Managing Psoriasis, Atopic Dermatitis, and Hidradenitis Suppurativa During COVID-19
The outbreak of COVID-19 affects the management of chronic dermatologic disease in those patients already receiving therapy and patients about to begin a new treatment.
Patients with psoriasis, atopic dermatitis, and hidradenitis suppurativa can remain on their treatment protocol despite the novel coronavirus disease 2019 (COVID-19) pandemic, suggests a study review published in the American Journal of Clinical Dermatology. The biologic agents and nonbiologic immunosuppressive and immunomodulatory therapies that manage cutaneous disease may actually control the “cytokine storm” linked to poorer response in this patient population.
“The host’s dysregulated and excessive innate immune response is an important contributor to the disease process and tissue damage in severe cases of [severe acute respiratory syndrome coronavirus 2] SARS-CoV-2 infections,” the authors explained. Although the primary immune response will cause viral clearance for most patients, a subgroup of patients experience an exaggerated secondary immune response, the “cytokine storm” that results in inflammatory-induced lung damage and acute complications. This reaction may be managed with selective immunosuppressants such as tumor necrosis factor-α inhibitor adalimumab that discourages penetration of the SARS-CoV-2 into cells, Janus kinase inhibitors such as baricitinib for the treatment of atopic dermatitis that may reduce the ability of the virus to infect lung cells, anti-interleukin-1 agents, and anti-interleukin-6 drugs such as tocilizumab.
Most dermatologic societies, as well as rheumatology and gastroenterology communities, recommend postponement or discontinuation of immunosuppressive or biologic agent therapy in patients who have been diagnosed with COVID-19 until the patient recovers from the infection. However, treatment strategies remain the joint decision of patient and physician after weighing the risk for SARS-CoV-2 infection vs benefit of treatment, the authors wrote. They also reported that discontinuation of biologic agent treatment in patients with psoriasis because of their risk for infection is not supported by existing data.
Although discontinuation of immunosuppressive or biologic agent therapy is suggested in patients with active COVID-19 infection, in patients without active infection but with a higher risk for exposure because of living in an area with a high incidence of COVID-19 or having contact with patients with confirmed infection, an individualized treatment plan can be implemented that increases intervals between administration or temporarily suspends treatment.
However, the authors wrote, treatment interruption and isolation may be warranted for patients with the comorbid obesity, cardiovascular disease, chronic lung disease, asthma often seen with psoriasis, hidradenitis suppurativa, and atopic dermatitis as these conditions can negatively affect the course of COVID-19 infection.
“[A]vailable data on past and present outbreaks of coronavirus suggest that immunosuppressed patients are not at an increased risk for severe disease and complications compared with the general population,” the authors concluded.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Torres T, Puig L. Managing cutaneous immune‑mediated diseases during the COVID‑19 pandemic. Am J Clin Dermatol. [published online April 10, 2020] doi:10.1007/s40257-020-00514-2
