Exploring the Link Between COVID-19 Research and Psoriatic Disease

Four years after the start of the COVID-19 pandemic, researchers are continuing to make strides in their understanding of the relationship between the virus and dermatologic conditions, including psoriasis.

This week, Dermatology Times is highlighting recent COVID-19 research affecting skin, hair, and nails. Recently-published studies have explored the relationship between COVID-19 infection and psoriatic disease severity, case reports of psoriasis onset and exacerbation following vaccination, and more. We review these studies below.

Vaccination and Exacerbation

In one study, researchers investigated psoriasis flare-ups following COVID-19 vaccinations, examining 71 patients with a history of plaque psoriasis who experienced flare-ups post-vaccination.¹ They also explored cases of new-onset psoriasis and modifications in psoriasis subtypes. The research delved into various factors including patient characteristics, vaccination details, and exposome traits such as sex, age, comorbidities, and UV exposure. Clinical manifestations aligned with traditional symptoms of psoriasis, with pustular psoriasis being the most frequently reported subtype modification. The study found no significant association between biological treatment and flare occurrence, and timing of flare-ups varied widely. Additionally, there was an analysis of psoriasis flare-ups following non-COVID-19 vaccinations, albeit with fewer cases identified.

In one systematic review, registered on PROSPERO, researchers investigated cases of psoriasis exacerbation or induced psoriasis post-COVID-19 vaccination.² The review included research articles and correspondence reporting such cases, excluding active psoriasis cases. Through searches in PubMed, Google Scholar, and EBSCOHost until June 2022, 33 relevant articles were identified and analyzed. The included studies detail demographics, vaccine types, onset of psoriasis symptoms, comorbidities, and treatments. Most cases involved individuals with a history of psoriasis, with Pfizer being the most commonly associated vaccine. The onset of symptoms varied from 1 to 90 days post-vaccination, and treatments ranged from topical steroids to monoclonal antibodies, with notable clinical improvement observed in many cases.

The Risk of GPP and COVID-19

Another study explored the rare but potentially life-threatening variant of psoriasis known as generalized pustular psoriasis (GPP) and its interaction with COVID-19 infection, a topic scarcely documented previously.³ The report presented 2 cases of individuals with GPP who experienced fatal outcomes following SARS-CoV-2 infection. The first case involved a 20-year-old male with a history of psoriasis vulgaris who experienced a sudden exacerbation of GPP leading to acute respiratory distress syndrome (ARDS) due to COVID-19 infection. Despite medical intervention, including methotrexate and acitretin treatment, the patient succumbed to the illness. The second case was a 52-year-old female with a history of GPP under treatment with acitretin and cyclosporine, who also developed ARDS following COVID-19 infection and passed away despite medical management. Both cases underscore the potential severity of COVID-19 infection in individuals with GPP and emphasize the importance of awareness among dermatologists regarding the heightened risk of mortality in such patients.

Biologics and Risk Mitigation

A study conducted at the Second Affiliated Hospital of Zhejiang University aimed to assess the impact of COVID-19 infection on patients with plaque psoriasis, particularly those treated with or without biologic agents.⁵ Involving 209 patients over 18 years old with confirmed SARS-CoV-2 infection, the research categorized participants into non-biologics, ADA, IXE, and SEC treatment groups. Analysis of demographic data, treatment history, and PASI scores before and after COVID-19 infection revealed a significant increase in median PASI scores across all groups post-infection, indicating exacerbated psoriasis severity. Notably, patients treated with IXE demonstrated a lower likelihood of psoriasis exacerbation following COVID-19 infection compared to those on other biological agents. Additionally, serum analysis showed that biological agents, including ADA, SEC, and IXE, suppressed serum OAS2 and OAS3 levels while elevating OAS1 levels, potentially contributing to the protective effect against psoriasis exacerbation.

A population-based multicenter study investigated the incidence of COVID-19, medical interventions, and COVID-19-associated mortality among patients with psoriasis from December 2022 to February 2023 across 6 hospitals in China.⁶ Patients receiving psoriasis treatment were included, with those undergoing immunosuppressive therapy for reasons other than psoriasis excluded. Data on COVID-19 diagnoses, interventions, and mortality were collected, along with patient characteristics and treatment details. Statistical analysis revealed significant associations between treatment types, COVID-19 incidence, and outcomes. Specifically, IL-23 inhibitor treatment showed a decreased risk of COVID-19 compared to other treatments, with patients experiencing fewer symptoms and lower COVID-19 mortality. Outdoor work was associated with reduced COVID-19 risk, while vaccination status did not significantly correlate with infection rates. Additionally, patients with other allergic diseases exhibited lower COVID-19 risk.

References

1. Karampinis E, Papadopoulou MM, Chaidaki K, et al. Plaque psoriasis exacerbation and COVID-19 vaccination: Assessing the characteristics of the flare and the exposome parameters. Vaccines (Basel). 2024;12(2):178. Published 2024 Feb 9. Accessed March 19, 2024. doi:10.3390/vaccines12020178
2. Arifin ANF, Hengky A, Widjaja M, Wijaya L. New-onset and exacerbation of psoriasis following COVID-19 vaccination: A systematic review of case reports and case series. Indian J Dermatol. 2023;68(6):724. Accessed March 19, 2024. doi:10.4103/ijd.ijd_833_22
3. Narang T, Sharma A, Bhandari A, Handa S, Dogra S. SARS-CoV-19 and generalised pustular psoriasis: A lethal combination. Indian J Dermatol. 2023;68(6):726. Accessed March 19, 2024. doi:10.4103/ijd.ijd_914_22
4. Yang Z, Jin Y, Wang M, Li R, Li WQ, Li H. Enhanced impact of psoriasis severity on the treatment demands of patients during the COVID-19 pandemic: a cross-sectional study based on a national psoriasis registry in China. BMJ Open. 2024;14(2):e079627. Published 2024 Feb 17. Accessed March 19, 2024. doi:10.1136/bmjopen-2023-079627
5. Zheng YX, Chen XB, Wang ZY, Ye LR, Zheng M, Man XY. Biologics protect psoriasis patients from being exacerbated by COVID-19 infection. Heliyon. 2024;10(2):e24534. Published 2024 Jan 14. Accessed March 19, 2024. doi:10.1016/j.heliyon.2024.e24534
6. Hu Y, Huang D, Jiang Y, et al. Decreased risk of COVID-19 and long COVID in patients with psoriasis receiving IL-23 inhibitor: A cross-sectional cohort study from China. Heliyon. 2024;10(2):e24096. Published 2024 Jan 9. Accessed March 19, 2024. doi:10.1016/j.heliyon.2024.e24096