What to know about COVID-19 and psoriasis

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The details of how COVID-19 affects those with psoriasis remain unknown, but there is not yet evidence to suggest that it affects them differently than people without the condition.

According to the National Psoriasis Foundation (NPF), if a person is not taking an immunosuppressive medication and is free from other underlying diseases, there may be “minimal additional risk” of them contracting SARS-CoV-2 relative to the rest of the population.

However, as the virus is highly transmissible, spreads rapidly, and replicates rapidly, everyone is at risk. Even asymptomatic people can transmit the virus to others.

The NPF note that people with severe psoriasis, such as those who are on immunosuppressive therapies or have other medical conditions, probably are at higher risk of infection.

As psoriasis is a chronic immune-mediated condition, some people may take immunosuppressant drugs to keep their symptoms under control.

These medications can reduce immune function, which may increase the risk of infection with SARS-CoV-2 or other infectious agents. Immunosuppressive drugs could also increase the risk of severe symptoms.

According to the Centers for Disease Control and Prevention (CDC), conditions or medications that weaken the immune system and cause people to become immunocompromised increase the risk of severe COVID-19.

The International Psoriasis Council (IPC) recommend that people with psoriasis who receive a COVID-19 diagnosis discuss discontinuing or postponing their use of immunosuppressant medications with their doctor.

However, the IPC caution that doctors should carefully weigh the benefit-to-risk ratio of immunosuppressive treatments on an individual basis.

The medical board of the NPF do not recommend that people with psoriasis stop their treatment unless they have an active infection. They suggest that those in high risk groups discuss their options with their doctor.

The CDC list the following as high risk:

• those aged 65 years and older
• people living in a nursing home or care facility
• smokers
• individuals with underlying medical conditions (especially if poorly controlled) or risk factors that include:
  • chronic lung disease
  • moderate or severe asthma
  • serious heart conditions
  • a weakened immune system, for instance, due to cancer treatment or HIV
  • severe obesity
  • diabetes
  • chronic kidney disease
  • liver disease

The World Health Organization (WHO) and other expert bodies are still learning about the effects of COVID-19 on those with co-occurring conditions.

The WHO list the most common COVID-19 symptoms as:

• a dry cough
• fatigue
• fever

They state that other possible symptoms include:

• aches and pains
• diarrhea
• difficulty breathing
• nasal congestion
• runny nose
• shortness of breath
• sore throat

Some people with COVID-19 also report a loss of taste or smell.

Symptoms typically develop within 2–14 days of exposure to the virus. They range from mild to severe, although the majority of people experience a relatively mild form of the disease, which will not require specialist treatment in a hospital.

Some people may be asymptomatic, meaning that they have no symptoms, despite testing positive for the virus that causes COVID-19. Asymptomatic individuals can still transmit the virus to others, though.

People can reduce the risk of exposure to the novel coronavirus by:

• washing their hands regularly with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer
• maintaining a distance of 6-feet (2-meter) or more from others, especially those who are showing symptoms
• staying home as much as possible and limiting the amount of time that they spend out in public places, including parks and grocery stores
• stocking up on food, medications, and other essential items to reduce the number of trips outside the home
• avoiding nonessential travel
• cleaning and disinfecting surfaces and items in the home daily, including faucets, door handles, toilet handles, and remote controls
• avoiding sharing cutlery, towels, and other personal items with family members
• having sick members of the household isolate themselves as much as possible until symptoms resolve
• wearing a cloth face covering or mask when in public outside the home
• sick persons should wear a mask whenever in the presence of others

Anyone who thinks that they may have become exposed to the virus should:

• monitor their symptoms closely and check their temperature daily for fever
• call their doctor immediately if symptoms develop
• seek immediate medical attention if breathing difficulties or chest pain occurs

It is advisable to call ahead before presenting at an emergency facility in case they need to put safety measures in place.

The NPF recommend that people with psoriasis discuss their treatment with their doctor. A doctor may recommend continuing medications or taking a break from them.

It is important that people only adjust or stop their treatment after consulting with their doctor.

So far, there is no specific treatment or vaccine for COVID-19. In those who contract the virus and develop symptoms, treatment aims to alleviate these symptoms. Treatments include:

• cough medicines
• hydration
• pain relief
• rest

People who develop severe illness will require hospitalization. In the hospital, doctors may put them on oxygen or a ventilator, or provide other specialist care.

In some cases, doctors may speak to a person about participating in a clinical trial, which is very important in helping experts learn about the disease and find effective treatments.

People with psoriasis who develop COVID-19 should speak to their doctor about their psoriasis treatment while ill.

Those taking immunosuppressive medications will often need to stop treatment temporarily until their doctor says that it is safe to resume. The doctor will advise on other types of psoriasis treatment on a case-by-case basis.

What to do if the test is positive

When someone tests positive for the novel coronavirus, their doctor will provide them with instructions for recovery. They will also explain to the individual how to self-isolate to reduce the spread of the virus to others.

People with mild symptoms can typically recover at home, while those with severe illness often require a hospital stay.

It is difficult to determine the outlook for people with COVID-19 and psoriasis, but this generally depends on:

• the severity of the disease
• the person’s age, sex, and ethnicity
• the presence of additional underlying health conditions

Data from China showed that 80% of people who develop COVID-19 have mild-to-moderate symptoms and recover well. Of the remainder, 13.8% develop severe disease, and 6.1% become critical and require intensive care.

Prompt medical treatment may improve the outlook of people with severe disease and reduce the risk of complications, which include pneumonia and organ failure. In some cases, COVID-19 can also lead to death.

At present, experts know little about the effects of COVID-19 on people with psoriasis.

However, it seems that those who are not taking an immunosuppressive medication and do not have another co-occurring disorder have a similar risk to the rest of the population.

People taking immunosuppressive therapies who receive a COVID-19 diagnosis should consult their doctor immediately. It is likely that the doctor will advise them to stop taking these medications until they recover.

There is no specific treatment for the novel coronavirus, but individuals can reduce their risk of contracting it by maintaining physical distance from others, avoiding unnecessary public outings, and practicing good hygiene.

Individuals with psoriasis should speak to their doctor about their specific case. A doctor will address any concerns that a person has, and they may adjust their treatment plan accordingly.

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