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1.
Acta Dermatovenerol Croat ; 30(2): 99-105, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2073256

ABSTRACT

Psoriasis is a chronic inflammatory disease associated with a defective epidermal barrier, in which the immune system is already activated in lesional sites of the skin, and it is thus possible that affected individuals can have different immunologic rates of viral response. This is especially important in the era of the novel coronavirus disease (COVID-19) that is affecting the entire world. Patients with psoriasis are often receiving systemic therapy which includes immunosuppressive and biologic therapy, so this new infectious disease has raised concerns among dermatologists regarding psoriasis treatment. Some of the risk factors of psoriasis are obesity, diabetes mellitus, and hypertension - all of which are diseases linked with negative outcomes and higher severity of COVID-19. Psoriasis is mediated by inflammatory cells and proinflammatory cytokines such as IL-17, IL-23, IFN-γ, and TNF-α, and patients with skin diseases have been shown to be more susceptible to COVID-19 infection, but with a less severe disease course. As an anti-inflammatory agent, vitamin D could play a significant role in the future as a possible treatment for reducing the risk and severity of psoriasis and COVID-19. It has been suggested that patients treated with biologic therapy should continue treatment, as it has not been shown to cause severe complications of the COVID-19 disease. Preventive measures, including vaccination, should be taken to minimize the risk of infection and severity of the clinical outcome.


Subject(s)
COVID-19 , Psoriasis , Cytokines , Humans , Interleukin-17 , Interleukin-23/therapeutic use , Pandemics , Psoriasis/drug therapy , Psoriasis/therapy , Tumor Necrosis Factor-alpha/therapeutic use , Vitamin D
3.
PLoS One ; 17(9): e0275293, 2022.
Article in English | MEDLINE | ID: covidwho-2054372

ABSTRACT

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory disease. Beyond the physical dimensions, the disease has an extensive emotional and psychosocial effect on patients, influencing their quality of life, social life and interpersonal relationships. Thus patient-reported outcomes are a crucial instrument for the evaluation of disease burden. Navigating life in times of the COVID-19 pandemic is challenging, especially for persons suffering from chronic diseases. We here analyzed the impact of lockdown restrictions on psoriasis patients. OBJECTIVE: To compare the Dermatology Life Quality Index (DLQI) before and during the COVID-19 pandemic of patients with psoriasis. METHODS: Retrospective longitudinal analysis in adult patients with moderate to severe psoriasis undergoing biologic treatment between January 2020 and January 2021. DLQI, patient demographics, Psoriasis Area and Severity Index (PASI), and recent biologic treatment were recorded. RESULTS: 103 patients were identified, of whom 19 had additional psoriatic arthritis. Female (n = 29) and male (n = 74) patients were distributed 1 to 3. Median age of patients was 54 years (range 18-85). All patients received biologic systemic treatment: anti-IL-23 (n = 39), anti-IL-17A (n = 30), anti-IL-12/23 (n = 25), or anti-TNFα (n = 9). Comparing DLQI scores before the COVID-19 pandemic and under lockdown restriction showed improved DLQI scores over time. Further analysis displayed that patients mostly ticked "not relevant" on social activities during lockdown. Thus, the DLQI scores may be artificial improved and may not really reflect the actual disease burden. CONCLUSIONS: Psoriasis patients showed a contrary improvement of life quality despite harsh COVID-19 lockdown suggesting that DLQI should be modified when social life is restricted.


Subject(s)
Biological Products , COVID-19 , Psoriasis , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Communicable Disease Control , Female , Humans , Male , Middle Aged , Pandemics , Psoriasis/therapy , Quality of Life , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Young Adult
5.
J Rheumatol ; 49(6 Suppl 1): 10-12, 2022 06.
Article in English | MEDLINE | ID: covidwho-1726137

ABSTRACT

The efficacy and safety of coronavirus disease 2019 (COVID-19) vaccination in patients with autoimmune inflammatory diseases (AIRDs) who are treated with immunomodulatory therapies was the focus of a symposium at the 2021 virtual annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The keynote address was delivered by Dr. Jeffrey Curtis, chair of the American College of Rheumatology COVID-19 Vaccine Clinical Guidance task force, detailing what we do and do not know about vaccine efficacy and safety in patients with AIRDs and providing guidance about the need for modification of dosing in some immunomodulatory medications for optimal vaccine response. A consensus of the task force was that all patients with AIRDs should be vaccinated as soon as it is allowed in their respective locations, since the benefits of increased protection against COVID-19 infection outweigh the potential for vaccination reactions, including flares of underlying disease, or for reduced efficacy of vaccination because of disease state or medications. Key issues among patient research partners with psoriatic disease expressed in the premeeting survey and panel discussion/question-and-answer period included: vaccine efficacy and safety, the need to continue safe social habits and masking, how to assess efficacy of vaccination, how to deal with vaccine hesitancy among social contacts, medication management relative to vaccination, and concerns about the adequacy of ongoing telehealth visits vs the convenience of that technology.


Subject(s)
COVID-19 Vaccines , COVID-19 , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Humans , Psoriasis/diagnosis , Psoriasis/therapy , Research , Vaccination
6.
Cutis ; 109(2): 101-102, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1716155

ABSTRACT

Guttate psoriasis is a subgroup of psoriasis that most commonly presents as raindroplike, erythematous, silvery, scaly papules. Guttate psoriatic flares may follow rhinovirus or COVID-19 infection due to dysregulation of the innate immune response. We describe the case of a patient who experienced a moderate psoriatic flare 3 weeks after diagnosis of SARS-CoV-2 infection. We discuss the dysregulation of proinflammatory cytokines that we believe triggered this flare and the treatment regimen for our patient.


Subject(s)
COVID-19 , Psoriasis , COVID-19/complications , COVID-19/diagnosis , Humans , Psoriasis/therapy , SARS-CoV-2 , Skin
7.
J Rheumatol ; 49(6 Suppl 1): 1-3, 2022 06.
Article in English | MEDLINE | ID: covidwho-1690115

ABSTRACT

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held its annual meeting in 2021 in an online format due to travel restrictions during the ongoing COVID-19 (coronavirus disease 2019) pandemic. The virtual meeting was attended by rheumatologists, dermatologists, representatives of biopharmaceutical companies, and patient research partners. Similar to previous years, GRAPPA's annual meeting focused on the 3 overlapping missions of education, research, and clinical care of psoriatic disease (PsD). The virtual meeting allowed a variety of different types of sessions to be held, including the trainee symposium, keynote lectures, interactive sessions (5 Meet the Experts sessions, a debate on first-line therapy, and 5 guided poster sessions), 4 workshops (trainee workshop focusing on the diagnosis of PsD, ultrasound, magnetic resonance imaging, and the International Dermatology Outcome Measures group), updates on a variety of research topics (research findings from the 2020 GRAPPA research grant awardees, 3 basic science talks, Outcome Measures in Rheumatology [OMERACT] Working Group efforts, and Collaborative Research Network progress), current "hot topics" (use of Janus kinase inhibitors, promoting diversity and inclusion in PsD, progress on the updated GRAPPA treatment recommendations, and the introduction of the Young GRAPPA member group), and the presentation of four 2021 GRAPPA grant awardees and election results. In this prologue, we introduce the papers that summarize this meeting.


Subject(s)
Arthritis, Psoriatic , Psoriasis , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , COVID-19 , Humans , Psoriasis/diagnosis , Psoriasis/therapy , Research
8.
Expert Rev Clin Immunol ; 17(11): 1211-1220, 2021 11.
Article in English | MEDLINE | ID: covidwho-1483218

ABSTRACT

INTRODUCTION: In daily practice management of psoriasis, evaluation of risk factors for infections is having a growing influence. Indeed, in psoriatic patients, risk of infections may be due to psoriasis itself, immunomodulatory therapy, and comorbidities that may increase this risk and patient hospitalization. AREAS COVERED: Given the greater understanding of psoriasis pathogenesis and the increasing number of treatment options, it is particularly important to customize therapy according to each, single patient; psoriasis features and comorbidities are also essential to tailor treatment goals. EXPERT OPINION: In this perspective, the current knowledge on the infectious risk in psoriatic patient, related to comorbidities, such as diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary, to 'special populations,' to chronic infections, such as latent tuberculosis, chronic hepatitis B and C, and HIV, and to the most recent Covid-19 pandemic scenario, is reviewed and discussed in order to suggest the most appropriate approach and achieve the best available therapeutic option.


Subject(s)
COVID-19/prevention & control , Psoriasis/therapy , Risk Assessment/methods , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Pandemics , Psoriasis/epidemiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/physiology , Virus Diseases/epidemiology
9.
Photochem Photobiol Sci ; 20(9): 1239-1242, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1375868

ABSTRACT

BACKGROUND: In March 2020, social isolation measures were imposed in Brazil to contain the spread of the novel coronavirus (SARS-CoV-2), requiring health services to implement contingency plans. The main objective of the study was to verify the status of the disease, self-reported by patients who discontinued phototherapy, during a period of social isolation. METHODS: All patients receiving phototherapy at the Santa Casa de Porto Alegre, Brazil, prior to the implementation of social distancing measures were eligible for inclusion in the study. 86 patients answered a questionnaire during a medical evaluation. RESULTS: 95% of patients who stopped phototherapy reported a worsening of disease status. Only 19% of patients continued to attend phototherapy sessions during the social isolation period. CONCLUSION: The COVID-19 pandemic led most patients to stop phototherapy, resulting in the perception of increased disease severity in an outpatient sample in southern Brazil.


Subject(s)
COVID-19 , Phototherapy , Treatment Refusal , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Female , Humans , Lymphoma, T-Cell, Cutaneous/epidemiology , Lymphoma, T-Cell, Cutaneous/therapy , Male , Psoriasis/epidemiology , Psoriasis/therapy , Severity of Illness Index , Social Isolation , Surveys and Questionnaires , Vitiligo/epidemiology , Vitiligo/therapy
10.
Eur J Dermatol ; 31(2): 183-191, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1352755

ABSTRACT

BACKGROUND: COVID-19 poses significant challenges for care of patients with chronic inflammatory skin diseases including psoriasis. OBJECTIVES: To investigate changes in treatment and/or appointments for psoriasis patients in a German university hospital due to the pandemic. MATERIALS & METHODS: A postal survey was conducted between May 15 and June 15, 2020. Potential determinants of changes were analysed with descriptive statistics and multivariate logistic regression. RESULTS: Out of 205 respondents, 19.5% missed an appointment and 9.8% changed therapy due to the pandemic. Treatment alterations were encouraged by patients (50%) and physicians (40%), whereas cancellations of appointments mostly occurred on patients' request (70%). Several patient-related key drivers of changes, including sociodemographic, disease- and health-related characteristics were identified. Changes in treatment and appointments were associated with higher psoriasis severity scores and more frequent disease aggravations. CONCLUSION: It is particularly crucial to tailor psoriasis care to individual needs in order to protect the physical and mental well-being of patients during the pandemic.


Subject(s)
Appointments and Schedules , COVID-19 , Psoriasis/therapy , Germany , Hospitals, University , Humans
11.
Nutrients ; 13(5)2021 Apr 29.
Article in English | MEDLINE | ID: covidwho-1217109

ABSTRACT

Vitamin D, sunshine and UVB phototherapy were first reported in the early 1900s to control psoriasis, cure rickets and cure tuberculosis (TB). Vitamin D also controlled asthma and rheumatoid arthritis with intakes ranging from 60,000 to 600,000 International Units (IU)/day. In the 1980s, interest in treating psoriasis with vitamin D rekindled. Since 1985 four different oral forms of vitamin D (D2, D3, 1-hydroxyvitaminD3 (1(OH)D3) and 1,25-dihydroxyvitaminD3 (calcitriol)) and several topical formulations have been reported safe and effective treatments for psoriasis-as has UVB phototherapy and sunshine. In this review we show that many pre-treatment serum 25(OH)D concentrations fall within the current range of normal, while many post-treatment concentrations fall outside the upper limit of this normal (100 ng/mL). Yet, psoriasis patients showed significant clinical improvement without complications using these treatments. Current estimates of vitamin D sufficiency appear to underestimate serum 25(OH)D concentrations required for optimal health in psoriasis patients, while concentrations associated with adverse events appear to be much higher than current estimates of safe serum 25(OH)D concentrations. Based on these observations, the therapeutic index for vitamin D needs to be reexamined in the treatment of psoriasis and other diseases strongly linked to vitamin D deficiency, including COVID-19 infections, which may also improve safely with sufficient vitamin D intake or UVB exposure.


Subject(s)
COVID-19 , Psoriasis , SARS-CoV-2/metabolism , Sunlight , Ultraviolet Therapy , Vitamin D/analogs & derivatives , COVID-19/blood , COVID-19/therapy , Humans , Psoriasis/blood , Psoriasis/therapy , Vitamin D/blood , Vitamin D/therapeutic use
12.
14.
J Eur Acad Dermatol Venereol ; 35(2): 281-317, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1066706

ABSTRACT

This evidence- and consensus-based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The second part of the guideline provides guidance for specific clinical and comorbid situations such as treating psoriasis vulgaris patient with concomitant psoriatic arthritis, concomitant inflammatory bowel disease, a history of malignancies or a history of depression or suicidal ideation. It further holds recommendations for concomitant diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or patients with a wish for a child in the near future. Information on vaccination, immunogenicity and systemic treatment during the COVID-19 pandemic is also provided.


Subject(s)
Psoriasis/complications , Psoriasis/therapy , Humans , Psoriasis/psychology
15.
Dermatol Ther ; 34(1): e14691, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1003970

ABSTRACT

There is widespread concern about treatment of psoriasis in COVID-19 pandemic. We aimed to evaluate the epidemiological data, clinical characteristics, treatment features of the psoriasis patients during the pandemic period. We conducted a study in dermatology clinics of seven different tertiary centers. All adult psoriasis patients who were followed up between 11 March 2020 and 28 June 2020, were phone called or questioned in their visit to their follow-up clinics. A semistructured questionnaire was applied and patients' demographics and disease characteristics were recorded. Of 1322 patients, 52.4% were male, and 47.6% were female. According to the questionnaire responses, 964 (72.9%) of these patients could not communicate with their physician during this period, remained 358 (27.1%) patients contacted the physician by phone, email, or hospital visit. From the patients diagnosed as probable/confirmed COVID-19, 14 were female, and 9 were male. Nine of 23 (39.1%) patients were using biologic treatment. There was no statistically significant difference in terms of hospitalization from COVID-19 between the patients using biologics (n = 9) and those who did not (n = 14) (P = 1.00). No mortality was observed among them. Obesity, smoking, age, and accompanying psoriatic arthritis were not among the risk factors affecting the frequency of COVID-19. We only encountered an increased risk in diabetic patients. Also, an exacerbation of psoriasis was observed with the infection. No difference was found in patients with psoriasis in terms of COVID-19 infection in patients who use biologics and those who don't.


Subject(s)
COVID-19 , Psoriasis , Adult , COVID-19/complications , Female , Humans , Male , Middle Aged , Pandemics , Psoriasis/diagnosis , Psoriasis/epidemiology , Psoriasis/etiology , Psoriasis/therapy , SARS-CoV-2
16.
J Drugs Dermatol ; 19(11): 1101-1108, 2020 Nov 01.
Article in English | MEDLINE | ID: covidwho-941793

ABSTRACT

BACKGROUND: Clinical and economic comparisons of therapies for plaque psoriasis are regularly updated following each new devel- opment in the field. With the recent availability of a novel accessory (Multi Micro DoseTM [MMD®] tip) for the 308nm excimer laser (XTRAC®, Strata Skin Sciences, Horsham, PA), which can determine and deliver an optimal therapeutic dose (OTDTM) of ultraviolet-B light in an improved protocol, the need for comparative health-economic assessment recurs. To this end, a comprehensive evaluation of treatment-related costs was undertaken from the payer perspective. Results show that outcomes are influenced by many factors; most importantly, the severity and extent of disease, treatment selection, and patient preference, as well as compliance, adherence, and persistence with care. Among study comparators, the 308nm excimer laser – XTRAC – with its latest MMD enhancement, is safe and delivers incremental clinical benefits with the potential for significant cost savings. These benefits are particularly relevant today in the context of SARS-CoV-2 virus and the COVid-19 pandemic. J Drugs Dermatol. 2020;19(11):1101-1108. doi:10.36849/JDD.2020.5510.


Subject(s)
Coronavirus Infections , Health Care Costs/statistics & numerical data , Pandemics , Pneumonia, Viral , Psoriasis/therapy , COVID-19 , Cost-Benefit Analysis , Humans , Lasers, Excimer/therapeutic use , Patient Compliance , Patient Preference , Psoriasis/economics , Psoriasis/pathology , Severity of Illness Index , Ultraviolet Therapy/economics , Ultraviolet Therapy/methods
17.
J Allergy Clin Immunol ; 147(1): 60-71, 2021 01.
Article in English | MEDLINE | ID: covidwho-866801

ABSTRACT

BACKGROUND: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. OBJECTIVE: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. METHODS: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. RESULTS: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). CONCLUSION: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19-related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.


Subject(s)
COVID-19 , Hospitalization , Psoriasis , Registries , SARS-CoV-2 , Adult , Age Factors , COVID-19/mortality , COVID-19/therapy , Female , Humans , Male , Middle Aged , Psoriasis/mortality , Psoriasis/therapy , Risk Factors , Sex Factors
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