Cutaneous immune-mediated diseases may not have higher risk for severe COVID-19

Patients with cutaneous immune-mediated diseases, such as psoriasis, atopic dermatitis and hidradenitis suppurativa, may not have an increased risk for developing severe COVID-19, based on available data from the current and previous coronavirus outbreaks.

“Similarly to SARS-CoV and MERS-CoV, immunosuppressed status (due to transplantation, chemotherapy or other conditions requiring immunosuppressive treatment) has not been found to be a risk factor for an adverse outcome” in patients with COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vs. the general population, the authors said.

COVID-19 appears to be less severe and have a lower mortality rate than both SARS-CoV and MERS-CoV, but the authors said that they are alike in that the “SARS-CoV-2 infection in severe cases involves the host response as an important contributor to the disease process and tissue damage, mainly due to dysregulated and excessive innate immune responses.”

In these cases, patients are more likely to experience an exaggerated secondary immune response following a primary immune response, which usually results in viral clearance. The symptoms of this exaggerated response can include inflammatory-induced lung injury, pneumonitis, respiratory failure, acute respiratory distress syndrome, shock, organ failure and death.

While the reasons for this response are unknown, the researchers said that some immunosuppressants and immunomodulatory drugs may help control it.

According to the study, most dermatological societies and other immune-mediated disease specialties, such as rheumatology and gastroenterology, recommend discontinuing or postponing immunosuppressive and biologic therapy if the patient develops COVID-19. The decision is ultimately made by the patient and physician through an assessment of the risks and benefits on an individual basis.

The authors also noted that vaccination for SARS-CoV-2 will likely be a recommendation in the future for those who receive dermatological immunosuppressive and biologic treatments. – by Kalie VanDewater

Disclosures: Torres reports he has received consultancy and/or speaker honoraria from and/or participated in clinical trials sponsored by AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Janssen, Biocad, Leo Pharma, Eli Lilly, MSD, Novartis, Pfizer, Samsung Bioepis, Sanofi-Genzyme and Sandoz. Please see the study for all other authors’ relevant financial disclosures.