COVID-19 Guidelines for People with Psoriasis

Recommendation: Lower Your Exposure Risk

The task force recommends practicing physical distancing, wearing face coverings in public settings when physical distancing is difficult, and washing hands regularly.

Even though I feel fatigued trying to follow these recommendations month after month, I stay vigilant. Recent news suggests that COVID-19 might not go away for a while yet.

So I will continue to do my best to lower my exposure risk, even if I don’t always do it perfectly. That means washing my hands regularly and moisturizing them afterward, since they become irritated or dry if I forget. I try not to touch my face, although I struggle with eczema itchiness. I regularly wear face coverings in public, although sometimes the moisture buildup irritates my face.

Recommendation: Maintain Your Current Medications

A major question I had from the beginning of the coronavirus pandemic is whether I should continue taking my biologic, Skyrizi (risankizumab).

While I’m not a scientist or medical professional, I understand that psoriasis stems from an overactive immune system. Since my injectable biologic works by suppressing my immune system, I reasoned that it might raise my coronavirus risk.

But the task force recommends that people with psoriasis continue biologic or oral therapies. Here’s its statement: “While some uncertainties remain, initial data suggest that the benefit of continuing treatments for psoriatic diseases outweighs the hypothetical risks associated with immune-modulating treatment of poor COVID-19-related outcomes for most patients.”

The task force also encourages each individual with psoriasis or psoriatic arthritis to consult with their healthcare provider, who can discuss a therapy plan while considering factors such as a patient’s age, disease characteristics, current treatments, underlying medication conditions, and personal concerns.

I appreciate the task force’s acknowledgment that treatment decisions are unique for each person. To discuss my own options, I messaged my dermatologist a couple of months ago. We decided at the time, and again at my most recent telemedicine appointment, to continue my biologic therapy.

Without the biologic I would be at risk for a major flare, something I would like to avoid if possible. Because I mostly stay at home and am younger than 65 — two factors that reduce my risk of coronavirus exposure and complications — my dermatologist and I decided that controlling my psoriasis outweighed any possible risk associated with my medication. I feel at peace with this treatment course, knowing I can contact my dermatologist any time to discuss changes as necessary.

Recommendation: Discuss Treatment Options With Your Doctor if You Get Infected

I don’t like to think about what might happen if I become infected with COVID-19. I’d rather spend my time and energy minimizing exposure to prevent it from happening. But if I do contract the disease, I’m glad the task force addressed what to do.

As with other recommendations, they advise talking to a healthcare professional about whether to stop biologic or oral therapies while infected with COVID-19.

In past years, when I had a bacterial infection or the flu, my dermatologist advised me to stop any medications that affected my immune system. But with COVID-19, the situation may be different. The task force makes the point that psoriasis medications could potentially even treat COVID-19: “While it is generally advised to hold immune-modulating treatment during an infection, in the case of COVID-19, several different immune-modulating treatments used for psoriasis and other immune-mediated or autoimmune diseases are being studied in experimental placebo-controlled trials to treat or prevent severe COVID-19 illness in those infected with SARS-CoV-2.”

Recommendation: Consider Starting Treatment if You’re Newly Diagnosed

The task force recommends that people who are newly diagnosed with psoriatic conditions or living with untreated psoriatic disease consider initiating therapy: “Untreated psoriatic disease is associated with serious impact on physical and emotional health, and in the case of psoriatic arthritis, can lead to permanent joint damage and disability.” I know that without treatment my skin would be covered in psoriatic lesions that would lead to a lot of physical discomfort and emotional distress.

The task force also notes that stress is a potential trigger for worsening psoriasis. That has been true for me. My psoriasis and eczema worsened at the beginning of the pandemic, and I have experienced some sleepless nights worrying — insomnia is another psoriasis trigger for me. Furthermore, the task force mentions that there have been “reports of psoriasis flares associated with COVID-19 illness.” These serve as additional reasons to consider seeking treatment. Of course, all of these considerations entail a conversation with your healthcare provider.

I’m grateful for the task force’s work but am still left with my original question: Does having psoriatic disease elevate my risk of contracting the coronavirus or ending up with a worse COVID-19 outcome? The task force doesn’t seem to have an answer for me yet; I’ll keep an eye out for their next update.

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