The available data on past and present outbreaks of Coronavirus infections (SARS, MERS, COVID-19) suggest that immunosuppressed patients are not at increased risk for severe manifestations and complications of COVID-19 compared to the general population.
Immunosuppressive and immunomodulatory drugs (human interleukin-1 receptor antagonist and anti-interleukin-6) may potentially control the “cytokine storm” associated with a poorer outcome in these patients.
Thus, patients with cutaneous immune-mediated diseases (including psoriasis, atopic dermatitis, and hidradenitis suppurativa) can, in general (and subject to individual consideration with the prescriber), continue their treatment during the COVID-19 outbreak. This would prevent disease flares that can contribute to increasing patient burden, disability, poor quality of life, and healthcare usage.
Withholding immunosuppressive (e.g. methotrexate, cyclosporine) or biologic treatment in patients with active COVID-19 infection is generally recommended. Starting these treatments in the event of active infections is contraindicated.
If patients develop symptoms consistent with COVID-19 infection, it is advisable that such treatments are paused. We recognize that some comorbidities associated with psoriasis, hidradenitis suppurativa and atopic dermatitis (obesity, diabetes, hypertension, cardiovascular disease, chronic lung disease, asthma), and in those aged 60 years and older, worsen the prognosis of COVID-19 infection.
If patients live in areas with a high incidence of COVID-19 infection, or are close contacts of confirmed cases, individual consideration should be given to temporary discontinuation of some therapies considering factors such as age or comorbidities.
Currently we have no data regarding the impact of systemic psoriasis therapies (or therapies for atopic dermatitis and hidradenitis suppurativa) on susceptibility to or severity of COVID-19 infection. Thus, any guidance is based on previous clinical experience and an understanding of the mechanisms of action of our therapies. The TF recommends that all patients with these diseases who have either suspected or confirmed COVID-19 infection are entered into the relevant registries established to address this lack of data.
Repository of references and further readings:
• Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic
Abstract on recommendations for patients with cutaneous immune-mediated diseases,
Pr. Luis Puig and Dr Tiago Torres, Spain
American Journal of Clinical Dermatology, 10 April 2020
• Should biologics for psoriasis be interrupted in the era of COVID-19?
Concern about immunosuppressive or immunomodulating effects that might render patients on biologic therapies more susceptible to COVID-19 infection -> provide data on infectious complications for biologic therapies from pivotal trials for psoriasis.
Dr Mark Lebwohl, Ryan Rivera-Oyola /US, Dr. Dedee Murrell /Australia - JAAD, 31 March 2020
• Recommendations for systemic therapy in persons with psoriasis during the pandemic phase of SARS-CoV-2
Statement and patient information to be used in practice and/or hospital. The statement is based on currently available evidence and an expert consensus on the basis of data from published literature.
PSOBest / The German Psoriasis-Registry
PsoBest, 18 March 2020, SARS-CoV-2
• Statement on the Coronavirus (COVID-19) Outbreak
Recommendations for psoriasis patients treated with immunosuppressant medications
IPC (International Psoriasis Council)
COVID-19, IPC ALERT; 11 March 2020
• How to proceed in patients with concomitant diseases/comorbidities?
(Link available soon. Papers to be available during week 16 or 17)
GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis),
ECCO (European Crohn’s and Colitis Organisation)
SPIN Presentation
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Recent publications on Psoriasis and Atopic Dermatitis
on Psoriasis
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Bromodomain and extra-terminal domain (BET) protein plays an important role in epigenetic regulation, and the regulation of disruption contributes to the pathogenesis of cancer and inflammatory disease. With the goal of discovering novel BET inhibitors, especially BRD4 inhibitors, we designed and synthesized several compounds starting from our previously reported pyrido-benzodiazepinone derivative 4 to enhance BRD4 inhibitory activity while avoiding hERG inhibition. Molecular docking (...)
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Psoriasis is a complex recurrent inflammatory skin disease with different pathological changes in different stages. Psoriasis in its active stage, which is comparable to the blood-heat type in traditional Chinese medicine (TCM), has been treated by Liangxue Jiedu Decoction (LJD) in TCM for decades, with proven efficacy. According to TCM theories, LJD has the function of removing heat and pathogenic factors from the (...)
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Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of worldwide population, and causing long-term troubles to the patients. Therefore, it is urgent to develop safe and effective therapeutic drugs. Catalpol is a natural iridoid glucoside, that has several remarkable pharmacological effects, however, whether catalpol can alleviated psoriasis has not been explored. The goal of the present work is to study the role of catalpol in psoriasis in vivo and in vitro. (...)
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This study examined the full spectrum of comorbid disorders in all statutory-health-insured children aged 5 to 14 years with ADHD in 2017 by using nationwide claims data in Germany. Children with ADHD ( = 258,662) were compared for the presence of 864 comorbid diseases with a control group matched by gender, age, and region of residence ( = 2,327,958). Among others, metabolic disorders (odds ratio [OR] = 9.18; 95% confidence interval [CI] = [8.43, 9.99]), viral pneumonia (OR = 4.95; 95% (...)
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Qingxue jiedu formulation ameliorated DNFB-induced atopic dermatitis by inhibiting STAT3/MAPK/NF-κB signaling pathways.
J Ethnopharmacol.
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Qingxue jiedu Formulation (QF) is composed of two classic prescriptions which have been clinically used for more than 5 centuries and appropriately modified through basic theory of traditional Chinese medicine for treating various skin inflammation such as atopic dermatitis (AD), acute dermatitis and rash. Although QF possesses a prominent clinical therapeutic effect, seldom pharmacological studies on its anti-AD activity are (...)
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Methicillin-resistant from infected skin lesions present several virulence genes and are associated with the CC30 in Brazilian children with atopic dermatitis.
Virulence.
2021 Dec , 12, (1):260-269.
Atopic dermatitis (AD) is a chronic inflammatory skin disease and colonization by may affect up to 100% of these patients. Virulent and resistant isolates can worsen AD patient clinical condition and jeopardize the treatment. We aimed to detect virulence genes and to evaluate the biofilm production of isolates from infected skin lesions of children with AD. Methicillin resistance was detected by phenotypic and molecular tests and the virulence genes were detected by PCR. Biofilm formation (...)
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