Patients with DIMIDs and Pandemic Risks

Image Credit: © Nicholas Felix/peopleimages.com - stock.adobe.com

The COVID-19 pandemic significantly affected patients with immune-mediated inflammatory diseases (DIMIDs), including atopic dermatitis (AD), psoriasis, and vitiligo. The fear of morbidity, mortality, and vaccine hesitancy contributed to disruptions in their daily lives.¹ Patients with immunodeficiency diseases, older individuals, males, and those of non-White ethnicity were at an increased risk of severe COVID-19 outcomes.² Interestingly, vaccination, a healthy diet, and atopic conditions were considered protective factors against COVID-19.³ A recent prospective observational, multicenter, multidisciplinary cohort substudy explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo.⁴

T2B! Study and Immunosuppressant Therapy

The Target2B! (T2B!) substudy, a national prospective observational cohort study, analyzed patients with immune-mediated inflammatory diseases (IMIDs) to assess seroconversion and disease activity following vaccination. The study revealed that most IMID patients receiving immunosuppressants (ISPs) exhibited seroconversion comparable to controls. Notably, only a minority of patients reported increased disease activity based on patient-reported outcomes. However, many patients with DIMIDs were classified as controls since they did not use ISP therapy.

COVID-19 Risk in Patients with DIMIDs

During the pandemic, patients with AD exhibited lower life satisfaction and health ratings. Studies analyzing COVID-19 risk in patients with AD and psoriasis found that those with AD had similar infection rates and hospitalization risks compared to controls, though they were slightly more prone to developing COVID-19.⁵ In psoriasis, an increased risk of COVID-19 was noted, potentially linked to genetic predisposition.⁶ One study concluded that "no difference was found in the severity of COVID-19 among patients with AD, chronic urticaria, psoriasis, and vitiligo."⁷ However, no specific studies assessed the COVID-19 risk in patients with vitiligo.

DIMID Progression Post COVID-19 and Vaccination

The progression of DIMIDs after COVID-19 and vaccination has not been extensively studied. Researchers found case reports have documented patients developing psoriasis or vitiligo after contracting COVID-19 or receiving a vaccine. Additionally, instances of DIMID progression post-infection and vaccination have been reported, though comprehensive data remains limited.

Study Design and Participants

A substudy of the T2B! study analyzed participants aged 18 years and older diagnosed with DIMIDs (AD, psoriasis, or vitiligo) between February and August 2021. Participants were required to understand Dutch and were excluded if they were pregnant or undergoing concurrent ISP therapy for cancer or organ transplantation. Data were collected through standardized electronic forms and online questionnaires, capturing demographics, SARS-CoV-2 test results, vaccination records, and DIMID activity changes.

Findings on COVID-19 Risk and Disease Course

Among the 424 participants, researchers found patients with vitiligo had a significantly higher COVID-19 incidence (51.1%) compared to those with AD (42.0%) and psoriasis (34.3%). Older age was associated with lower COVID-19 risk, while progressive DIMID at baseline increased susceptibility. ISP therapy did not correlate with higher infection risk. Only 3 patients (2 AD, 1 vitiligo) required hospitalization, with 1 vitiligo patient admitted to intensive care due to a primary immunodeficiency disorder.

Seroconversion Following SARS-CoV-2 Vaccination

Seroconversion rates post-vaccination were found to be high across DIMID groups. After the first dose, 69.0% of those with AD, 78.6% of those with psoriasis, and 91.1% of those with vitiligo achieved seroconversion. Following the second dose, seroconversion reached 96.5% in AD, 97.9% in psoriasis, and 100% in vitiligo. Older age was linked to lower seroconversion rates, whereas factors like sex, baseline immunization status, and progressive disease did not significantly impact antibody response.

Impact of COVID-19 and Vaccination on DIMID Activity

Increased DIMID activity was reported in 384 instances, primarily post-vaccination (51.8%), after COVID-19 infection (22.9%), or unrelated to these events (25.2%). Self-reported increased disease activity following COVID-19 was noted in 6.6% of patients, with higher occurrences in patients with AD and vitiligo. Post-vaccination, researchers stated increased DIMID activity was observed in 12.26% of patients, particularly in psoriasis (17.1%) and AD (14.2%) groups. Only a minority of patients required medical intervention due to worsening symptoms. Notably, "progressive disease at baseline was the only risk factor associated with reporting increased DIMID activity after COVID-19 (OR, 4.27; p = 0.02) or SARS-CoV-2 vaccination (OR, 3.45; p = 0.002)."

Conclusion

This study underscores that patients with vitiligo faced a higher COVID-19 risk than those with AD and psoriasis, though severe outcomes were rare. ISP therapy did not influence infection risk, and nearly all patients achieved seroconversion with standard vaccination regimens. Self-reported increased disease activity post-COVID-19 and vaccination was noted in a subset of patients, with baseline progressive disease as the primary risk factor. Researchers suggested further research is needed to elucidate the long-term impact of COVID-19 and vaccination on DIMIDs.

References

1. Ma Q, Liu J, Liu Q, et al. Global percentage of asymptomatic SARS-CoV-2 infections among the tested population and individuals with confirmed COVID-19 diagnosis: A systematic Review and meta-analysis. JAMA Netw Open. 2021;4(12):e2137257. doi:10.1001/jamanetworkopen.2021.37257
2. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017
3. Zhang JJ, Dong X, Liu GH, Gao YD. Risk and protective factors for COVID-19 morbidity, severity, and mortality. Clin Rev Allergy Immunol. 2023;64(1):90-107. doi:10.1007/s12016-022-08921-5
4. van Buchem-Post NF, Ouwerkerk W, Stalman EW, et al. Impact of COVID-19 disease and vaccination on dermatological immune-mediated inflammatory diseases atopic dermatitis, psoriasis, and vitiligo: a Target2B! substudy. J Dermatol. Published online February 14, 2025. doi:10.1111/1346-8138.17664
5. Zhang J, Loman L, Kamphuis E, Schuttelaar MLA; Lifelines Corona Research Initiative. Impact of the COVID-19 pandemic on adults with moderate-to-severe atopic dermatitis in the Dutch general population. JAAD Int. 2022;6:86-93. doi:10.1016/j.jdin.2021.12.006
6. Gu X, Chen X, Shen M. Association of psoriasis with risk of COVID-19: A 2-sample Mendelian randomization study. J Am Acad Dermatol. 2022;87(3):715-717. doi:10.1016/j.jaad.2022.01.048
7. Criado PR, Ianhez M, Silva de Castro CC, et al. COVID-19 and skin diseases: results from a survey of 843 patients with atopic dermatitis, psoriasis, vitiligo and chronic urticaria. J EurAcad Dermatol Venereol. 2022;36(1):e1-e3. doi:10.1111/jdv.17635