Coronavirus and psoriasis: what you need to know

Short summary

• Take seriously the social distancing, hand-washing, and other recommendations from the CDC so we can stop the spread of this novel coronavirus.
• Those with psoriasis and psoriatic arthritis should check in with their doctor to ask if treatment alterations should be made in light of the virus spreading across the country.
• The best advice we have heard so far is that for most patients, not making changes is probably the better route, though it’s a closer call for those on prednisone or methotrexate.
• Do not make any changes without asking your physician first.
• Keep in mind that the anti-malaria drug chloroquine, in the news lately as a possible coronavirus treatment, can trigger psoriasis flares for some patients susceptible to psoriasis.

March 19, 2020 update

President Donald Trump and FDA Commissioner Dr. Stephen Hahn reported today on drugs that may show promise in treating coronavirus (COVID-19). Drugs that treat malaria are one option. Chloroquine (and its molecular cousin, hydroxychloroquine [brand name Plaquenil, among others]) is already FDA-approved for treating malaria, lupus and rheumatoid arthritis. Investigators are trying to determine, according to the FDA, if it “can be used to treat patients with mild-to-moderate COVID-19 to potentially reduce the duration of symptoms, as well as viral shedding, which can help prevent the spread of disease.”

Chloroquine has been around for decades, so its safety profile is well-known. Doctors are free even now to prescribe it “off-label” for coronavirus if they believe it would be beneficial to do so; however, insurers do not always cover use of drugs “off-label.”

Psoriasis patients should be aware that anti-malaria drugs, including chloroquine, can sometimes trigger a psoriasis flare in those who are susceptible to psoriasis. But the decision to use chloroquine in a patient with psoriasis has always been made on a case-by-case basis, balancing costs and benefits. Some psoriasis patients have used chloroquine successfully without flaring. Still, if you were to come down with coronavirus, you should discuss this with your dermatologist before begging your coronavirus physician for off-label chloroquine.

Main article

Coronavirus is upending lives across the world. For those of us with chronic health issues, concerns about the risk of contracting the virus can be magnified. The many unknowns surrounding coronavirus only exacerbate the situation.

Here we share what we have learned about the coronavirus (COVID-19 and sometimes called Wuhan or Chinese flu) and its potential impact on those with psoriasis and psoriatic arthritis.

First, for everyone, the standard preventative measures should be followed as best you, your loved ones, friends, and coworkers can. Here is a coronavirus plan of action for the American people. Another key resource is the US Centers for Disease Control and Prevention (CDC) Coronavirus (COVID-19) website at coronavirus.gov.

We urge you to visit these web pages. Your state (and possibly county or city) likely has supplemental information directly relevant to specific regulations in effect for your jurisdiction.

Certain categories of people seem to be at increased risk from coronavirus, particularly:

• Older adults; and
• People who have serious chronic medical conditions, including heart disease, diabetes, and lung disease.

People in one or both of those groups would want to follow the enhanced safety measures suggested by CDC, which can be summarized as “stay home and avoid other people.”

But what about those with psoriasis or psoriatic arthritis?

There are three issues of potential concern.

First, people with psoriasis have a higher risk of infection, including respiratory infections and pneumonia, than the general population. The risk is higher for those with severe psoriasis than those with mild disease.

Second, many psoriasis medications partially inhibit the immune system, further increasing infection risk. This could theoretically make it easier to catch COVID-19, as well as make it more difficult to treat.

We spoke to two dermatologists and a rheumatologist to get their views on whether people with psoriatic disease should adjust their treatment regimen while COVID-19 is spreading across America. The consensus was first, that each patient should speak to their own medical professional that handles their psoriasis and/or psoriatic arthritis, to discuss this with respect to their particular medical profile and current treatments.

But they also felt that on balance, it was probably better to remain on your psoriasis treatments, based on the limited information currently available as well as the havoc that a psoriasis flare could have on you and your immune system.

One dermatologist added that for those on methotrexate and prednisone, the decision might be a closer call, as they might be said to confer more risks than many of the other treatments, including most biologics.

Most importantly, they all stressed that you should not alter your treatment regimen without first discussing it with your physician. That is always sound advice.

A third issue of concern has been whether using non-steroidal anti-inflammatory drugs, specifically ibuprofen (brand name Advil, among others) for the treatment of fever for people with COVID-19, could exacerbate the progression of the coronavirus.

The internet and news media has been flooded with discussion of this after two professors wrote a letter to the Lancet suggesting theoretical concerns. A World Health Organization (WHO) spokesperson then appeared to endorse this view.

But since that time, WHO has retreated from that suggestion, stating that there is no evidence that ibuprofen poses any particular risk with respect to COVID-19, and that there are no case reports from doctors treating coronavirus patients identifying any issues related to ibuprofen.

In short, that means if you are taking ibuprofen for psoriatic arthritis, or other reasons, you can do so without worrying about increased COVID-19 risk.

We hope you are remaining healthy and COVID-19-free, and we are also concerned for the millions who are being negatively affected economically or otherwise by this worldwide pandemic.

We urge you to take the CDC advice to heart, so that we can minimize the number of people who will be harmed by the virus and so we can all return to the freedom we love as soon as possible.

[Last updated 3-20-2020]

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