• Emily Baumrin, Abby Van Voorhees, Amit Garg, Steven R Feldman, and Joseph F Merola.
• Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: ebaumrin@partners.org.
• J. Am. Acad. Dermatol. 2019 Jul 1; 81 (1): 102-110.

BackgroundHerpes zoster (HZ) incidence is linked to immunosuppression. Patients with psoriasis or psoriatic arthritis (PsA) on systemic therapy might be at an increased risk for HZ.ObjectiveTo assess HZ risk in patients with psoriasis and PsA by systemic treatment and provide recommendations regarding HZ vaccination.MethodsA systematic literature search was performed for HZ in patients with psoriasis and PsA. HZ vaccination guidelines were reviewed, and the medical board of the National Psoriasis Foundation made consensus recommendations in psoriasis and PsA patients using graded evidence.ResultsIn total, 41 studies met inclusion criteria. Systemic corticosteroids (strong, 1), tofacitinib (strong, 1), and combination therapy with biologic and conventional synthetic disease-modifying antirheumatic drugs (weak, 2a) carry increased HZ risk while monotherapy does not. There is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors or apremilast (weak, 2a). Recombinant zoster vaccine is recommended for all psoriasis and PsA patients >50 years old and patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment. Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis.LimitationsThere was significant heterogeneity between studies.ConclusionHZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all psoriasis and PsA patients >50 years old and younger patients at increased risk.Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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