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This has been reviewed and updated as of May 29, 2020.
Because psoriasis primarily impacts the skin, many people assume it is merely a cosmetic problem. In reality, psoriasis is an autoimmune disease. This means that an overactive immune system is driving inflammation and overproduction of skin cells.
As with other autoimmune conditions, psoriasis patients may have a higher than average risk of contracting COVID-19 (novel coronavirus) or developing serious complications, though more research on this patient population is needed. It is too preliminary to say whether or to what degree people with psoriasis could be affected differently by COVID-19.
An observational study that aims to determine how prevalent COVID-19 is in psoriasis patients who are using immunosuppressive medication is currently underway in Italy.
Recently, a study from the Perelman School of Medicine at the University of Pennsylvania found that psoriasis patients who use an IL-17 inhibitor (secukinumab, ixekizumab, or brodalumab) were more likely to develop respiratory tract infections during previously conducted drug trials. They did not specifically look at risk for COVID-19, as these trials were conducted prior to the pandemic.
The flip side: IL-17 inhibitors have shown some promise as a potential treatment for COVID-19 patients who experience a cytokine storm.
One small case study, published recently in the New England Journal of Medicine, found that people with inflammatory conditions, including psoriasis, who took biologics and had COVID-19 were not any more likely to develop complications compared to inflammatory disease patients who were not using these drugs. Read more about the research here. But larger studies may yield different findings, and there are other reasons to be concerned.
“People with psoriasis are also known to have a greater incidence of co-occurring chronic medical conditions, such as heart disease, that can put one at higher risk for COVID-19 complications,” says California-based dermatologist Cynthia Bailey, MD, a diplomate of the American Board of Dermatology.
Having psoriasis during the coronavirus pandemic may also be problematic because your skin is much more apt to become irritated from all the frequent hand washing and sanitizing. You may also develop skin cracks or sores.
“I wonder if the virus can pass through open skin sores, but I could not find any scholarly scientific information to suggest that it has been seen,” says Dr. Bailey. At this time, it is believed that COVID-19 is primarily transmitted when someone inhales virus particles, or touches them and then touches their mouth, nose, or possibly eyes.
Even if direct skin transmission does not turn out to be possible, breaks in the skin’s barrier and irritation are still serious issues, says Joshua Zeichner, MD, director of Cosmetic and Clinical Research in the Department of Dermatology at The Mount Sinai Hospital in New York City.
“The skin on your fingers is generally where the virus lives, and when you touch it you can spread it to your face,” he explains.
People who are prone to skin inflammation and scaly plaques on their hands may have a hard time washing their hands thoroughly. “If you can’t wash your hands well you may be more likely to spread the virus if you come in contact with it,” he adds.
Dr. Bailey also has concerns about hand hygiene in patients experiencing psoriasis flares. “Psoriatic skin lesions are characterized by a lot of scale, and these are rough places where viral particles may be able to lodge and resist easy removal by washing,” she says.
Here’s what you can do to stay healthy.
Follow CDC and local government recommendations for social distancing
If you’re on immunosuppressing medications or have other underlying health conditions that place you at a higher risk for coronavirus complications, you should avoid leaving your home as much as possible and avoiding close contact with other people if you need to go to work or run an essential errand. Wear a cloth face mask when you’re out in public places.
Touch base with your dermatologist
You should never make any changes to your current medication regimen without first talking to your doctor.
The American Academy of Dermatology (AAD) recommends that most patients using psoriasis medication that can affect the immune system, such as various biologic medications, continue their usual treatment at this time — unless they have symptoms of COVID-19 or have tested positive for the virus.
In that case, the AAD suggests taking a temporary break from the medication until you have recovered from COVID-19.
Whatever you do, don’t go it alone or you risk having your condition worsen. “I do not recommend stopping your medicine without your doctor’s supervision and future plan of action,” says Dr. Zeichner.
If you have not yet been in touch with your dermatologist, it’s a good to check in. Many doctors are seeing patients over telehealth (video appointments) so you don’t need to go in person if you’re not comfortable.
Use soap and water over hand sanitizers
This is good advice for everyone because hand sanitizers are not as effective for removing COVID-19 as plain old-fashioned hand washing, but it is especially key for anyone prone to skin problems.
“Alcohol-based hand sanitizers are drying and will lead to irritant hand dermatitis,” says Dr. Bailey.
Choose gentle cleansers
There’s no need for harsh abrasives or antibacterial formulas. “Stick to hydrating cleansers that will not dry out the skin barrier,” says Dr. Zeichner. Dr. Bailey adds that hypoallergenic, foaming soaps are often a good pick.
The importance of scrubbing thoroughly with soap has been drilled into everyone at this point, but don’t forget to rinse well with water when you’re done. “Any retained [soap] residue will continue to strip skin oils and lead to chapping and painful hand cracking,” says Dr. Bailey.
Moisturize, moisturize, moisturize
Keep a thick, hydrating cream near every sink in your home and use it after you wash your hands. Petrolatum-based moisturizers like Vaseline are among the options worth considering. “They help form a protective seal over the surface of the skin, which keeps hydration in and microbes out,” says Dr. Zeichner. If you find your skin getting irritated, ask your dermatologist for product recommendations that are right for your psoriasis-prone skin.
Watch for strange dermatologic symptoms
While COVID-19 primarily targets the respiratory system, some people with the virus have developed purple or red lesions on their hands and/or feet. If you notice any unusual skin changes (especially if they don’t look like psoriasis), contact your dermatologist to find out if you should be tested.
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Guidance on the Use of Immunosuppressive Agents. American Academy of Dermatology. https://www.aad.org/member/practice/coronavirus/clinical-guidance/biologics.
Haberman R, et al. Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York. New England Journal of Medicine. April 29, 2020. doi: https://doi.org/10.1056/NEJMc2009567.
Hand washing: Expert advice for people with skin conditions. Medical News Today. https://www.medicalnewstoday.com/articles/hand-washing-advice-for-people-with-skin-conditions.
Interview with Cynthia Bailey, MD, dermatologist in California
Interview with Joshua Zeichner, MD, director of Cosmetic and Clinical Research in the Department of Dermatology at The Mount Sinai Hospital in New York City
Statement on Dermatologic Manifestations of COVID-19. American Academy of Dermatology. May 7, 2020. https://www.aad.org/member/practice/coronavirus/clinical-guidance/dermatological-manifestations-covid-19.
Wan MT, et al. The Risk of Respiratory Tract Infections and Symptoms in Psoriasis Patients Treated with IL-17-Pathway Inhibiting Biologics: A Meta-Estimate of Pivotal Trials Relevant to Decision-Making During the COVID-19 Pandemic. Journal of the American Academy of Dermatology. May 9, 2020. doi: https://doi.org/10.1016/j.jaad.2020.05.035.