Psoriasis and COVID-19: What You Need to Know

Does Having Psoriasis Increase My Risk for COVID-19 Complications?

Early in the coronavirus outbreak, the International Psoriasis Council (IPC) wrote in a statement, “It remains unknown to what extent the coronavirus impacts psoriasis and the treatment of psoriasis.”

And unfortunately, there’s still no definite answer on this issue. However, the National Psoriasis Foundation (NPF) created a COVID-19 task force to ensure psoriasis patients have access to current, appropriate health recommendations. According to the task force, existing data suggests that patients with psoriasis and/or psoriatic arthritis have similar rates of SARS-CoV-2 infection and COVID-19 outcomes as the general population. (SARS-CoV-2 is the virus that causes COVID-19 illness.)

“For patients with chronic immunocompromised conditions like psoriasis, there is a triple whammy—the coronavirus itself, of course, but also how stress and inflammation present and flare during these times, plus the atopic irritants from keeping bacteria at bay,” says Ava Shamban, M.D., a board-certified dermatologist at Ava MD in Santa Monica, California. She’s referring to ingredients in some soaps, hand sanitizers, and household cleaners, which can cause skin irritation.

Stress and flare-ups can be a vicious cycle, and Shamban always recommends combatting that cycle by managing stress, eating a healthy diet, and getting plenty of sleep. “These things are key for psoriasis patients,” she says.

What If I’m on Medication?

If you’re on medication for your psoriasis, it’s important to ask your doctor if you should continue—particularly if you take immunosuppressant meds, which may lower the body’s ability to fight off some infections.

Advice from the IPC is for physicians to “discontinue or postpone use of immunosuppressant medications” in psoriasis patients with an active COVID-19 infection, in accordance with guidelines from the American Academy of Dermatology. These guidelines state that immunosuppressive psoriasis treatments—such as the biologics etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), and the non-biologic cyclosporine (Neoral)—are contraindicated in patients with active infections. These patients should contact their doctors once their COVID-19 infection resolves for further instruction on how to restart their medications.

“Theoretically, because some medications can inhibit immune-symptom functions, there could be additional risk factors or potential heightened complications,” says Shamban.

However, the research on this isn’t conclusive. A study published in the Annals of the Rheumatic Diseases looked at the European League Against Rheumatism (EULAR) database containing information on the effects of COVID-19 on patients with rheumatic and musculoskeletal diseases. The researchers studied several drugs, including anti-malarials, methotrexate, biological therapies such as TNF-alpha inhibitors, and nonsteroidal anti-inflammatory drugs such as Naproxen, and found that none of them were associated with hospitalization or severe complications in patients who had COVID-19.

Shamban did caution that some people who are taking immune-modulating medications may have a higher anti-inflammatory response to COVID-19, which means there’s a potential for those people to have more acute respiratory distress if infected.

The IPC’s position is that there’s “insufficient evidence to determine how COVID-19 will impact psoriasis patients on systemic treatment who are infected with the virus.”

Meanwhile, the NPF COVID-19 task force recommends, in most cases, that patients who do not have COVID-19 continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis.

Until there is more concrete evidence to go on, doctors will weigh the benefits and risks of continuing with immunosuppressive medications on a case-by-case basis. This means your doctor usually will recommend that you stick with your current treatment plan.

If you are immunocompromised, the CDC advises staying at home as much as possible during the COVID-19 pandemic. When you have to go out, cover your mouth and nose with a cloth face covering and practice physical distancing from others by staying at least six feet away from them. Wash your hands frequently with soap and water or hand sanitizer, especially after you’ve been in a public place.

What Can I Do About Irritation from Handwashing?

All that handwashing can be difficult for people with psoriasis, making cracks and blisters on the hands extra painful and itchy.

“The additional washing can certainly cause additional flare-ups,” says Shamban. To prevent that as well as you can, washing and moisturizing should go hand in hand—literally, she adds. Wash your hands with tepid instead of hot water, then use a soft towel to dry them—but not completely. While your hands are still damp, apply a calming, soothing moisturizer.

Shamban also recommends ensuring that all cleansing products—be it soap or antibacterial hand sanitizer—are gentle. Look out for fragrances and harsh ingredients like triclosan, sodium lauryl sulfate, and parabens, which may be irritating for people with sensitive skin or psoriasis on their hands. Also, when you’re cleaning and disinfecting surfaces, wear gloves for protection.

Is It Safe to See My Doctor?

If you have a flare-up and need to go to your doctor’s office, that might feel extra stressful, but a quick phone call to your doctor should put your mind at ease. Ask what precautions are being taken there. For example, at Shamban’s practice, great care has been taken to create a safe space for patients.

“Besides our PPE, full disinfecting of rooms between patients, and our in-room air filtration systems, we have also eliminated our waiting room,” she says. “We limit patient appointments daily and access to the office is managed and monitored. We have no-touch automatic entrance doors and a hand sanitizer station, and patients complete a questionnaire and get a temperature check on the way into the office. Plus, patients can’t remove their mask until they’re in the room with the treating practitioner.”

What Can I Do About Pandemic Stress?

Of course, there are so many things to get stressed about besides going to your doctor’s office. Times are tough for many people right now in a variety of ways, due to the pandemic.

“The best way to avoid the cycle of stress is to incorporate daily breaks into your day,” says Gina Marie Guarino, LMHC, a licensed mental health counselor in New York City. “Taking time to relax and focus on your breathing is important, even if there are responsibilities that need to be taken care of. Prioritizing self-care and allowing yourself to break and rest, even if everything is not in perfect order, is an important part of developing stress tolerance.”

It’s also important to keep in mind that it’s okay to feel like you are not in control sometimes, Guarino adds. Give yourself permission to let some things go, and try to keep in mind that struggle does not mean failure or incompetence.

Guarino recommends creating a calm home environment as a good way to handle stress during the pandemic. She suggests lighting scented candles or using an oil diffuser if you find fragrances de-stressing and not irritating. “It can also be helpful to declutter and make sure fresh air circulates through your home,” she says.

If you work from home, Guarino advises making sure you have a space that is dedicated only to working. “When you can create a workspace for yourself, you can create a mental separation between work mode and living mode,” she explains. “It makes a big difference in how you carry work stress after work hours, and it can be helpful for staying organized.”

Don’t forget the basics, Shamban adds, like managing your sleep, eating a healthy diet, and taking care to avoid your personal triggers, which can go a long way in helping you feel better during these tumultuous times and perhaps keep flare-ups at bay.

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