The National Psoriasis Foundation Task Force met to update the guidance for the management of psoriatic disease in the context of the COVID-19 pandemic. This task force consists of 18 physicians who review new literature on a weekly basis. The expertise of these physicians range from dermatology to rheumatology, epidemiology, infectious disease and critical care.
The original 22 guidelines statements have been updated with new scientific evidence, and 5 new items have been added. It is important to note that these are not comprehensive guidelines, this is considered a live document, and evidence in some cases is limited in quality or quantity. These guidelines have been divided into 5 categories based on 5 questions (see below). Summaries of guidelines provided under each question:
1. What are the effects of psoriatic disease itself on severe acute respiratory syndrome COVID-19 infection and COVID-19 illness?
Patients with psoriatic disease appear to have similar rates of infection and similar outcomes to the general population. Likelihood of poor outcomes are driven by age and comorbidities such as heart/lung/kidney disease or metabolic disorders (diabetes/obesity).
2. What are the effects of psoriasis or PsA treatment on COVID-19 infection and illness?
Reaffirmed that treatments for psoriasis and psoriatic arthritis do not alter the risk of acquiring COVID-19, and do not affect outcomes. Patient not infected with COVID-19 are recommended to continue their biologic or oral therapies in most cases. Chronic systemic corticosteroids should be avoided if possible. Shared decision making between patients and providers is important.
3. How should medical care be delivered to patients with psoriatic disease to lower their risk of infection with COVID-19 while still ensuring quality of care?
Telemedicine can be appropriate – short interruptions to in-person care is ok. Certain patients should always be seen, including: those where there is concern for melanoma or non-melanoma skin cancer, new psoriasis patients, and flaring patients. It is recommended that clinic staff wear masks, social distance, and perform hand-hygiene.
4. What should patients with psoriatic disease do to protect themselves from becoming infected with COVID-19?
Patients should follow measures to prevent infection, including: social distancing, wearing a mask to cover the nose and mouth, hand-hygiene. An mRNA vaccine (Pfizer or Moderna) is recommended for all unless contraindicated. Influenza vaccine is also recommended. Treatments for psoriasis or psoriatic arthritis can be continued during the vaccine period.
5. What should patients with psoriatic disease do if they become infected with COVID-19?
Monitor their symptoms and discuss with healthcare providers. Should be prescribed and adhere to evidence based COVID-19 therapies. Consider a hold of psoriasis medications during active infection – share decision making with a physician (same for resuming treatments). Patients who become infected should follow CDC guidance on home isolation. Patients in close contact with someone with COVID-19 should quarantine themselves for 14-days after last contact and discuss management of their psoriatic disease with their provider.
*Reference: Gefland et al. National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2 – Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments. Journal of the American Academy of Dermatology. May 2021.