The More Severe the Eczema, the Higher the Shingles Risk, Research Shows

People with atopic dermatitis, commonly known as eczema, may face a higher risk of developing shingles than those without the condition, and that risk appears to exist independent of the medications commonly used to treat it, according to a new study published in Journal der Deutschen Dermatologischen Gesellschaft using UK primary care data.

Shingles, caused by a reactivation of the herpes zoster virus, can lead to painful rashes and, in some cases, longer-term nerve pain. Some treatments already used for atopic dermatitis, including oral corticosteroids and other immunosuppressants, have previously been linked to a higher risk of shingles, raising the question of whether eczema itself carries additional risk beyond its treatments.

To investigate, researchers conducted a matched cohort study using data from the UK Clinical Practice Research Datalink Aurum database, drawing on nearly three decades of routinely collected primary care records, from 1997 to 2023. The team used statistical modeling to account for age, cigarette smoking, alcohol abuse, obesity, coexisting health conditions and different treatment exposures. A total of 14,081,774 observations from 13,426,267 people were ultimately included in the analysis.

Eczema tied to higher shingles risk, even after adjusting for treatment

The results showed that people with atopic dermatitis had a 28% higher relative risk of developing shingles compared with those without the condition. Notably, that risk barely changed even after researchers adjusted for different types of oral corticosteroid use and other traditional immunosuppressant treatments, suggesting the elevated risk isn't simply a byproduct of the medications used to manage eczema.

Risk climbed sharply with disease severity

The study also found a clear relationship between eczema severity and shingles risk. People with mild atopic dermatitis had a 22% higher relative risk of shingles, while those with moderate disease had a 28% higher risk. For people with severe atopic dermatitis, that risk more than doubled, reaching a 133% higher relative risk compared with people without eczema. The pattern suggests that as skin inflammation becomes more extensive or persistent, the risk of shingles rises along with it.

Why this matters beyond the skin

Researchers noted that this elevated baseline risk carries particular significance now, given that newer eczema treatments, including Janus kinase, or JAK, inhibitors, already carry a known risk of shingles as a side effect. If eczema itself independently raises shingles risk, that risk could compound for patients using these newer therapies, making the overall picture more complex for both patients and prescribers to navigate.

What this could mean going forward

The study's authors suggested their findings may help inform future vaccination guidance for people with atopic dermatitis. Shingles vaccines are already recommended for older adults and certain immunocompromised populations, and this research raises the question of whether patients with eczema, particularly those with moderate to severe disease, should be considered a higher-priority group for vaccination discussions with their doctors.

For patients living with eczema, especially more severe or persistent cases, the findings offer a reason to talk with a dermatologist or primary care provider about shingles risk specifically, rather than assuming that risk is tied only to which medications they're taking. As with any observational study, the results show a strong statistical association rather than proof that eczema directly causes shingles, but the size and consistency of the effect across severity levels adds weight to the case for closer attention to this risk.