Abstract
Recently, a study of patients with rheumatoid arthritis who developed herpes zoster while taking a tumor necrosis factor (TNF)‐α inhibitor reported a decreased incidence of postherpetic neuralgia. The objective of this study was to investigate whether patients on TNF‐α inhibitors who developed herpes zoster have a lower incidence of subsequent development of postherpetic neuralgia. A retrospective review of herpes zoster patients on TNF‐α inhibitors (infliximab, etanercept, or adalimumab) was conducted in 12 dermatology clinics. Medical records of such patients were reviewed thoroughly to confirm herpes zoster and TNF‐α inhibitors and any subsequent development of postherpetic neuralgia (pain score ≥3 out of 10 after 90 days of shingles onset) was noted. A total of 206 cases were reviewed, of which only 2 cases (<1%) developed postherpetic neuralgia, a considerably lower incidence rate than noted in the literature. Increasing age is a known risk factor in the development of postherpetic neuralgia. However, of the 58 (28.1%) cases ≥70 years of age, only 1 patient (1.7%) developed neuralgia compared to approximately 50% of patients who develop postherpetic neuralgia in this age group as reported in the literature. Treatment with TNF‐α inhibitors may be associated with a lower incidence of postherpetic neuralgia but further prospective large‐scale studies are needed to confirm this data. J. Med. Virol. 83:2051–2055, 2011. © 2011 Wiley‐Liss, Inc.