Psoriasis Exacerbation After Covid
- Journal of the European Academy of Dermatology and Venereology: JEADV
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What You Should Know About Vaccines With Psoriasis
Vaccines and psoriasis don’t always go well together. For staying healthy with psoriasis, find out why some vaccines need to be used with caution in psoriasis and why any vaccine might cause a psoriasis flare.
Getting vaccines with psoriasis is important because some medications you may be taking for the condition can increase your risk for certain diseases that vaccinations help prevent.
There can, however, be side effects of immunizations. Knowing the whole story will help you make the right choices.
Vaccines made from dead viruses are not usually a problem for people with psoriasis. Two live viral vaccines should be used with caution in psoriasis — these are the shingles virus and the live flu virus. Fortunately, you can take the killed version of the flu virus, explained Julie Anne Moore, MD, a dermatologist at Loyola University Gottlieb Memorial Hospital in Melrose Park, Ill.
The second thing you should know is that getting vaccines with psoriasis could cause psoriasis symptoms to flare, no matter what type of vaccine it is.
Thats because just putting a needle through your skin can cause a type of psoriasis reaction called a Koebner response, named after the German dermatologist who first described it in the 1800s.
Is It Safe To Get The Covid
The short answer: Yes. Having psoriatic arthritis is not a contraindication the vaccine. In fact, getting the vaccine when you have psoriatic arthritis may be especially important, given the disease may put you at higher risk for COVID-19 or severe outcomes.
Many patients with autoimmune conditions who take medications that affect immune system function are concerned that certain vaccines could give them the virus. This could theoretically occur with vaccines like the MMR vaccine for measles and mumps, which is a live vaccine. That means it is a weakened form of the virus intended to cause a harmless infection that your immune system rapidly eliminates.
However, none of the COVID-19 vaccines currently authorized in the U.S. Pfizer, Moderna, and Johnson & Johnson are live vaccines. You cannot get coronavirus from the COVID-19 vaccine. It is safe for people with psoriatic arthritis, including those who take immunosuppressant medication.
According to the U.S. Centers for Disease Control and Prevention , the only contraindications to receiving the COVID-19 vaccine are:
- Severe allergic reaction after a previous dose or to a component of the COVID-19 vaccine.
- Immediate allergic reaction of any severity to a previous dose or known allergy to a component of the vaccine. See the ingredients in each vaccine here.
For more information, refer to our full guide: Can You Safely Get a COVID-19 Vaccine If You Have a History of Allergic Reactions?
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Skin Reactions And Psoriasis: Tips To Avoid The Koebner Response
Any type of skin trauma can lead to formation of a psoriasis plaque, or Koebner reaction, in the area of the trauma. The Koebner response may occur in anyone with psoriasis. It may sometimes cause the first symptoms of psoriasis or other skin diseases, like lichen planus. Cuts, scratches, tattoos, and vaccinations are common triggers for this response, said Moore.
Other causes may include sunburn, poison ivy, or even a bug bite. These minor traumas can cause a psoriasis plaque to form at the site of trauma within one to two weeks of the injury. About 50 percent of people with psoriasis experience the Koebner response.
Update On Biologics And The Covid
Many of our patients are taking injectable biologic medications to help reduce the severity and symptoms of their skin condition. This includes patients with psoriasis, hidradenitis, atopic dermatitis, and other conditions. We have received numerous questions about the use of these medications during the pandemic, as well as their effect on the Covid vaccine. Here is the latest info:
Commonly used psoriasis biologic medications include Cimzia, Cosentyx, Enbrel, Humira, Ilumya, Remicade, Siliq, Skyrizi, Stelara, Taltz, and Tremfya.
Sanova Dermatology follows the recommendation of the National Psoriasis Foundation Covid-19 Task Force Guidance Statements:
1. Do patients with psoriasis have an increased risk of Covid-19, or a worse outcome with a Covid-19 infection? Short answer: No-Existing data, with some exceptions, generally suggest that patients with psoriasis and/or psoriatic arthritis have similar rates of SARS-CoV-2 infection and COVID-19 outcomes as the general population.
Many of our patients with eczema, or atopic dermatitis, are on immune-modifying medications such as prednisone, azathioprine, cyclosporine, methotrexate, mycophenelate mofetil, and dupilumab . The National Eczema Society has a succinct page on Advice on Covid-19 for eczema patients. Highlights include:
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Psoriasis happens to be a chronic skin condition where an overproduction of skin cells leads to the formation of scales and plaques on the skin. It is a long-term disease that eventually doesnt have any cure.
With the ongoing pandemic, many psoriasis patients are concerned that their ongoing medications may lessen the effectiveness of COVID vaccines or cause psoriasis flares. Though there is no current evidence to support this, but COVID-19 may cause serious complications in people with psoriasis. Thats why it is always advised to get the COVID vaccine without much delay.
To take the Vaccine or Not
The Psoriasis and Psoriatic Arthritis Alliance and the National Psoriasis Foundation recommend people affected with psoriasis take their COVID vaccine shot.
People with chronic health issues, including those with psoriasis, have an increased risk of severe illness if they get infected with COVID-19 virus. People with psoriasis may also take medicines that suppress their immune system. People taking such types of medicines have an increased likelihood of experiencing severe COVID-19.
Vaccination against COVID-19 can significantly reduce the risk of developing the disease and experiencing severe complications. Although the COVID-19 vaccines may not be as effective in people affected with psoriasis taking immunosuppressant drugs, they are much likelier to provide some degree of protection against COVID-19.
Study Design And Population
A web-based cross-sectional study was conducted in a group of Chinese patients with psoriasis. We developed a self-administered online survey for the collection of questionnaires. The survey link was created through Wen-Juan-Xing platform , the largest online survey platform in China. Our study population was psoriatic patients in social media platforms no matter whether they completed SARS-CoV-2 vaccination. Patients with a confirmed diagnosis of psoriasis in dermatology clinics were introduced by their dermatologists to the platforms for the purposes of health management and follow-up.10,11 We posted the link on the platforms without any incentive measures when they anonymously completed the survey. All participants can submit the questionnaire only once based on their IP addresses. For the purpose of quality control, the questionnaire cannot be submitted unless all required questions have been answered. This survey was conducted between 22 Jul 2021 and 3 Aug 2021. Electronic informed consents were obtained from all patients before the investigation. This study adhered to the Declaration of Helsinki and was approved by the institutional research ethics boards of Xiangya Hospital, Central South University .
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Psoriasis Task Force Says Take The First Available Covid
The National Psoriasis Foundation COVID-19 Task Force has updated its guidance statements to recommend that individuals with psoriasis or psoriatic arthritis receive the first COVID-19 vaccine offered to them, as all 3 currently available vaccines are highly effective at preventing serious COVID-19 outcomes like hospitalization and/or death. Information about methotrexate use following vaccination also was included in the update.
Co-Chair of the NPF COVID-19 Task Force Joel M. Gelfand, MD, MSCE, said that the most common concerns expressed by his patients with psoriasis or psoriatic arthritis are: 1) will the vaccine flare my psoriasis? and 2) what is the long-term safety of the vaccines?
There is no evidence or reason to believe that the COVID-19 vaccines will flare a patients psoriasis, explained Dr Gelfand, who also is professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine. Regarding safety issues, In the long history of vaccines, safety issues typically arise within 1 to 2 weeks of vaccination. There is no reason to believe that there will be long-term side effects associated with these vaccines.
I also let the patient know that I was first in line to get vaccinated once I was eligible, Dr Gelfand noted. Delaying vaccination to receive a particular vaccine puts individuals at unnecessary risk of death from COVID-19.
Updates for Patients Taking Methotrexate
Rare Reactions That Have Been Reported
As with all vaccines, there’s a chance that there will be a serious side effect. All side effect reports, including the rare reactions below, continue to be monitored closely by:
- Health Canada
- the Public Health Agency of Canada
- provincial and territorial health authorities
- the manufacturers
Health Canada is:
- working closely with the manufacturers to ensure the labelling reflects relevant information
- continuing to monitor these reports and is working with international regulators to review information as it becomes available
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Note Blood Clots And The Astrazenica Vaccine
At the time of writing the Medicines and Healthcare products Regulatory Agency * has issued new advice, concluding there is a possible link between AstraZenica COVID-19 vaccine and extremely rare forms of blood clots on the brain.
The evidence suggests that these clots are more likely to occur in younger adults and in the setting of certain blood abnormalities. For this reason, those in this younger age-group, should be offered an alternative to the AstraZenica vaccine if available.
However, it is very important to understand how small the risk of this complication is: Around 1 in a million. That’s roughly the same risk as being murdered in the next month or – if you get into a car and drive for 250 miles – the risk of you dying in a road accident on that journey.
Accordingly, at PAPAA we continue to endorse the view of the MHRA that the benefits of vaccination overwhelmingly outweigh any risks.
We also note the MHRA recommendation that careful consideration should be given to people who are at higher risk of specific blood clots because of their medical condition.
Clearly this issue will continue to be closely monitored by the regulatory authorities.
Please note that the above are general guidelines. If you are still unsure as to whether vaccination against COVID-19 is right for you, please discuss it with your family doctor.
*For further and the latest information about COVID-19 vaccinations, visit the MHRA website
References and resources
Complications Of Psoriasis And Covid
If you test positive for COVID-19, have symptoms, or think you have been exposed to the virus, you should reach out to your primary doctor right away. Be sure to tell them you are taking immunosuppressive drugs to treat psoriasis.
If you test positive, you should also reach out to the doctor who treats your psoriasis so they can tell you how to manage your psoriasis care while you are recovering. They might suggest you alter or delay your next dose or treatments that suppress your immune system.
Your doctor will also give you information about treatment options for preventing a flare-up during this time.
There isnt enough evidence on how COVID-19 affects people with psoriasis or if they might be affected differently than people without psoriasis. Regardless, COVID-19 is highly transmissible and spreads rapidly, which means everyone is at risk. Even if you dont have symptoms, you can still spread COVID-19.
But it is unknown whether people with psoriasis have an elevated risk for these types of complications. The small amount of research available seems to indicate that their risk isnt different from others in the general population.
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Can I Just Go And Get The Third Shot Or Do I Need To Talk To My Doctor First
You should talk to the physician you see for psoriasis treatment to and determine if you are on an immunosuppressive medication prior to getting the booster shot, says Lisa Zaba, MD, PhD, a clinical associate professor of dermatology at Stanford University School of Medicine in Palo Alto, California.
You dont need a prescription or a doctors note to get a third shot, but you should bring your vaccination card. The dose will be the same as the first and second shot, and the side effects should be similar, says the CDC.
If I Get A Third Shot How Good Is The Protection
A third dose will likely provide you with better protection, but how much better is not yet clear, says Zaba.
Some studies have found that people who were severely immunocompromised and had virtually no protection from the Pfizer or Moderna vaccine had an improved antibody response after a third shot of the same vaccine, says the CDC.
Right now, we dont know if a third or booster shot has clinically meaningfully benefits , says Gelfand. But given the emergence of the Delta variant, which is much more transmissible than previous variants, its likely that booster vaccines will be necessary and helpful.
Even after receiving a third dose of the vaccine, youll need to take extra precautions to avoid exposure to COVID-19, such as wearing a mask and avoiding crowds.
To reduce your odds of exposure, its also important that your family members and other close contacts get vaccinated.
If they are already immunized, they too will be eligible for a third shot beginning on September 20. Thats when the federal government is planning to roll out boosters for all Americans who received their second vaccine dose at least eight months prior.
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How To Stay Safe
Having psoriasis and a compromised immune system is a good reason to want to stay healthy.
To minimize your risk for COVID-19, take the following CDC precautions:
- Stay home as much as you can.
- Avoid crowds, and limit close contact with others when out in public.
- Avoid touching your face, nose, and mouth when out.
- Avoid touching frequently touched surfacessuch as doorknobs and shopping cartswhen out in public. Carry disinfecting wipes for when you need to touch surfaces.
- Wear a mask when in a crowded place.
- Talk to your doctor about whether the COVID vaccine is an option for you, and if it is, get vaccinated as soon as you can.
- Wash your hands with soap and water for at least 20 seconds or use hand sanitizer after coming inside or after touching commonly touched surfaces.
Most Rheumatologists And Public Health Experts Want People Living With Rheumatic Diseases Like Psoriatic Arthritis To Get The Vaccine As Soon As They Can
Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.
If you live with psoriatic arthritis, an inflammatory and autoimmune form of arthritis that affects about 30 percent of people with psoriasis, you may understandably have many questions and concerns about getting the COVID-19 vaccine.
Heres the bottom line: Especially if you have an autoimmune condition like psoriatic arthritis, most rheumatologists and public health experts recommend you get vaccinated against COVID-19. In its COVID-19 Task Force Guidance, the National Psoriasis Foundation says that in most cases, patients with psoriatic disease who dont have contraindications should take the first authorized COVID-19 vaccine that becomes available to them.
Similarly, the American College of Rheumatology states that autoimmune and inflammatory rheumatic disease patients , which includes people with psoriatic arthritis, should receive the vaccine when theyre eligible.
The ACR also states that disease activity and severity should not delay you from getting the vaccine except in extreme cases . That said, vaccination would ideally take place in the setting of well-controlled disease.
Heres everything you need to know about getting the COVID-19 vaccine if you have psoriatic arthritis.
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Remaining Patient During The Covid
An effective and safe vaccine represents so much more to me than not getting sick with COVID-19. While Ive tried to stay strong and appear unaffected, my excitement at the arrival of the vaccines revealed just how much this crisis has worn on me. I see the vaccine as the beginning of the end to the pandemic.
Of course, I wish that I could immediately go back to life the way it was before the pandemic, but it will take time. Im still not sure when I will be able to get my shot. While initial vaccine shipments have arrived, vaccinations in my county are rolling out more slowly due to limited dose availability. County officials are urging patience, which is something that I know I will continue to need in high supply.
Even after I get vaccinated, the Centers for Disease Control and Prevention says that I will still need to follow its safety recommendations including wearing masks, maintaining physical distance of six feet from others, and washing hands.
The Pfizer and Moderna COVID-19 vaccines require two doses spaced three to four weeks apart and take time to build immunity. Until researchers have a clearer understanding of whether its possible for people who are vaccinated to pass the virus to others, I want to stay vigilant in following safety protocols. It will take months for enough people to be vaccinated to halt the spread of the virus.