Do You Need a COVID-19 Vaccine Booster If You Have Psoriasis?

This includes people who have received organ transplants or are undergoing cancer treatment, as well as some individuals with chronic health conditions who are taking drugs that can suppress their immune response, raising their risk of serious, prolonged COVID-19.

If you have psoriasis and are taking an immunosuppressive medication, such as high-dose steroids or a biologic, you may wonder what the new vaccine guidance means for you — and when, how, or even if, you should get a booster shot.

If I Have Psoriasis, Should I Get a Booster?

Anyone with psoriatic disease who is being treated with immune-modulating drugs and has already received two doses of a COVID-19 vaccine from Pfizer-BioNTech or Moderna is eligible for a third dose, says Joel Gelfand, MD, the cochair of the National Psoriasis Foundation and a professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

Among those patients, Dr. Gelfand believes the following are most likely to benefit from a third shot:

• Those age 50 or older
• Those taking abatacept, cyclosporine, leflunomide, glucocorticoids (such as prednisone), methotrexate, or tofacitinib
• Those who received their second dose of the Pfizer or Moderna vaccine more than six months ago
• Those with underlying health complications known to increase the risk of severe COVID-19, such as those who are overweight; who smoke or used to smoke; or who have diabetes, cardiovascular disease, or a chronic disease affecting the lungs, liver, or kidneys

What Should I Do if I Got the Johnson & Johnson Vaccine?

Right now, psoriasis patients and other immune-compromised people who received the Johnson & Johnson (J&J) single-dose vaccine are not eligible for a booster shot.

Can I Just Go and Get the Third Shot or Do I Need to Talk to My Doctor First?

“You should talk to the physician you see for psoriasis treatment to [get their input] and determine if you are on an immunosuppressive medication prior to getting the booster shot,” says Lisa Zaba, MD, PhD, a clinical associate professor of dermatology at Stanford University School of Medicine in Palo Alto, California.

You don’t need a prescription or a doctor’s note to get a third shot, but you should bring your vaccination card. The dose will be the same as the first and second shot, and the side effects should be similar, says the CDC.

Do I Need to Get the Same Vaccine I Got for My First Two Doses?

If possible, yes, says Gelfand. The CDC is recommending that people get the same vaccine they received for their first two shots, so if you are already inoculated with either Pfizer or Moderna, you should get the same for your third shot.

If that isn’t feasible, or you don’t know which vaccine your received for your first two doses, the agency says you should get your additional dose with either the Pfizer or Moderna vaccine.

I Recently Got My Second Dose; How Long Should I Wait Before Getting a Third Dose?

“For people who are immune-compromised or taking immune-suppressing medications, it’s recommended that they wait at least 28 days after they had the second dose before getting a booster,” says Zaba.

Should I Temporarily Go Off My Psoriasis Medication After I Get the Third Shot?

It’s very important to talk to your doctor before making any changes in your psoriasis medication, says Gelfand.

He notes that patients taking methotrexate with well-controlled disease may — in consultation with their doctors — consider pausing their medication for two weeks after getting the booster.

While this approach may improve antibody response, it’s not known if it will result in any meaningful benefit in terms of the risk of contracting COVID-19 or developing severe disease, he says.

If I Went Off Medication for Previous Vaccine Doses, Do I Still Need to Get a Third Shot?

Because the effects of pausing methotrexate after getting a COVID-19 vaccine aren’t yet known, people with psoriasis who paused their medication after the first two COVID-19 vaccine doses should still consider getting a third shot, says Zaba.

If I Get a Third Shot, How Good Is the Protection?

A third dose will likely provide you with better protection, but how much better is not yet clear, says Zaba.

Some studies have found that people who were severely immunocompromised and had virtually no protection from the Pfizer or Moderna vaccine had an improved antibody response after a third shot of the same vaccine, says the CDC.

“Right now, we don’t know if a third or booster shot has clinically meaningfully benefits [for psoriasis patients on immunosuppressive medication],” says Gelfand. “But given the emergence of the Delta variant, which is much more transmissible than previous variants, it’s likely that booster vaccines will be necessary and helpful.”

Even after receiving a third dose of the vaccine, you’ll need to take extra precautions to avoid exposure to COVID-19, such as wearing a mask (especially inside) and avoiding crowds.

To reduce your odds of exposure, it’s also important that your family members and other close contacts get vaccinated.

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