People with atopic dermatitis, commonly known as eczema, have a significantly elevated risk of developing herpes zoster, the virus that causes shingles. A large study of over 13 million people in the UK found a 28% increased risk for shingles in patients with eczema after adjusting for age, sex, and other health factors. The risk increased substantially with disease severity, suggesting that the skin condition itself may confer additional vulnerability independent of treatments used to manage it.

What Does the Research Show About Eczema and Shingles Risk?

Researchers analyzed primary care data from 13.4 million people, including 2.4 million with atopic dermatitis, published in August 2026 in the Journal of the German Dermatological Society. The findings revealed a clear pattern: as eczema severity increased, so did shingles risk. People with mild eczema had a 22% higher risk, moderate eczema carried a 28% higher risk, and severe eczema was associated with more than double the risk compared to people without eczema.

Age emerged as another important factor. The relative risk was highest in people aged 30 to 40 years, followed by those aged 40 to 50 years, though the absolute number of shingles cases remained lower in younger groups overall. Dermatologists emphasized that the association persisted even when accounting for common eczema treatments, suggesting the disease itself plays a role in shingles susceptibility.

"We have known for some time that patients with AD can have increased susceptibility to certain infections, and we also know that some of our systemic treatments can increase the risk of HZ. What is particularly notable here is the suggestion that AD itself may confer some additional risk, independent of those treatments," said Peter Lio, MD.

Peter Lio, MD, Founder of the Chicago Integrative Eczema Center and Clinical Assistant Professor of Dermatology at Northwestern University

Why Might Eczema Increase Shingles Vulnerability?

The exact mechanism linking eczema to shingles remains unclear, but experts point to the compromised skin barrier and immune system changes associated with atopic dermatitis. The study adjusted for common eczema treatments, including topical corticosteroids and systemic immunosuppressants, yet the association remained significant. This suggests that disease severity itself, rather than medication alone, may be driving the increased risk.

Dermatologists noted that the findings open new research questions. One expert raised whether shingles takes longer to resolve in eczema patients, whether longer antiviral treatment might be needed, and whether shingles vaccination could modify the risk in this population.

How to Protect Yourself if You Have Eczema

• Get Vaccinated: Experts recommend shingles vaccination as part of comprehensive eczema care. Vaccination is a potentially preventable way to reduce shingles risk and should be discussed with your dermatologist or primary care provider.
• Manage Eczema Severity: Since risk increases with disease severity, working with a dermatologist to keep your eczema well-controlled through appropriate treatments may help reduce shingles vulnerability.
• Avoid Infection Triggers: Protect yourself from viral infections like colds and flu by staying up to date on vaccinations, washing your hands regularly, and avoiding close contact with sick individuals.
• Monitor for Symptoms: Be aware of shingles symptoms, including pain, burning, or tingling on one side of the body, followed by a blistering rash. Early treatment with antivirals can reduce severity and duration.

"For me, the practical takeaway is not that we should alarm our patients with AD about shingles, but that we should recognize another potentially preventable complication and keep vaccination and infectious-risk assessment in mind as part of thoughtful, comprehensive AD care," noted Peter Lio, MD.

Peter Lio, MD, Founder of the Chicago Integrative Eczema Center and Clinical Assistant Professor of Dermatology at Northwestern University

What Are Hidden Triggers Making Eczema Worse?

While the shingles connection represents a new concern for eczema patients, dermatologists have also identified numerous overlooked triggers that can worsen skin flares. Many of these culprits hide in everyday products and habits. Understanding and avoiding these triggers may help reduce disease severity and, by extension, potentially lower shingles risk.

Fragrances represent one of the most common hidden triggers. They lurk not just in perfumes and cosmetics but also in scented candles, air fresheners, and even natural products like tea tree oil. During winter holidays, scented candles can be particularly problematic for eczema sufferers. Viral infections, including the common cold and flu, spike inflammation throughout the body and can trigger significant flares. Additionally, the herpes simplex virus that causes cold sores can lead to eczema flares and poses a risk of a serious complication called eczema herpeticum.

Microscopic triggers also matter. Dust mites, which feed on dead skin and live in bedding and furniture, can provoke allergic reactions in eczema-prone skin. Insect-related triggers extend beyond visible bites; cockroaches shed particles that can trigger flares even without direct contact.

• Bathing Habits: Overwashing removes natural skin oils and compromises the skin barrier. Experts recommend one bath or shower daily in lukewarm water with a gentle cleanser, followed by immediate moisturizing.
• Hand Washing: While hygiene is important, excessive handwashing can damage the already-compromised skin barrier in eczema. Use gentle cleansers, lukewarm water, and moisturize immediately after.
• Jewelry and Metals: Nickel, often found in earrings, necklaces, rings, and even buttons and zippers, can trigger contact eczema in people with nickel sensitivity. A nickel allergy develops through repeated exposure and persists once established.
• Fabric Choices: Wool, nylon, and polyester trap heat and sweat or irritate skin, while cotton, bamboo, and silk are gentler alternatives.
• Face Masks: During the COVID-19 pandemic, dermatologists observed increased flare-ups around the mouth and lips from mask use. Reusing masks and dyes in mask materials can worsen inflammation.
• Certain Foods: Acidic foods like tomatoes, strawberries, and citrus fruits can trigger flares in some people. Common food allergens include eggs, fish, shellfish, milk, peanuts, tree nuts, sesame, and wheat, particularly in children.

Managing these triggers requires personalized attention, as what provokes a flare varies from person to person. Keeping a flare diary and working with a dermatologist can help identify your specific culprits.

The connection between eczema severity and shingles risk underscores the importance of comprehensive skin care management. By controlling eczema flares, staying current on vaccinations, and being aware of hidden triggers, patients can take proactive steps to protect their skin health and reduce the risk of serious complications.