella-zoster virus. Virology and clinical management. Cambridge (UK): Cambridge University Press; 2000. p. 246–75.
19.
KatzJCooperEMWaltherRR. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis2004;39:342–8, doi:10.1086/421942.
20.
HardingSPLiptonJRWellsJC. Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement. Br J Ophthalmol1987;72:353–8, doi:10.1136/bjo.71.5.353.
21.
O'TooleEAMooneyEEWalshJB. Disseminated herpes zoster in the elderly. Ir J Med Sci1997;166:141–2, doi:10.1007/BF02943592.
22.
GuptaSJainAGardinerCTyringSK. A rare case of disseminated cutaneous zoster in an immunocompetent patient. BMC Fam Pract2005;6:50, doi:10.1186/1471-2296-6-50.
23.
WellerTH. Varicella-herpes zoster virus. In: EvansASKaslowRA, editors. Viral infections of humans. Epidemiology and control. 4th ed.New York: Plenum; 1997. p. 866.
24.
BowsherD. Pain, sensory change, and allodynia in postherpetic neuralgia. In: WatsonCPNGershonAA, editors. Herpes zoster and postherpetic neuralgia. Vol 11. 2nd ed. The Netherlands: Elsevier Science VB: 2001. p. 143–7.
25.
Van SeventerRSadoskyALuceroMDukesE. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. Age Ageing2006;35:132–7, doi:10.1093/ageing/afj048.
26.
SchmaderKE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain2002;189:350–4, doi:10.1097/00002508–200211000-00002.
27.
NagasakoEMJohnsonRWGriffinDRJDworkinRH. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. J Am Acad Dermatol2002;46:834–9, doi:10.1067/mjd.2002.120924.
28.
EdmundsWJBrissonMRoseJD. The epidemiology of herpes zoster and potential cost-efectiveness of vaccination in England and Wales. Vaccine2001;19:3076–90, doi:10.1016/S0264-410X(01)00044-5.
29.
LancasterTSilagyCGrayS. Primary care management of acute herpes zoster: systematic review of evidence from randomized controlled trials. Br J Gen Pract1995;45:39–45.
30.
De MoragasJMKierlandRR. The outcome of patients with herpes zoster. Arch Dermatol1957;75:193–6.
31.
DworkinRHSchmaderKE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. In: WatsonCPNGershonAA, editors. Herpes zoster and postherpetic neuralgia. Vol 11. 2nd ed. The Netherlands: Elsevier Science VB: 2001. p. 39–64.
32.
CoplanPMSchmaderKNikasA. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain2004;5:344–56, doi:10.1016/j.jpain.2004.06.001.
33.
DworkinRHGnannJWJrOaklanderAL. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain2008;9(1 Suppl 1):37–44, doi:10.1016/j.jpain.2007.10.008.
34.
ZaalMJVolker-DiebenHJWienesenM. Longuitudinal analysis of varicella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol2001;131:25–9, doi:10.1016/S0002-9394(00)00652-8.
35.
WoodMJKayRDworkinRH. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis1996; 22:341–7.
36.
BeutnerKRFriedmanDJForszpaniakC. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother1995; 39:1546–53.
37.
TyringSBarbarashRANahlikJE. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. Ann Intern Med1995;123:89–96.
38.
DegreefH, Famciclovir Herpes Zoster Clinical Study Group. Famciclovir, a new oral antiherpes drug: results of the first controlled clinical study demonstrating its efficacy and safety in the treatment of uncomplicated herpes zoster in immunocompetent patients. Int J Antimicrob Agents1994;4:241–6, doi:10.1016/0924-8579(94)90024-8.
39.
TyringSKBeutnerKRTuckerBA. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med2000;9:863–9, doi:10.1001/archfami.9.9.863.
40.
LiQChenNYangJ. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database of Systematic Reviews2009;(2):CD006866, doi:10.1002/14651858.CD006866.pub2.
41.
SchmaderKOxmanMNLevinM. Persistence of zoster vaccine efficacy. Presented at the 48th ICAAC/IDSA 46th annual meeting; 2008Oct25–8; Washington, DC.
42.
Merck Frosst Canada. Zostavax Canadian product monograph. Date of revision: August20, 2009. Date of approval: October 23, 2009.
43.
SimberkoffMSArbeitRDJohnsonGR. Safety of herpes zoster vaccine in the Shingles Prevention Study. A randomized trial. Ann Intern Med2010;152:545–54.
44.
BrissonM. Estimating the number needed to vaccinate to prevent herpes zoster-related disease, health care resource use and mortality. Can J Public Health2008;99:383–6.
45.
SutradharSCWangWWBSchliengerK. A comparison of the levels of immunogenicity and safety of ZOSTAVAX in adults 50–59 years old and adults 60 years old or older. Clin Vaccine Immunol2009;16:646–52, doi:10.1128/CVI.00407-08.
46.
KerznerBMurrayAVChengE. Safety and immunogenicity profile of the concomitant administration of ZOSTAVAX and inactivated influenza vaccine in adults aged 50 and older. J Am Geriatr Soc2007;55:1499–507, doi:10.1111/j.1532-5415.2007.01397.x.
47.
MacIntyreCREgertonTMcCaugheyM. Concomitant administration of zoster and pneumococcal vaccines in adults ≥60 years old. Hum Vaccin2010;6:18–26.
48.
Canadian Adult National Immunization Coverage (Adult NICS). Survey-2006. Prepared for: Public Health Agency of Canada (PHAC). Ottawa: Environics Research Group; November2006. HC POR #466–05.
49.
LebwohlMBagelJGelfandJM. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis. J Am Acad Dermatol2008;58:94–105, doi:10.1016/j.jaad.2007.08.030.
50.
PoulinYBourcierM. Practical aspects of prescribing a biologic. J Cutan Med Surg2009;13Suppl 2:S93–101.
51.
CohenJL. Rheumatoid arthritis and the incidence of herpes zoster: risky business. Clin Infect Dis2009;48:1372–4, doi:10.1086/598332.
52.
GordonKBGottliebABLeonardiCL. Clinical response in psoriasis patients discontinued from and then reinitiated on etanercept therapy. J Dermatolog Treat2006;17:9–17, doi:10.1080/09546630500472838.
53.
MenterAFeldmanSRWeinsteinGD. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol2007;56:31.e1–15, doi:10.1016/j.jaad.2006.07.017.
54.
MenterATyringSKGordonK. Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. J Am Acad Dermatol2008;58:106–15, doi:10.1016/.jaad.2007.09.010.
55.
PappKOkumMVenderR. Adalimumab in the treatment of psoriasis: pooled efficacy and safety results from three pivotal studies. J Cutan Med Surg2009;13Suppl 2:S58–66.
56.
GildermanLILawlessJFNolenTM. A double-blind, randomized, controlled, multicenter safety and immunogenicity study of a refrigerator-stable formulation of Zostavax. Clin Vaccine Immunol2008;15:314–9, doi:10.1128/CVI.00310-07.
57.
McaladadNMarcanoTGuzmanM. Safety and immunogenicity of a zoster vaccine in varicella-zoster virus seronegative and low-seropositive healthy adults. Vaccine2007; 25:2139–44, doi:10.1016/j.vaccine.2006.11.011.
58.
LangleyJWarshawskyBIsmailS. An advisory committee statement (ACS). National Advisory Committee on Immunization (NACI) statement on the recommended use of herpes zoster vaccine. Can Commun Dis Rep2010;36:1–19.
