Eczema may raise shingles risk

Clinical takeaway: Adults with eczema, particularly those with more severe disease, may have a higher baseline risk of shingles independent of systemic immunosuppressive therapy. This elevated risk should be considered when discussing shingles vaccination, particularly for patients who may also be candidates for treatments known to increase herpes zoster risk.

Eczema (atopic dermatitis) is increasingly recognized as a systemic inflammatory disease with effects beyond the skin. A large UK cohort study suggests that adults with eczema have a higher risk of developing shingles, raising questions about whether vaccination strategies should account for the underlying disease itself rather than treatment alone.

Researchers analyzed electronic health records from more than 13.4 million adults in England, including approximately 2.4 million with eczema, and identified more than 329,000 cases of shingles during over 84 million person-years of follow-up. After adjustment for age, sex, comorbidities, smoking, alcohol use, obesity, and other factors, eczema was associated with a 28% higher risk of shingles compared with matched controls.

The association strengthened with increasing eczema severity. Compared with adults without eczema, shingles risk was 22% higher in mild disease, 28% higher in moderate disease, and more than doubled in severe disease. Adjusting for oral corticosteroids and conventional immunosuppressants only minimally changed the findings, suggesting that eczema itself contributes to the increased risk.

The relative association was strongest in adults younger than 50 years, although absolute shingles rates remained highest in older adults. The authors noted that newer eczema therapies, including Janus kinase (JAK) inhibitors, are also associated with herpes zoster, making an elevated baseline risk clinically relevant when weighing treatment decisions and preventive strategies.

These findings suggest that shingles prevention, including vaccination discussions, may warrant greater attention in adults with eczema, particularly as treatment options that can further increase herpes zoster risk become more widely used.

Source: Schober AK, et al. (2026 Aug 5) J Dtsch Dermatol Ges. Atopic dermatitis is associated with herpes zoster in adults: A matched cohort study using electronic health records data in England