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Cited by 132Herpesvirus Infections and TreatmentsDrug-Induced Adverse ReactionsCytomegalovirus and herpesvirus research

Nonsteroidal anti‐inflammatory drug use and the risk of severe skin and soft tissue complications in patients with varicella or zoster disease

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Mikaeloff, Yann, Kezouh, Abbas, Suissa, Samy·2008·British Journal of Clinical Pharmacology
DOI 10.1111/j.1365-2125.2007.02997.xPMC PMC2291221
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Abstract

What is already known about this subject • Three previous epidemiological studies found an increased risk of severe skin and soft tissue infectious complications associated with exposure to NSAIDs in children with varicella. • In vitro studies demonstrated that decreases in defences against infections induced by NSAIDs could be due to impairment of neutrophil blood cell function. What this study adds • The use of NSAIDs is associated with an increased risk of severe skin and soft tissue complication of varicella in children. • The use of NSAIDs is also associated with a small increased risk of such complications in zoster disease in adults and the elderly. • This study supports the limited prescription of NSAIDs in VZV infection. Aims To assess the risk of severe skin and soft tissue complications associated with the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) in treating patients with varicella zoster virus infection. Methods The design was a nested case‐control study, with matching for age and practice. The setting was primary care in the United Kingdom (United Kingdom's General Practice Research Database). Two population‐based cohorts of all patients with a primary varicella (n = 140 111) or zoster (n = 108 257) diagnosis during 1994–2005 were followed up for 2 months after diagnosis. Main outcome measures of severe skin or soft tissue complications (mostly cellulitis and abscess) associated with current NSAID or paracetamol use were estimated, and adjusted for potential confounding factors, including sex, drug use, and comorbidity. Results In patients with varicella, there were 386 cases of severe skin or soft tissue complications (rate 2.8 per 1000) during the 2 month follow‐up period (mean age 10.7 years). The rate of complications associated with exposure to NSAIDs was increased (rate ratio 4.9; 95% CI 2.1, 11.4). In patients with zoster disease, there were 681 cases of severe skin or soft tissue complications (rate 6.3 per 1000) during the 2 month follow‐up (mean age 60.9 years). The rate ratio of complications associated with exposure to NSAIDs was 1.6 (95% CI 1.1, 2.4). In both conditions, there was no increased risk of complication associated with a current exposure to paracetamol. Conclusions The use of NSAIDs is associated with an elevated risk of severe skin and soft tissue complications of varicella zoster virus infection, mostly in children with varicella.

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  • The inference that acute inflammation usually has positive effects is strongly supported by findings that inhibiting the inflammatory response by nonsteroidal anti-inflammatory drugs worsens wound and bone healing, increases the risk of anastomotic failure or sepsis after surgery, aggravates heart and renal failure, interferes with an adequate immune response to antigen presentation in the gut, or

    “The inference that acute inflammation usually has positive effects is strongly supported by the finding that inhibiting the inflammatory response by nonsteroidal anti‐inflammatory drugs worsens wound and bone healing,47, 48, 49, 50 increases the risk of anastomotic failure or sepsis after surgery,51, 52 aggravates heart and renal failure,53, 54 interferes with an adequate immune response to”

    From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [47]

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Research works printed but not linked: 2

  1. Hambleton S. Chickenpox. Curr Opin Infect Dis 2005; 18: 235-40.
  2. Heininger U, Seward JF. Varicella. Lancet 2006; 368: 1365-76.

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Authors
Mikaeloff, Y., Kezouh, A., & Suissa, S.
Affiliations
  • Assistance Publique – Hôpitaux de Paris (FR)
  • McGill University (CA)
Corresponding author
Suissa, Samy
ORCID
Venue
British Journal of Clinical Pharmacology
Publisher
Wiley
Published
2007-08-15
Volume
65
Issue
2
Pages
203-209
ISSN
  • 0306-5251 (ISSN-L)
  • 1365-2125
DOI
10.1111/j.1365-2125.2007.02997.x
PMC
PMC2291221
OpenAlex
W2016022909
Cited by
132
References
37
Citations by year
2026: 6 · 2025: 9 · 2024: 9 · 2023: 3 · 2022: 8 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 5 · 2017: 10 · 2016: 11 · 2015: 7 · 2014: 7 · 2013: 7 · 2012: 3
FWCI
4.13
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • British Journal of Clinical Pharmacology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
Keywords
nonsteroidal anti-inflammatory drugs, varicella, herpes zoster, varicella-zoster virus infection, cellulitis, abscess, paracetamol, NSAID adverse effects, children, older adults, neutrophil function, infection risk, primary care patients, Clinical Practice Research Datalink, nested case-control study, confounding
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Chickenpox, Child, Female, Follow-Up Studies, Herpes Zoster, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Case-Control Studies, Skin Diseases, Viral, Soft Tissue Infections

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