With the novel coronavirus outbreak continuing to evolve as a public health concern, the need for tailored medical guidance and updated clinical recommendations is emerging across specialties. General guidelines issued by the CDC and WHO, such as social distancing and self-isolation when possible, apply to all individuals. However, the coronavirus may have challenging implications on the care of certain dermatologic patients prompting the need for updated recommendations focused on the global dermatology community.
While the impact of the novel coronavirus on the chronic inflammatory skin condition psoriasis and its treatment remains unknown, several agencies raise awareness of potential concerns related to disease management at this time. The International Psoriasis Council, the National Psoriasis Foundation, and other organizations have recently issued guidelines and educational online resources to inform the treatment of psoriasis in light of the coronavirus outbreak.
The International Psoriasis Council advises physicians to be aware of the potentially harmful effects of COVID-19 on psoriatic patients , although no specific implications have been named. Currently, the NPF recommends pediatric and adult patients with psoriasis or psoriatic arthritis follow CDC, WHO, and federal/local guidelines to protect themselves and others. In addition, health experts encourage physicians to conduct telehealth appointments when possible for routine visits and to ensure patients with concerns remain in contact with a medical professional.
Although psoriasis and psoriatic arthritis are immune-mediated inflammatory diseases, individuals who do not take immunosuppressive medications or have other comorbid diseases may be at a minimal added risk of COVID-19 infection. However, according to the latest guidance, those with severe disease, those on potentially immunosuppressive therapies, and those with comorbid conditions may be at greater risk of infection.
As a result, the Council recommends clinicians consider discontinuing or postponing the use of immunosuppressant medications in patients diagnosed with COVID-19 disease. This guidance comes in accordance with established psoriatic guidelines – which state that immunosuppressive psoriasis treatments are contraindicated in patients with active infections.
It is essential for patients with confirmed or suspected COVID-19 infections to be under the care of healthcare provider and to let their provider know they are taking a biologic medication. In addition, patients should be reminded that the decision to halt oral systemic therapy must be made in consultation with a healthcare provider.
Per the most recent guidelines, the NPF Medical Board does not recommend all patients discontinue biologic therapy. They do, however, recommend individuals stop taking biologics if they have an active COVID-19 infection and suggest patients in high-risk groups discuss treatment options with their healthcare providers. Important factors for clinicians to consider when determining the most appropriate treatment solution are the type of biologic drug being used; the age, disease characteristics, and possible underlying health conditions of the patient; and the patient’s specific health concerns.
While there is currently no strong evidence to necessitate official guidelines or the identification of added risk level for patients on oral immunosuppressive therapy, the NPF maintains it is possible they may face greater risk of COVID-19 infection. The Foundation urges clinicians to maintain caution with higher risk demographics, including patients over the age of 60, smokers, and those with chronic medical conditions such as lung disease, heart disease, diabetes, or cancer. As more becomes known about the implications of coronavirus on psoriasis, its treatment, and other cutaneous conditions, further updated guidance for the dermatology community is expected to emerge.