Safety of Herpes Zoster Vaccine in Psoriasis Patients on Biologic Therapies

Herpes zoster (HZ) is a blistering, dermatomal cutaneous eruption caused by the reactivation of varicella zoster virus. The incidence of HZ increases exponentially with age and is commonly seen in adults >60 years of age. Patients with psoriasis on biologic therapies have ≍2 times the risk of developing HZ compared with the general population. The approval of HZ vaccine by the US Food and Drug Administration in 2006 has significantly reduced the incidence of HZ and postherpetic neuralgia by 61.1% and 66.5%, respectively. However, this live vaccine is not currently recommended for immunocompromised patients, such as individuals with psoriasis on biologics. Two major concerns with live vaccinations in this patient population include the risk of impaired immunologic response and the increased incidence of HZ and its complications. However, recent evidence has shown that, despite these concerns, vaccinating patients with psoriasis on biologics with an HZ vaccine can be both safe and effective.