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

Abstract

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. 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. 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. 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. 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. 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.