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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le lundi 17 février 2020
Doi : 10.1016/j.jaad.2019.12.073
accepted : 31 December 2019
Association of herpes zoster and chronic inflammatory skin disease in US inpatients
 

Raj Chovatiya, MD, PhD a, Jonathan I. Silverberg, MD, PhD, MPH b,
a Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
b Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC 

Correspondence to: Jonathan I. Silverberg, MD, PhD, MPH, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Ave, Washington, DC 20037.Department of DermatologyThe George Washington University School of Medicine and Health SciencesSuite 2B-430, 2150 Pennsylvania AveWashingtonDC20037
Abstract
Background

Patients with chronic inflammatory skin disease (CISD) have potential risk factors for herpes zoster (HZ). However, little is known about HZ risk in CISD.

Objective

To determine whether CISD is associated with HZ.

Methods

Data were analyzed from the 2002 to 2012 Nationwide Inpatient Sample, a representative cohort of US hospitalizations (N = 68,088,221 children and adults).

Results

In multivariable logistic regression models including age, sex, race/ethnicity, insurance, household income, and long-term systemic corticosteroid use, hospitalization for HZ was associated with atopic dermatitis (adjusted odds ratio [95% confidence interval], 1.38 [1.14-1.68]), psoriasis (4.78 [2.83-8.08]), pemphigus (1.77 [1.01-3.12]), bullous pemphigoid (1.77 [1.01-3.12]), mycosis fungoides (3.79 [2.55-5.65]), dermatomyositis (7.31 [5.27-10.12]), systemic sclerosis (1.92 [1.47-2.53]), cutaneous lupus erythematosus (1.94 [1.10-3.44]), vitiligo (2.00 [1.04-3.85]), and sarcoidosis (1.52 [1.22-1.90]). Only lichen planus (crude odds ratio [95% confidence interval], 3.01 [1.36-6.67]), Sézary syndrome (12.14 [5.20-28.31]), morphea (2.74 [1.36-5.51]), and pyoderma gangrenosum (2.44 [1.16-5.13]) showed increased odds in bivariable models. Sensitivity analyses among those younger than 60 and younger than 50 years showed similar results. Predictors of HZ in CISD included female sex, fewer chronic conditions, and long-term systemic corticosteroid use.

Limitations

Cross-sectional study.

Conclusions

Many CISDs are associated with increased hospitalization for HZ, even below the ages recommended for HZ vaccination. Additional studies are needed to establish CISD-specific vaccination guidelines.

The full text of this article is available in PDF format.

Key words : autoimmune, burden, chronic, cost of care, dermatitis, herpes zoster, hospitalization, inflammation, inflammatory skin disease, length of stay, shingles

Abbreviations used : AA, AD, BP, CISD, CIU, CLE, HCUP, HS, HZ, LOS, LP, MF, NIS, PG, Poh, RZV, SLE, SS, SSc, VZV



 Funding sources: This publication was made possible by support from the Agency for Healthcare Research and Quality (Dr Silverberg), the Dermatology Foundation (Dr Silverberg), and grant numbers K12 HS023011 (Dr Silverberg) and T32 AR060710 (Dr Chovatiya).
 Conflicts of interest: None disclosed.
 IRB approval status: Reviewed and approved by the IRB at Northwestern University.



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