There is no guidance at this time from the Centers of Disease Control (CDC) or the Department of Public Health on how psoriasis patients should respond to the Coronavirus (Covid-19) epidemic, nor are there good studies in the literature for physicians to use as a basis for recommendations. As a result, we at UDSCC have no advice that we can give that is based on proven data. The following has been shared by Dr. Jeffery Sobell, a well renowned psoriasis expert. Both Dr. Patrick Retterbush and Dr Lauren Whalen agree with the following:
For psoriasis patients on biologics (Enbrel, Humira, Remicade, Cimzia, Stelara, Cosentyx, Taltz, Siliq, Tremfya, Ilumya, Skyrizi)
For patients who have been healthy on their biologic up to now with no obvious increase in infection rate, continuing therapy LIKELY WILL NOT increase their risk of contracting the virus. Furthermore, if an infection should occur, it is NOT LIKELY that their ability to fight the infection will be affected. But, of course, as with any significant infection, patients should hold future doses until they fully recover.
With that being said, if psoriasis patients are still concerned and would rather hold their biologic medication for now, that is certainly a reasonable option. But keep in mind the following two issues:
- The psoriasis will recur. Depending on the specific biologic, half the psoriasis returns on average in 3 to 6 months.
- Restarting the biologic after a long break may or may not work as well as their previous experience to control their psoriasis.
For psoriasis patients on oral prescriptions
1) For patients on Cyclosporine and Methotrexate, Dr. Sobell advises to reduce the dose to the lowest possible that still adequately controls their symptoms. For patients on Otezla, as it is not associated with a high risk of infection, it is reasonable to continue at the current dose. But, should a significant infection occur while under any of these three treatments, Dr. Sobell would hold future doses of all three of these medications until the infection has completely resolved.
2) For patients on Acitretin, this medication does not impair the immune system so it is acceptable to continue.
For all patients
Our best defense against infection is proper hand hygiene and avoidance of close contact with people showing signs of respiratory illness.
If you have specific concerns about your psoriasis therapy and Covid-19, please contact our office.