Herpes zoster (HZ) incidence during biologic treatments for psoriasis is higher than the general population, according to data recently published by the Japanese Dermatological Association.

In Japan, infliximab (Remicade), adalimumab (Humira) and ustekinumab (Stelara) are all approved for treatment of psoriasis, and are recognized for improved efficacy and lower frequency of organ toxicity compared with other treatments. However, the incidence of infection is slightly higher, according to the study authors.

Yoshinori Umezawa, MD, PhD, from the Jikei University School of Medicine in Tokyo, and colleagues detailed four patients with psoriasis who developed HZ within a year of starting biologic treatment in the Journal of Dermatology.

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During regular monitoring of 144 psoriasis patients for bacterial and fungal infections during biological treatment, Umezawa and colleagues discovered four male patients, ages 46 to 75 years, who developed HZ: one of 39 patients on infliximab, two of 65 patients on adalimumab and one of 40 patients on ustekinumab.

The odds ratio of onset of HZ in patients with biologic treatment was 7.1 (P<0.01) compared with the general population, according to the findings. None of the patients who developed HZ received any immunosuppressive drugs with biologic treatment.

“Our experience shows that the incidence in these patients may be higher than that in the general population, although our results are retrospective,” Umezawa and colleagues wrote. “On consideration of previous studies and our own experiences, the risk of HZ incidence during biologic treatments for psoriasis may be increased, similar to those of RA patients undergoing biologic treatment.”


  1. Umezawa Y. J Dermatol 2014; 41: 1-3.

Disclosure: The study authors report no relevant financial disclosures or conflicts of interest.