Considerations for Safety in the Use of Systemic Medications for Psoriasis and Atopic Dermatitis during the COVID-19 pandemic.
Coronavirus disease 2019 (COVID-19), is responsible for at least 2,546,527 cases and 175,812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis are common, chronic, inflammatory skin conditions, with immune dysregulation as a shared mechanism; therefore, mainstays of treatment include systemic immunomodulating therapies. It is unknown whether these therapies are associated with increased to COVID-19 susceptibility or worse outcomes in infected patients. In this review, we discuss overall infection risks of non-biologic and biologic systemic medications for psoriasis and atopic dermatitis, and provide therapeutic recommendations. In summary, in patients with active infection, systemic conventional medications, the JAK inhibitor tofacitinib, and biologics for psoriasis should be temporarily held until there is more data; in uninfected patients switching to safer alternatives should be considered. Interleukin (IL)-17, IL-12/23 and IL-23 inhibitors are associated with low infection risk, with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and postmarketing data also suggest that IL-17 and IL-23 blockers are safer than TNF-blockers. Apremilast, acitretin and dupilumab, have favorable safety data, and may be safely initiated and continued in uninfected patients. Without definitive COVID-19 data, these recommendations may be useful in guiding treatment of psoriasis and atopic dermatitis patients during the COVID-19 pandemic. This article is protected by copyright. All rights reserved.