Psoriasis is a chronic medical condition that causes thick, scaly patches to develop on different areas of the skin. Psoriasis symptoms can be triggered by infections, certain medications, and even stress. 

Some people with psoriasis worry that vaccines will make their symptoms worse. However, the National Psoriasis Foundation (NPF) recommends that most people with psoriasis get all vaccinations recommended by the Centers for Disease Control and Prevention (CDC). 

The shingles vaccine Shingrix is used to prevent shingles in both older and immunocompromised adults. Learn more about getting the shingles vaccine with psoriasis, including safety, risks, benefits, side effects, and more.

Risk of Shingles in People With Psoriasis

A 2017 study found that people with psoriasis were 29% more likely to develop shingles. Women and people with severe psoriasis were especially at risk. This is most likely because of the effects of certain medicines that many people with psoriasis take to control their symptoms.

Many psoriasis medications act as immunosuppressants—medicines that lower the body’s natural defense mechanisms to fight off infections. While they help manage severe psoriasis flare-ups (times when symptoms worsen), they can also increase the risk of infection and illness.

Older and immunocompromised adults, including some people with psoriasis, are also especially prone to shingles complications. The most common shingles complication is postherpetic neuralgia (PHN). PHN causes severe, long-term nerve pain in the initial area of the shingles rash.

Other possible shingles complications include pneumonia (lung inflammation), vision problems, hearing loss, encephalitis (brain inflammation), and death. About 30% of the people who are hospitalized for shingles have a weakened immune system.

The Role of the Immune System

The exact cause of psoriasis is unknown. However, it is most likely an autoimmune disorder, which means that it causes the body’s immune system to attack its own healthy cells. 

People with psoriasis most likely have an overactive immune system that causes skin cells to grow faster than normal. This activates the body’s inflammatory response, which leads to the development of thick patches on the skin that can be painful. 

People with autoimmune and inflammatory disorders are more likely to develop infections and illnesses, including shingles. According to the CDC, the risk of shingles is approximately 2 to 4 times higher among people with autoimmune disorders. 

People with psoriasis also have a higher risk of many other medical conditions, including:

• Kidney disease
• Crohn’s disease (an inflammatory bowel disease)
• Liver disease
• Uveitis (inflammation of the middle part of the eye)
• Heart disease
• Stroke
• Certain cancers
• Diabetes
• Osteoporosis (thinning and weakening of the bones) 

Many of these conditions also weaken the immune system, which can increase the risk of shingles even more.

Symptoms of Shingles vs. Psoriasis

Psoriasis is often mistaken for other skin conditions. If you’re unsure of whether you have shingles, psoriasis, or another skin condition, talk to your healthcare provider. They can refer you to a dermatologist for a definitive diagnosis. 

The most common type of psoriasis is plaque psoriasis. Plaque psoriasis causes thick, scaly, inflamed patches to develop on various parts of the body. Common affected areas include the scalp, elbows, knees, torso, and back.

The patches may appear red, silvery, white, or purple, depending on the person’s skin color and type. The symptoms of psoriasis are often chronic yet unpredictable, sometimes getting worse before going away for months or even years. 

Shingles causes a painful rash and blisters, usually on only one side of the body (often the torso) or face. The blisters often appear in a band. They typically spread before scabbing over within seven to 10 days. 

Shingles and psoriasis symptoms also share some triggers in common, such as:

• Stress
• Infection, illness, or disease
• Certain medications, such as immunosuppressive drugs
  

Can You Get the Shingles Vaccine With Psoriasis?

Shingrix is effective and safe for most people, including people with autoimmune conditions like psoriasis. 

In 2019, the medical board of the National Psoriasis Foundation released new guidelines for people with psoriasis regarding Shingrix (the recombinant zoster vaccine, or RZV). The NPF recommendations were as follows:

• People with psoriasis or psoriatic arthritis ages 50 and up should get two doses of Shingrix. 
• People under 50 years old with psoriasis or psoriatic arthritis who are taking certain medicines, such as Xeljanz (tofacitinib), systemic steroids, or combination systemic treatments, should get two doses of Shingrix.
• Other people under 50 years old with psoriasis or psoriatic arthritis should consider getting the shingles vaccine.

The NPF medical board also found that many people with psoriasis have an increased risk of developing shingles due to the medicines they take to control their symptoms. This makes it especially important for people with psoriasis to consider getting the shingles vaccine.

Clinical trials have not yet been conducted on the safety of Shingrix for patients with psoriasis. However, recent studies have found that Shingrix is safe and effective for people with other autoimmune conditions, including people over 80 years old. Research also suggests that two doses of Shingrix significantly reduces the risk of PHN among people with autoimmune disorders.

Shingrix Ingredients

Shingrix is typically delivered as a shot in the upper arm in two doses given two to six months apart. 

Shingrix is a recombinant vaccine, meaning that it is created from a single piece of the germ that causes shingles. Recombinant vaccines like Shingrix are generally considered safe for people with psoriasis and other autoimmune conditions. 

The previous shingles vaccine, Zostavax (zoster vaccine live), was a live vaccine. Since 2020, Zostavax has not been available for use in the United States. Live vaccines, which are made from a weakened version of the virus, are generally not recommended for people who are taking immunosuppressive therapy. 

In addition to its active ingredient, Shingrix contains an adjuvant—a harmless ingredient that helps the vaccine produce a stronger, longer-lasting immune response. On average, the shingles vaccine can protect you from shingles and related complications for seven years.

Potential Psoriasis Medication Complications

Many of the medications that help to control psoriasis symptoms work by reducing your body’s natural immune response. Studies suggest that taking the following psoriasis medications may increase your risk of getting shingles: 

• Enbrel (etanercept)
• Humira (adalimumab)
• Rheumatrex (methotrexate)
• Imuran (azathioprine)
• Systemic corticosteroids
• Xeljanz (tofacitinib)

Additionally, a 2021 study found that certain psoriasis treatments—including Soriatane (acitretin) and phototherapy (light therapy)—were associated with a reduced risk of shingles. 

Medications that weaken your immune response may also make certain vaccines less effective. If you are taking or planning to take immunosuppressive drugs to treat your psoriasis symptoms, let your healthcare provider know. They can help you decide whether or not to get Shingrix and how to time your doses to get the best results.

Where the FDA and CDC Stand

The CDC currently recommends that all people ages 50 and older, and all immunocompromised adults ages 19 and older, get Shingrix to prevent shingles and shingles-related complications. 

Additional CDC recommendations for people with autoimmune and inflammatory conditions (such as psoriasis) are as follows: 

• People whose immune systems are weakened, whether by a medical condition or a prescribed medication, should talk to their healthcare provider about getting their second Shingrix dose just one to two months after the first dose.
• If you are about to start taking immunosuppressive drugs, it’s best to get the shingles vaccine before you start the treatment. If that isn’t possible, you should get Shingrix at a point during your therapy when your immune function is not significantly reduced.
• If you’re currently having a psoriasis flare-up, consider waiting until your symptoms are under control to get the shingles vaccine.

According to the CDC, Shingrix is over 90% effective in preventing shingles and related complications among older adults with typical immune function. In immunocompromised adults, Shingrix is approximately 68%–91% effective.

In 2017, the Food and Drug Administration (FDA) approved Shingrix for the prevention of shingles and related complications in adults ages 50 and older. In 2019, the FDA approved the shingles vaccine for use in all immunocompromised adults.

What Causes Shingles to Activate?

Shingles is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chicken pox. 

Anyone who has ever had chickenpox can get shingles. Around 99% of people in the United States. born in 1980 or earlier have had chicken pox at some point. Many didn’t know they had it at the time. 

People with weakened immune systems and people over 50 years old are especially at risk of developing shingles and complications like PHN. Stress, illness, and infection are all possible triggers for the reactivation of VZV.

Shingles Vaccine Alternatives

Shingrix is typically effective and free from dangerous side effects. It is the best way to prevent shingles and related complications. 

However, if you have psoriasis and don’t want to get the shingles vaccine, here are a few ways to lower your risk of getting shingles:

• Manage stress: Stress is a potential trigger for both psoriasis and shingles. Meditation, breathing exercises, relaxation techniques, and maintaining a healthy sleep routine may help you prevent potential flare-ups.
• Consider different medications: Certain psoriasis treatments, such as light therapy, have not been found to increase the risk of shingles. If you are concerned about getting shingles while taking immunosuppressive drugs, talk to your healthcare provider about alternative options. 
• Lower your risk of infection: Illness increases your shingles risk. Protect yourself from infections by washing your hands frequently, eating healthy foods, exercising regularly, and getting enough rest.
  

Summary

Psoriasis is an autoimmune disorder that causes thick, scaly patches on different parts of the body. Psoriasis can increase the risk of various other medical conditions, including shingles. 

Shingles (herpes zoster) is a condition that causes a painful, burning rash and blisters. In some cases, it causes complications like postherpetic neuralgia (PHN)—long-term nerve pain in the area of the rash. Shingrix is a recombinant vaccine that prevents shingles and related complications in older and immunocompromised adults.

The CDC and FDA recommend that people age 50 and older and immunocompromised adults age 19 and older, get two doses of Shingrix. The National Psoriasis Foundation advises people over age 50 with psoriasis and younger people with psoriasis who are taking immunosuppressants to control their symptoms to get the shingles vaccine.

A Word From Verywell

Psoriasis can increase your risk of developing many different conditions, including shingles. If you’re worried about getting Shingrix with psoriasis, talk to your healthcare provider about your concerns. They can help you make the best decision based on your symptoms, medical history, and medications.