What to Know About Psoriasis and COVID-19

Risks, Complications, Considerations, and More

Living with psoriasis, you might wonder how COVID-19 might affect your health and your treatment plan. Fortunately, researchers have learned a lot since early 2020 about coronavirus, the virus that causes COVID-19, and how it affects different health conditions, including psoriasis.

The good news is that most of the data suggest the additional risks COVID-19 might pose to people with psoriasis are minimal. This includes people with psoriasis who are on medicines that affect the function of their immune systems.

Keep reading to learn more about the potential risks of COVID-19 for people with psoriasis, including treatment effects, how to stay healthy and reduce your risk for COVID-19 complications, and answers to frequently asked questions.

Psoriasis Skin Pain

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Psoriasis and COVID-19 Risk

Coronavirus has affected people all across the globe. For those with chronic health conditions like psoriasis, there is concern about the risk of contracting COVID-19 and for complications in an immune system that is already fragile.

What is known is that certain groups are particularly vulnerable to contracting COVID-19 and becoming severely ill, including people older than age 65 and people who have serious medical conditions, such as heart disease, diabetes, lung conditions, and kidney and liver disease.

While the Centers for Disease Control and Prevention (CDC) doesn’t include people with psoriasis or other autoimmune diseases among those being at high risk, many people with psoriasis may have additional conditions that might put them at higher risk for COVID-19.

People with psoriasis also have a higher risk for infection, including respiratory infections and pneumonia, compared to others in the general population. The risk is even higher for people with severe psoriasis.

According to a 2021 report in the British Journal of Dermatology, people with psoriasis have a 36% increased risk for infection and a 33% increased risk for death due to infection. That risk exists with and without factors related to comorbidity (existing conditions).

Data were presented at the American Academy of Dermatology Virtual Meeting Experience 2021 regarding the connection between psoriasis and COVID-19 risk, and systemic (whole-body) treatments for psoriasis and how they might contribute to risk.

Overall, the study’s researchers found people with psoriasis were more likely to get COVID-19 when compared to others in the general population. Data showed a 33% increased risk based on the number of people with psoriasis who contracted COVID-19 compared to those without psoriasis (controls) who also contracted the virus.

They speculated that the increased risk was attributable to the use of systemic therapies that could increase the risk for upper respiratory infections, like COVID-19. People with psoriasis also have a higher risk for comorbidities, such as obesity and high blood pressure—conditions that have been linked to severe COVID-19 infections.

In this study, researchers reviewed data covering more than 280 million people. They identified people ages 20 and older who had either psoriasis or psoriatic arthritis from May 1, 2019 to January 1, 2020. They compared these cases to a follow-up period from January 1 to November 11, 2020.

The researchers found that the data subjects who were using biologic drug therapies (TNF inhibitors) had a lower risk than those using topical treatments for psoriasis. The use of TNF inhibitor biologic therapies showed an 18% reduction in COVID-19 occurrence, and TNF inhibitor users were 13% less likely compared to those on topical therapy to contract COVID-19.

In addition, people with psoriasis and/or psoriatic arthritis on some oral-systemic drugs, including methotrexate, had a lower chance of infection from COVID-19 when compared to people treating with topicals. With methotrexate, that reduction was 25% compared to 31% of controls.

People with psoriatic diseases using other types of biologic therapies—Stelara (ustekinumab) and IL-17 inhibitors—had a higher risk for contracting COVID-19. IL-17 inhibitors were linked to a 36% increase in COVID-19 occurrence, and Stelara was linked to a 37% increased risk compared to the controls.

This study doesn’t appear to have looked at the disease severity of COVID-19 once contracted by people with psoriatic disease (psoriasis and/or psoriatic arthritis) or COVID-19 outcomes among this group. Researchers only note that further research is needed to understand the full impact of systemic and biologic therapies on COVID-19 outcomes in people with psoriatic disease.

Symptoms of COVID-19 With Psoriasis

The symptoms of COVID-19 you might experience with psoriasis are the same as they would be for anyone else who gets COVID-19. The most common symptoms are fever, body aches, cough, fatigue, chills, headache, sore throat, and loss of smell or taste.

Some people might experience more severe symptoms, such as a high fever and shortness of breath. It takes about two to 14 days to develop symptoms if you have been exposed to COVID-19.

Complications of Psoriasis and COVID-19

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 (period of high disease activity) during this time.

There isn’t 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 don’t have symptoms, you can still spread COVID-19.

Complications of COVID-19—acute respiratory distress, cardiac injury, blood clots, and more—can affect anyone who contracts the infection, especially those with a higher risk for the condition.

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 isn’t different from others in the general population.

One small study reported in 2020 in the New England Journal of Medicine found that people with inflammatory diseases like psoriasis who took biologics and developed COVID-19 were not more likely to develop complications than people who weren’t taking these drugs.

Additionally, the number of hospitalizations reported in this study was consistent with what was experienced by people without inflammatory conditions. However, the researchers found people with inflammatory diseases could have an increased risk for COVID-19 complications in the presence of co-occurring medical conditions like heart disease and chronic obstructive pulmonary disease (COPD).

An April 2021 report in the Journal of Clinical Medicine suggests biologics are beneficial to people with psoriasis who contract COVID-19. The report’s authors note that there are many case reports of people with psoriasis who are presenting with mild COVID-19 infections, and these cases mainly seem to have more favorable outcomes.

The authors also note that while higher levels of TNF have been found in people with COVID-19, overall they believe that TNF inhibition is effective in reducing coronavirus and associated complications of COVID-19, including organ damage.

IL-17 inhibition might also be effective in controlling inflammation that could lead to COVID-19 severe disease, but the study’s authors note that the role of IL-23 inhibition and processes in COVID-19 was not yet known.

The study’s authors emphasize the importance of adherence to psoriasis treatments during the current pandemic. They also stress that psoriasis treatment isn’t a prevention tool for COVID-19, and they encourage people with psoriasis to get the COVID-19 vaccine.

Long COVID-19 and Psoriasis

Most people who get COVID-19 recover completely within a few weeks. But some will continue to have symptoms, or long COVID, after their initial recovery. The term used to describe these people is “long haulers.” Symptoms in long COVID persist for more than four weeks after the initial COVID-19 diagnosis.

Older adults and people with serious medical conditions are more likely to experience lingering COVID-19 symptoms. Still, even younger, generally healthy people can feel unwell for weeks or months after their infection.

Common long COVID symptoms might include:

  • Fatigue
  • Joint and/or muscle pain
  • Shortness of breath or breathing difficulties
  • Memory or concentration troubles
  • Chest pain or cough
  • Sleep problems
  • Fast or pounding heart rate
  • Loss of taste or smell
  • Depression or anxiety
  • Dizziness
  • Fever

Researchers don’t know if people with psoriasis or other autoimmune disease have a higher risk for long COVID. However, some have been studying the link between COVID-19 and the development of autoantibodies—similar to the same autoantibodies responsible for psoriasis inflammation.

Autoantibodies are immune cells that mistakenly target healthy tissues and organs. The research has shown that these autoantibodies can act as a driving force in long COVID.

While this research is helpful, it doesn’t explain if having pre-existing autoantibodies in psoriasis and other autoimmune conditions could contribute to more severe COVID-19. Additionally, it doesn’t give any indication of how long COVID might affect someone with psoriasis.

Even if an additional risk of long COVID for people with psoriasis exists, most people who have severe psoriasis are already on medications that counteract the inflammatory response of autoantibodies, which could potentially reduce the risk for long COVID.

Unfortunately, the researchers in the long COVID study did not discuss this issue or the effects of treatment of long COVID in people with psoriasis.

Psoriasis Treatments and COVID-19

People who are immunocompromised are believed to have a higher risk for COVID-19. While this usually applies to people with cancer on chemotherapy and those with poorly controlled HIV/AIDS, it can also apply to people who take medications that affect the function of their immune systems.

People with psoriasis will use different immunosuppressive drug therapies, including methotrexate, biologics, cyclosporine, and Janus kinase inhibitors. Taking these medicines can partially inhibit your immune system, which adds to your infection risk.

The current guidelines of the American Academy of Dermatology recommend that people who take immunosuppressive drugs continue to take them unless they test positive or if they have symptoms of COVID-19.

Further, most recent research suggests people with psoriatic disease, including those on biologic drug therapy, are at no additional risk for contracting or being seriously harmed by COVID-19 from their psoriasis treatments.

According to the National Psoriasis Foundation COVID-19 Task Force, the overall existing data suggest that most treatments for psoriasis “do not meaningfully alter the risks of contracting SARS-CoV-2 or having a worse course of COVID-19 illness.”

The effects of immunosuppressive therapy on the immune system aren’t a reason to stop treatment. Your doctor is the best person to answer questions about your treatment plan. They can also best advise you on how the pandemic might affect your health situation and current treatment plan.

It is never a good idea to make any changes to your treatment plan without first consulting with your doctor. Provided you have not been diagnosed with COVID-19 and don’t have symptoms, sticking to your treatment is an important way to stay healthy. It is also the best way to keep your psoriasis from flaring up and increasing your infection risk.

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 surfaces—such as doorknobs and shopping carts—when 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.

Handwashing With Psoriasis

People who have inflamed skin or scaly plaques on their hands may have a harder time washing their hands or using alcohol-based sanitizers.

Try using hypoallergenic foaming soaps, and avoid ones with harsh abrasives and antibacterial formulas. Make sure you rinse well with water.

Last, use a thick, hydrating cream after patting your hands dry to moisturize skin. Petroleum-based moisturizers like Vaseline are a good bet.

If you find your skin becomes irritated from handwashing or moisturizing, ask your dermatologist about products that might be safer for your psoriasis-prone skin.

Summary

Having psoriasis does not put you into a high-risk group for COVID-19 infection or complications. People with psoriasis who are taking immunosuppressive therapy should continue to do so. If you test positive for COVID-19, your healthcare professional will advise what modifications may be needed.

The COVID-19 vaccine is recommended for people with psoriasis. It, and standard infection-prevention precautions, are the best way to avoid COVID-19.

A Word From Verywell

The COVID-19 pandemic has proved to be a challenging time for people managing serious illnesses like psoriasis. But having psoriasis in the middle of a pandemic doesn’t mean you should fear going out, going to your doctor’s office, or getting infusion therapies.

Preventing COVID-19 can be as simple as getting vaccinated and practicing good hygiene. These practices might seem tiresome, but they are the most important tools you have for reducing your chances of getting sick and for keeping psoriasis managed.

Frequently Asked Questions

Should I get a COVID-19 vaccine if I have psoriasis?

You are probably wondering if it is safe for you to take the COVID-19 vaccine. The answer is yes for most people with psoriasis. Both the International Psoriasis Council and the National Psoriasis Foundation recommend that people with psoriasis take the vaccine.

According to the International Psoriasis Council on COVID-19, “there is no evidence that vaccines affect psoriasis onset or severity.”

The National Psoriasis Foundation recommends people with psoriatic disease, who have not previously had problems with vaccination, receive the “mRNA-based COVID-19 vaccine as soon as it becomes available to them based on federal, state, and local guidance.”

If you have any concerns about taking the vaccine or worry you might have adverse skin effects from the vaccine, talk to your doctor. They are the best source of information about the vaccine, and they can offer advice based on your unique health situation.

Is the COVID-19 vaccine effective for people with psoriasis?

Research has found one in 10 people with autoimmune diseases, including psoriasis, may not be properly protected against COVID-19. Additional research suggests that people using systemic medications, such as methotrexate and Rituxan (rituximab), might respond poorly to the vaccine, but these findings are still in the early stages.

None of the research confirms or suggests that people with autoimmune diseases should avoid vaccination. In fact, the American College of Rheumatology recommends that all people with rheumatic and autoimmune diseases get vaccinated.

They note that even if vaccines do not offer full protection, they are still a benefit to the public. This is because even partial protection can guard against severe symptoms, life-threatening complications, and death from COVID-19.

Is COVID-19 more dangerous for people with psoriasis?

Even though people with psoriasis have a higher risk for infection, no evidence to date has found that COVID-19 might be more dangerous for them in comparison to others without the condition.

What the research does show is that having other risk factors, including older age and serious medical conditions, adds to the risk for a more severe illness or complications from COVID-19.

Your doctor is the best resource when it comes to questions and fears you may have about your risk for COVID-19. You should always reach out to your doctor if you think you might have COVID-19 or if you experience new or changed psoriasis symptoms.

How high is my risk of being exposed to COVID-19 if I come in for psoriasis treatment?

COVID-19 has made treating serious health conditions like psoriasis more challenging, but even so, you still need to communicate with your doctor and attend regular appointments.

Even in a pandemic, you can go to inpatient appointments because your doctor and their staff are doing everything to keep you safe when you come to their offices.

Precautions being taken include limiting the number of people coming in and out of their spaces, practicing masking, creating ways to physically distance, screening for COVID-19, disinfecting frequently touched surfaces, and sanitizing stations for staff and patients.

If you don’t feel like coming into your doctor’s office or you are not feeling well, you have the option of telemedicine. That way, you can still meet with your doctor and get treatment using various videoconferencing technologies in real time, including Zoom and FaceTime.

Studies have found that people with psoriasis who received treatment via telemedicine had similar outcomes to people who saw their dermatologists in person.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

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