El Hayderi Lara, Colson Fany, Dezfoulian Bita, Nikkels Arjen F
Department of Dermatology, CHU du Sart Tilman, University Hospital of Liège, Liège, Belgium.
Psoriasis (Auckl). 2016 Oct 18;6:145-151. doi: 10.2147/PTT.S102202. eCollection 2016.
As TNF-α is a major factor in the immune defense against herpes zoster (HZ); an increased incidence and severity of HZ cases were suspected in patients undergoing treatment with TNF antagonists. Several studies and clinical experience provided evidence that the incidence of HZ increases by twofold to threefold in this patient category. The number of severe cases of HZ, with multisegmental, disseminated cutaneous, and/or systemic involvement, is also increased. Concerning psoriasis patients under biologicals, the clinician should be more alert for an eventual HZ event, in particular during the first year of biological treatment, and be aware of the possibility of more severe HZ cases. HZ may also undergo an age-shift toward younger patients. Rapid identification of risk factors for severe HZ, such as severe prodromal pains and/or the presence of satellite lesions, is recommended. The treatment recommendations of HZ in this patient group are identical to the recently published guidelines for the management of HZ. The live attenuated viral vaccine OKA/Merck strain anti-HZ vaccination is recommended before initiating biological treatment in psoriasis patients. The new adjuvanted anti-HZ vaccine will probably also benefit patients while on biological treatment.
由于肿瘤坏死因子-α（TNF-α）是抵抗带状疱疹（HZ）免疫防御的主要因素，因此怀疑接受TNF拮抗剂治疗的患者中HZ病例的发病率和严重程度会增加。多项研究和临床经验表明，该类患者中HZ的发病率增加了两倍至三倍。多节段、播散性皮肤和/或全身受累的严重HZ病例数量也有所增加。对于接受生物制剂治疗的银屑病患者，临床医生应更加警惕可能发生的HZ事件，尤其是在生物治疗的第一年，并应意识到出现更严重HZ病例的可能性。HZ的发病年龄可能会向年轻患者转移。建议快速识别严重HZ的危险因素，如严重的前驱疼痛和/或卫星病灶的存在。该患者群体中HZ的治疗建议与最近发布的HZ管理指南相同。建议在银屑病患者开始生物治疗前接种减毒活病毒疫苗OKA/默克株抗HZ疫苗。新的佐剂抗HZ疫苗可能也会使正在接受生物治疗的患者受益。
