Lorraine L. Rosamilia, MD
Dr. Rosamilia is from the Department of Dermatology, Geisinger Health System, State College, Pennsylvania.
Dr. Rosamilia reports no conflicts of interest in relation to this post.
On June 1, Dermatology (2012;224:251-256) published a study outlining the risk for herpes zoster in patients exposed to biologic agents. The incidence and clinical features of zoster were examined in a single cohort of 1220 patients taking biologics for psoriasis and other US Food and Drug Administration–approved indications. There was indeed an increased incidence of zoster, particularly in patients older than 60 years, but it did not reach statistical significance. However, the presence of severe and prolonged skin involvement, multidermatomal distribution, and persistent postherpetic neuralgia was common.
What’s the issue?
Herpes zoster and postherpetic neuralgia certainly contribute to notable morbidity, particularly in elderly patients. The question remains: Who is and should manage these patients’ needs in terms of diagnosis, treatment, and prevention?
In an informal poll of my family members older than 50 years, none of them were vaccinated and none had heard about it from their primary care physicians. Most of them saw the cartoon commercial on television though.
Dermatologists commonly prescribe biologics and other immunosuppressives (which can increase the severity of zoster based on the above study), and we often manage the acute and chronic effects and educate patients on its pathogenesis. On the other hand, primary care physicians are on the front lines of acute visits for zoster and general vaccination strategies. Should we (dermatologists) be the ones spearheading increased efforts to vaccinate with Zostavax® (zoster vaccine live), or should they (primary care physicians)?