The dermMentors™ Resident of Distinction Award™ recognizes top residents in dermatology. DermMentors.org and the dermMentors™ Resident of Distinction Award™ are sponsored by Beiersdorf Inc and administered by DermEd, Inc. The 2019 dermMentors™ Residents of Distinction™ presented new scientific research during the general sessions of the 15th Annual Coastal Dermatology Symposium on October 5, 2019.
Overall Grand Prize
Chronic Inflammatory Skin Diseases Are Associated With Herpes Zoster in US Inpatients
Raj Chovatiya, MD, PhD; Jonathan I. Silverberg MD, PhD, MPH, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Disclosures: None.
Raj Chovatiya, MD, PhD
Background
Herpes zoster (HZ) is a vaccine-preventable, viral eruption that affects 1 of every 3 people in the United States in their lifetime. Despite evidence-based guidelines and public health advocacy, many high-risk individuals remain unvaccinated and at risk for significant morbidity from HZ. Patients with chronic inflammatory skin diseases (CISDs), including allergic and autoimmune conditions, have potential risk factors for HZ, including long-term use of systemic corticosteroids and immunosuppressants, and immune dysregulation in the skin and periphery. We sought to determine whether CISDs are associated with HZ in hospitalized patients in the US.
Methods
Data were analyzed from the 2002-2012 Nationwide Inpatient Sample, a representative 20% cross-sectional cohort of US hospitalizations (N=68,490,364 children and adults).
Results
The estimated incidence of primary hospitalization for HZ in the US population was 5.0 per 100,000 persons from 2002-2012. In multivariable weighted logistic regression models including age, sex, race/ethnicity, insurance, mean household income, and long-term systemic corticosteroid use, primary hospitalization for HZ was associated with multiple CISDs: 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]). Lichen planus (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 but not in multivariable models. Whereas, hidradenitis suppurativa, chronic idiopathic/spontaneous urticaria, and alopecia areata were not associated with HZ. Similar results were seen in sensitivity analyses among adults age <60 and <50 years. Significant predictors of primary hospitalization for HZ among patients with CISDs included older age, female sex, non-white race/ethnicity, decreasing number of chronic comorbid conditions, and long-term systemic corticosteroid use. Inpatient length of stay and/or inflation adjusted cost of care were significantly higher in inpatients with CISD with vs. without a primary diagnosis of HZ.
Conclusion
CISDs are associated with increased hospitalization for HZ, prolonged length of inpatient stay and increased cost of hospital care. The associations of CISDs and HZ were significant even below the recommended ages (<60 and <50 years) for vaccination with live and recombinant HZ vaccine, respectively. Additional studies are needed to confirm these findings and determine the mechanisms of VZV reactivation. Patients with CISDs constitute a significant, previously under-recognized group that is high-risk for hospitalization for HZ. Dermatologists are the primary physicians who manage the vulnerable population of CISDs. They should be on the forefront of screening, intervention, and most importantly, vaccination for their patients. Future studies should explore implementation of outpatient HZ vaccination by dermatologists and revised disease-specific guidelines to cover the spectrum of CISDs.