Objectives <p>Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with highly heterogenous clinical manifestations and severity. Herpes zoster (HZ) is a viral disease caused by reactivation of varicella-zoster virus which remains dormant in the dorsal root sensory ganglia after a previous varicella infection. There is limited information on the association between HZ and childhood-onset SLE (cSLE). This study aimed to determine the risk factors for HZ in patients diagnosed with cSLE.</p> Patients and methods <p>Single-center retrospective cohort study which included all patients less than 19 years old with SLE at a tertiary hospital in the Philippines.</p> Results <p>A total of 388 patients were included in the study. The prevalence of HZ was 15.72%, with an incidence rate of 38.40 per 100 person-years. The most common location of the HZ was the upper extremities (18.03%). The median SLEDAI at HZ diagnosis was 4, 16.39% had recurrent HZ, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with HZ (54.10% vs. 40.37%). Glucocorticoid dosage ≥ 5&#xa0;mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid doses of ≥ 5&#xa0;mg increased the risk for the development of HZ by 1.61 (<i>p</i> = 0.048), 2.07 (<i>p</i> = 0.009), and 10.20 (<i>p</i> = 0.001) times, respectively.</p> Conclusion <p>The prevalence and incidence of HZ in cSLE patients are 15.72% and 38.40 per 100 person-years, respectively. The risk factors identified for HZ among cSLE patients were lymphopenia, lupus nephritis, and immunosuppressive agents. Glucocorticoid dosage ≥ 5&#xa0;mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ.</p>