Psoriasis management in times of COVID-19: the knowledge is growing steadily

A task force of psoriasis experts is offering guidance to dermatologists caring for psoriatic patients during the COVID-19 pandemic. Patients with psoriatic disease should stay on their treatment during the pandemic unless they become acutely infected. Psoriasis patients should further take any mRNA-based vaccine as soon as offered. Lastly, adhering to evidence-based treatments only is encouraged.

The COVID-19 task force of the National Psoriasis Foundation has already issued nearly 30 recommendations concerning COVID-19 and psoriasis that are constantly updated [1–3]. The aim of this group of experts is to aid decision-making for psoriasis patients during the pandemic [4]. Discussed was whether psoriatic patients have an augmented risk for severe disease when infected with SARS-CoV-2. Results indicated the underlying psoriasis itself does not put patients at a higher risk but the higher prevalence of co-morbidities such as hypertension, obesity, and chronic kidney disease does, as those have been identified to contribute to poor outcomes of COVID-19.

A particular concern was the potential effect of biologic therapy for psoriasis on infection risk and the course of COVID-19. “The registry data is largely reassuring; it does not seem that any strong signal exists for psoriatic disease treatment being associated with higher risk of COVID-19 or worse outcomes in any meaningful way,” said Prof. Joel Gelfand (University of Pennsylvania Perelman School of Medicine, PA, USA). Results from clinic-based cohorts have provided mostly reassuring insights concerning biological treatment: rates of infections, hospitalisation, and mortality were similar to those in the general population. Furthermore, results from automated databases such as TriNetX ­–containing electronic medical records of 53 million people– indicated that patients on TNF inhibition or methotrexate did not have a heightened risk of hospitalisation [5]. All in all, the existing literature gives mostly encouraging results, but larger and long-term studies are still needed [4]. “The committee suggests that we should be balancing known benefits of our therapies with theoretical risks and, in general, our consensus is that patients with psoriatic disease should stay on their treatment during the pandemic, unless they become acutely infected,” summarised Prof. Gelfand.

In terms of mRNA-based vaccination, Prof. Gelfand indicated that dermatologists should be aware of the occurrence of about 0.8% delayed injection-site reactions 2, 3, or up to 8 days after vaccination. These reactions do not pose a contraindication for receiving a second dose. Due to the latest pause of the adenovirus-vectored vaccine, the current recommendation is that patients with psoriasis should take any mRNA-based vaccine as soon as offered and in general continue their systemic treatment.

Finally, concerning treatment of a SARS-CoV-2 infection, Prof. Gelfand encouraged to adhere only to evidence-based treatments. For outpatients, cocktails of bamlanivimab plus etesevimab and casirivimab plus imdevimab have demonstrated benefit in preventing progression to severe COVID-19. Among the recommendations for inpatients are dexamethasone and remdesivir, also in combination with baricitinib depending on the individual patient’s specific criteria. Lastly, Prof. Gelfand encouraged staying in touch with the continuously updated COVID-19 resource centre for psoriasis patients.

1. Gelfand JM, et al. J Am Acad Dermatol. 2020;83(6):1704-1716.
2. Gelfand JM, et al. J Am Acad Dermatol. 2021;84(5):1254-1268.
3. COVID-19 Task Force Guidance Statements. Retrieved from psoriasis.org/covid-19-task-force-guidance-statements on 20 May 2021.
4. Gelfand J. Management of psoriasis during the COVID-19 pandemic. Session S009, AAD VMX 2021, 23-25 April.
5. Yousaf A, et al. J Am Acad Dermatol. 2021;84(1):70-75.

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Posted on 7 June 202116 February 2024