Psoriasis and COVID
When cases of COVID-19, caused by the serious acute respiratory syndrome coronavirus 2 (SARS-Cov2), began to be widely reported outside of China in February / March 2020 it rapidly became apparent that there was a need to record and to monitor the interplay between COVID-19 and skin disease. This can be ascertained in two ways: (i) the cutaneous manifestations of COVID-19 and; (ii) the effect of COVID-19 on pre-existing skin disease and the drugs used to treat it. Esther Freeman (Boston, USA) and colleagues working in league with the ILDS, the AAD and other organisations established an international registry to record the cutaneous manifestations of COVID-19. This registry (www.aad.org/covidregistry), has highlighted a range of skin conditions and that milder cases of COVID-19 are more likely associated with pernio, “COVID toe”, whereas severe disease is associated with retiform purpura. This ongoing register is allowing even greater insights into the interactions between infection with SARS-Cov2 and the skin. At the same time, specialists caring for patients with immune-mediated inflammatory diseases (IMIDs) such as inflammatory bowel disease, rheumatic diseases and atopic dermatitis also established registries to investigate the consequences of COVID-19 in these conditions.
The psoriasis community similarly decided that global registries to address the following questions relevant to clinical management were imperative: what is the course of COVID-19 in people with psoriasis; what is the course of psoriasis in the context of COVID-19; which factors are associated with hospitalisation for COVID-19 in people with psoriasis; do biologic therapies affect outcome and; how are people with psoriasis coping during the pandemic? Registries were set up in the US, Italy and in Germany amongst others but perhaps the key global registries were the two established in a very short period of time at the start of the pandemic by Satveer Mahil and Catherine Smith (Kings College London, UK). The registries – PsoProtect (www.psoprotect.org) capturing clinician-entered anonymised data on patients with psoriasis with confirmed or highly suspected of having COVID-19 and PsoProtectMe (www.psoprotectme.org) for anonymised data entered by people with psoriasis and how they were coping during the pandemic. Both registries depend on a truly global collaborative and collegial effort by dermatologists and partnering dermatology organisations including the ILDS, IFPA, IPC and many national and international societies. Important, recently published findings (Mahil et al JACI 2020; epub) indicate that risk factors for hospitalisation in people with COVID and psoriasis are: male; older age; non-white ethnicity and; comorbidities such as diabetes. Treatment with biologics as opposed to non-biologic systemic therapy has a lower rate of hospitalisation and by implication severe disease. Psoriasis itself does not appear to be adversely affected by COVID infection. Patients report greater risk-mitigating behaviour if they are on biologics. What is currently unknown is whether people with psoriasis are at higher or lower risk than the general population of contracting COVID-19
The registries will continue to recruit, seek to collaborate further and to combine data with other IMID registries to investigate these early findings. PsoProtect (666 registrants) and PsoProtectMe (3302 registrants) are easy to enter data into and this is encouraged. Further work will of necessity also focus on accruing data on the effect of SARS-CoV2 vaccines on psoriasis-COVID outcomes.
The collaborative, non-competitive nature of the global dermatology community in rising to and addressing the challenges of the pandemic to skincare has been overwhelming. I am sure I speak for the majority by hoping this spirit of collegiality and global togetherness will continue long after the pandemic has passed.