COVID-19 and Psoriasis: Is There a Link?

From webmd.com

April 19, 2023 – New research is shedding light on how an infection with COVID-19 may reactivate, or even cause, psoriasis. 

The  skin condition affects about 7.5 million adults in the United States, according to the National Psoriasis Foundation.  Psoriasis has several well-established triggers, including stress, skin injury, cold or warm air, and allergies. Illnesses like strep throat can also cause a psoriasis flare in some people – and it appears COVID may also do so. 

“Psoriasis flares have long been associated with bacterial and viral infections, particularly a form of psoriasis called guttate, which is characterized by tons of tiny red scaly bumps all over the body,” said Joel M. Gelfand, MD, a professor of dermatology and epidemiology at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia. “Infection with COVID-19 has been associated with flares of guttate and pustular psoriasis, and even psoriasis that affects 100% of the skin, which is called erythroderma, in many published case reports.” 

Israeli researchers recently found that psoriasis patients have a slightly higher risk of getting COVID,  although they are not at higher risk of hospitalization or death. This could be because psoriasis is sometimes treated with immune-modulating therapy, which can leave patients more at risk of infections.

If you have psoriasis and test positive for COVID, arm yourself with information. Although we don’t know everything yet about the possible link between the two conditions, there are ways to treat the problem.

How Could COVID Cause Psoriasis to Flare? 

Psoriasis is an autoimmune condition, and inflammation can cause symptoms.

A study from Albany Medical College/Weirton Medical Centre found that people in the study who were already diagnosed with the skin condition had an unexpected flare within a week to a month after testing positive for COVID. New psoriasis after a COVID infection was also found. The researchers think this could be because COVID causes inflammation in the body, which negatively affects previously well-controlled psoriasis. They also think it’s possible that COVID-related inflammation could trigger a genetic tendency to have psoriasis, which may explain why it can appear for the first time after a positive test.

Inflammation in the body commonly manifests itself through skin conditions. 

“The skin is the largest organ in the body,” said Robert O. Carpenter, MD, director of wellness at Texas A&M College of Medicine in  Bryan, TX. “A viral infection like COVID-19 can signal the release of pro-inflammatory factors that can appear as rashes, such as with psoriasis.”

What are the Symptoms of COVID-Related Psoriasis?

The signs are the same as those of any form of psoriasis. According to the Mayo Clinic, these signs can include: 

• A patchy, scaly, raised red rash. Psoriasis can also be purple, pink, grey, brown or silver. The rash can appear anywhere on the body. Psoriasis can also look like dandruff. 
• Dry, cracking skin that sometimes peels
• Itching, burning, or painful skin

If I Have Psoriasis, Will COVID Automatically Make It Worse?

Not necessarily.

“Psoriasis is a common condition, so people should be aware that new psoriasis that develops may not be related to COVID-19,” said Esther Freeman MD, PhD, director of global health dermatology at Massachusetts General Hospital in Boston.

As with every aspect of COVID, doctors and scientists are still learning about how serious and widespread a problem psoriasis after COVID-19 may be. “We have seen case reports that psoriasis can flare after COVID-19,” said Freeman, who is also an associate professor of dermatology at Harvard Medical School. “I will say, this has not been a tidal wave – more like sporadic cases here and there. So I do not think psoriasis flares are a major post-COVID finding, nor do they necessarily mean you have long COVID. That being said, we know that many different infections can cause psoriasis flares, and so in that respect, it's not that surprising that SARS-CoV-2, like other infections, could trigger a psoriasis flare.”

Could getting COVID more than once cause psoriasis to flare? It’s possible.

“Your body can change after having COVID-19,” said Carpenter. “We don’t know the long-term implications, but having COVID-19 repeatedly can increase the risk of long COVID, which can cause many systemic changes in your body." 

Another important point: If you take biologics, the immune-modulating therapy to treat psoriasis, getting vaccinated and boosted for COVID is an important step to take to help protect yourself. 

Is Psoriasis Itself a Potential Symptom of COVID? 

“Yes, but we don’t know the frequency at which this may occur, and a causal relationship is difficult to establish from just case reports,” said Gelfand, who’s also medical director of the Clinical Studies Unit in the Department of Dermatology at his university. “Typically, if a patient presents with a flare of psoriasis, particularly guttate, pustular, or erythrodermic forms, an infectious trigger should be considered, and testing for strep and possibly COVID-19 may be appropriate.”

If you do have a flare of psoriasis, or get one for the first time after testing positive for COVID, you should also ask your dermatologist about new treatment options.

“You could need to change the medication you take for psoriasis, or utilise medication for the first time,” Carpenter said. 

It’s important to know that the problem can be controlled. 

“Flares of psoriasis caused by infections typically improve over a period of months,” Gelfand said. “We have many safe and effective ways to treat flares of psoriasis, including new topical medications, ultraviolet light phototherapy, and pills. There is no reason to suffer with psoriasis – most patients can be helped with all of the recent advances in treatment.”

https://www.webmd.com/skin-problems-and-treatments/psoriasis/news/20230419/covid-and-psoriasis-is-there-a-link

Are COVID-19 Vaccines Safe If You Are Taking Psoriasis Medication?

From healthline.com

Psoriasis is a chronic condition in which itchy, red patches appear on the skin. It happens when the immune system becomes dysfunctional, leading to increases in inflammation in the body and the rapid accumulation of skin cells.

Since psoriasis is an immune-mediated condition, its common treatments involve the use of drugs that suppress the immune system. These can include:

• corticosteroids like prednisone
• traditional immunosuppressants like methotrexate or cyclosporine
• biologics like adalimumab (Humira) and infliximab (Remicade)

Because these drugs weaken the immune system, some people with psoriasis may be concerned about receiving COVID-19 vaccines. COVID-19 vaccines are both safe and effective for people with psoriasis.

Let’s dive deeper into what we know so far about COVID-19 vaccines and psoriasis medications. 

Are COVID-19 vaccines safe for people with psoriasis and taking psoriasis medications?

Currently, all of the available evidence suggests that COVID-19 vaccines are safe for people taking psoriasis medications.

Let’s explore some of the concerns regarding vaccine safety for people with the condition.

Psoriasis medications can weaken the immune system. This makes people taking these medications more vulnerable to contracting and becoming seriously ill with various infections.

Similarly, vaccines containing live versions of a germ aren't typically used in people with a weakened immune system, as they may replicate in the body and cause illness. Some examples are the flu nasal spray vaccine and the measles, mumps and rubella (MMR) vaccine. 

However, none of the currently available COVID-19 vaccines contain live virus. Instead, they contain either an mRNA molecule or a modified adenovirus that cannot replicate within the body.

While researchers continue to study COVID-19 vaccines in people with a weakened immune system, research indicates that other inactivated vaccines, such as the flu shot and the hepatitis B vaccine, are safe for people with immune-mediated inflammatory conditions like psoriasis.

However, vaccination may trigger a flare of any autoimmune condition, including psoriasis. It’s important to discuss this possibility with your doctor.

Immunosuppressants like methotrexate and COVID-19 vaccines

Methotrexate was initially used to treat cancer, but was approved to treat severe psoriasis in the 1970s. It works by inhibiting an enzyme that leads to rapid skin cell growth.

One of the potential side effects of taking methotrexate is a weakened immune system, specifically due to low levels of infection-fighting white blood cells. This increases infection risk.

Because of this, people taking methotrexate are at an increased risk of serious illness from COVID-19. This makes vaccination vital.

People taking methotrexate are not at an increased risk from the COVID-19 vaccine. However, it appears as if those taking methotrexate generate a reduced immune response to COVID-19 vaccination. More on that later.

Are COVID-19 vaccines effective in people with psoriasis and taking psoriasis medications?

According to the Centres for Disease Control and Prevention (CDC), researchers are still learning how well COVID-19 vaccines protect people with a weakened immune system, including those on immunosuppressive drugs.

In fact, people taking immunosuppressive drugs were excluded from the COVID-19 vaccine trials. This is actually a standard practice for vaccine trials. It allows researchers to evaluate the immune response to the vaccine without the confounding effects of immunosuppressive drugs.

Future research will examine those with weakened immune systems more closely. For now, we do have indications that the COVID-19 vaccine is effective for those taking psoriasis medications, particularly biologics. 

Two 2021 reports on people taking biologics for psoriasis found that antibodies to the novel coronavirus spike protein were developed following vaccination. How long this protection lasts is currently unknown, though.

COVID-19 vaccines and methotrexate

Current data suggests that the immune response to COVID-19 vaccination may not be as strong in people taking methotrexate.

Trusted SourceA 2021 study compared the immune response to the first dose of the Pfizer-BioNTech vaccine:

• A total of 17 healthy individuals and 84 people with psoriasis were included in the study. Of the people with psoriasis, 17 were taking methotrexate and 67 were taking biologics.
• Compared to the healthy individuals, immune response rates were lower in those taking psoriasis medications. The lowest immune response was seen in people taking methotrexate.
• Healthy individuals and people taking biologics more readily produced antibodies that could neutralize the coronavirus.
• The cellular immune response, which involves CD8 T cells that specifically target cells infected with the coronavirus, was preserved across all three groups.

Another 2021 study supported these findings. It compared the immune response to two doses of the Pfizer-BioNTech vaccine in both healthy individuals and people with immune-mediated inflammatory conditions, predominantly those with psoriasis:

• Two groups were used in the study:
  • The first group included 26 healthy individuals and 51 people with immune-mediated inflammatory conditions.
  • The second group included 182 healthy individuals and 31 people with immune-mediated inflammatory conditions.
• Healthy individuals and those taking biologics had a robust antibody response following vaccination 90 percent of the time.
• Individuals taking methotrexate had an adequate antibody response only 62.2 percent of the time.
• Unlike the previous study, activation of CD8 T cells did not increase in people taking methotrexate.

You may now be wondering why the immune response to the COVID-19 vaccine seems to be lower in people taking methotrexate compared to those taking biologics. The answer could be the ways that these medications impact the immune system.

Biologics only target very specific parts of the immune system. Traditional immunosuppressants like methotrexate are very general in their effects. It could be that this broader effect could be dampening the immune response to the COVID-19 vaccine in people taking methotrexate.

Should people with psoriasis get vaccinated?

It’s important for people with psoriasis to receive the COVID-19 vaccine. The CDC recommends that  everyone aged 12 and older get vaccinated for COVID-19.

Additionally, a task force organized by the National Psoriasis Foundation (NPF) recommends that all people who don’t have contraindications to the vaccines receive it as soon as it’s available to them.

Taking psoriasis medications is not a contraindication for COVID-19 vaccination. In fact, the NPF task force recommends that those receiving the COVID-19 vaccine continue to take their psoriasis medications in most cases.

They do note that some people taking methotrexate may, in consultation with their doctor, suspend their medication for 2 weeks after vaccination to help promote an improved immune response. This guidance applies to people who meet all of the following criteria:

• are going to receive the Johnson and Johnson vaccine
• are 60 or older
• have at least one other health condition that increases their risk of serious complications from COVID-19

According to the CDC, the only contraindications for a COVID-19 vaccine are:

• a severe allergic reaction, called anaphylaxis, to a previous dose of the COVID-19 vaccine or to an ingredient in the COVID-19 vaccine
• an immediate allergic reaction, such as hives or wheezing, to a previous dose of the COVID-19 vaccine
• a known allergy to an ingredient in the COVID-19 vaccine

Should already vaccinated people with psoriasis get a vaccine booster shot?

People with a weakened immune system that have received both doses of either mRNA vaccine may not develop the same level of immunity as those with a healthy immune system.

This includes people that are actively taking immunosuppressive medications, such as psoriasis medications.

The CDC recommends that individuals who are moderately to severely immunocompromised receive a booster shot at least 28 days after their second dose. The aim is to improve the immune response from the initial vaccine series.

Currently, this only applies to the two mRNA vaccines: Pfizer-BioNTech and Moderna. Additional data is needed to determine the benefits of a vaccine booster in individuals who received the Johnson and Johnson vaccine.

The NPF task force also recommends that individuals with psoriasis or psoriatic arthritis that are currently taking immunosuppressive drugs should receive a booster shot.

They’ve also identified groups that are more likely to benefit from a booster, including people:

• who are 50 years old or older
• who are taking the following psoriasis medications:
  • corticosteroids
  • traditional immunosuppressants like methotrexate, cyclosporine, and leflunomide
  • the biologics abatacept (Orencia) and tofacitinib (Xeljanz)
• who received their second dose over 6 months ago
• who have additional health conditions that increase risk of serious COVID-19 illness

Can COVID-19 vaccines cause psoriasis or make the skin condition worse?

Now that we’ve discussed COVID-19 vaccinations and psoriasis, you may be curious if the COVID-19 vaccines can cause or exacerbate psoriasis.

Can COVID-19 vaccines cause psoriasis?

There’s currently no evidence that the COVID-19 vaccines can cause psoriasis.

Other vaccines, specifically the flu shots used between 2009 and 2010, have been linked with new-onset psoriasis.

However, the authors of the 2015 study reporting this finding note that in addition to it being very rare, they could not directly prove a direct causative relationship between the vaccine and psoriasis.

Can COVID-19 vaccines cause psoriasis flares?

Vaccine-related psoriasis flares are a concern for some. A 2021 study of 142 people who were reluctant to receive a COVID-19 vaccine found that 21 percent listed the risk of a psoriasis flare as a concern.

There have been reports of psoriasis flares following COVID-19 vaccination. However, researchers have been unable to directly link them to the vaccines themselves.

It’s important to note that, in these reports, people experiencing a flare after vaccination were reported to either not be taking any medications for their psoriasis or only be using topical treatments to manage their condition.

Three further reports have found that people taking psoriasis medications, specifically biologics, experienced no flares after COVID-19 vaccination. However, whether certain treatments affect the likelihood of a flare after vaccination is currently unknown.

Additionally, other factors may lead to psoriasis flares, with stress being one example. It’s possible that stress related to the pandemic or to receiving a vaccination could contribute to a flare after vaccination.

Trauma to the skin, including injections, can also lead to psoriasis symptoms at the injury site. This is called the Koebner phenomenon. The incidence of the Koebner phenomenon is estimated to be between 11 to 75 percent in people with psoriasis.

Takeaway

Medications for psoriasis can weaken the immune system. Because of this, people with psoriasis may be at an increased risk of serious illness from COVID-19.

The available evidence indicates that COVID-19 vaccines are safe and effective for people taking psoriasis medications. Additionally, taking psoriasis medications isn’t a contraindication for vaccination.

The NPF recommends that people with psoriasis receive the vaccine as soon as they can. Additionally, booster vaccines are now recommended for immunosuppressed people, including those taking certain psoriasis medications.

If you have concerns about receiving the COVID-19 vaccine or how your psoriasis medications will impact the vaccine, be sure to discuss them with a doctor.

https://www.healthline.com/health/psoriasis/covid-vaccine-and-psoriasis

COVID-19 Vaccine and Psoriasis

From psoriasis-association.org.uk

Information about the COVID-19 vaccine(s), psoriasis and immunosuppressant medications

The COVID-19 vaccine provides the best protection against coronavirus. Four vaccines for COVID-19 have currently been approved for use in the UK: the Pfizer/BioNTech vaccine; the Oxford/AstraZeneca vaccine; the Moderna vaccine; and the Janssen vaccine. The Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines are now being given to people at sites across the UK. The Janssen vaccine will be available in the UK later in 2021.

While this is certainly cause for optimism, it’s completely understandable that people who are taking immunosuppressive drugs for their psoriasis and/or psoriatic arthritis may have some concerns about whether or not it is safe for them to receive a COVID-19 vaccine.

We’ve put the following information together to try and address some of the concerns you may have. It’s important to note that we are learning more about both COVID-19 itself and the different vaccines that are being developed all the time. We will ensure that this section is updated regularly as further information is released.

Is the COVID-19 vaccine suitable for people with psoriasis and/or psoriatic arthritis?

Yes, current evidence suggests that the Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines are all suitable for people who are living with psoriasis and/or psoriatic arthritis. Therefore, having psoriasis and/or psoriatic arthritis, or taking prescribed medicines to treat your condition will not affect whether or not you can receive the COVID-19 vaccine, or which vaccine is best for you.

Is a COVID-19 vaccine likely to affect my psoriasis?

There is no evidence to suggest that vaccines are bad for psoriasis (or likely to make it worse, or flare), hence why people are encouraged to have the flu vaccine each year. At this stage, scientists are having to extrapolate data from other vaccines such as the flu vaccine and can see no reason why the COVID-19 vaccine would be any different in terms of flaring/causing psoriasis from, say, the flu vaccine. Systematic reviews have not found evidence that (non-live) vaccines are bad for psoriasis.

Is it safe for people who are taking immunosuppressant medication to receive a COVID-19 vaccine?

Yes, the Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines are all considered suitable for people who are living with psoriasis and/or psoriatic arthritis regardless of whether they are receiving drugs that affect the immune system (such as methotrexate and biologic injections, for example) or not.

People who are receiving drugs which affect the immune system are not able to receive live (also known as 'attenuated') vaccines, however the Pfizer/BioNTech, Oxford AstraZeneca and Moderna vaccines are not live vaccines. Non-live vaccines can generally be given safely to people receiving drugs that affect the immune system (such as methotrexate and biologic injections, for example), however further study is required to understand how well the vaccines work in the context of these medications.

For further reassurance on this point, please refer to the British Society for Immunology statement on COVID-19 vaccines for patients who are immunocompromised or immunosuppressed.

Will a COVID-19 vaccine be effective in people who are taking immunosuppressant medication?

It is not yet known whether taking an immunosuppressant (such as methotrexate) or biologic medication reduces the effectiveness of COVID-19 vaccines. Trials to date have not included people taking drugs that affect the immune system and thus vaccine efficacy in this specific population will need to be established.

However, even a reduced response to the vaccine is better than none, so you are still advised to get vaccinated even if you are taking an immunosuppressant medication.

In July 2021, results of a study which investigated the immune response to the first dose of the Pfizer COVID-19 vaccine in people taking immunosuppressant drugs for psoriasis were published. You can find out more here.

I have been offered one of the COVID-19 vaccines - should I stop or delay my immunosuppressant or biologic medication?

The British Association of Dermatologists currently does not usually advise stopping or delaying immunosuppressant or biologic treatment before receiving the COVID-19 vaccine.

There may be situations where your doctor advises reducing or stopping your treatment - for example, if your risk of COVID-19 is high and your psoriasis or psoriatic arthritis is well-controlled and unlikely to flare up. This should be discussed with your doctor on an individual basis. Do not stop any of your treatments without first discussing with your doctor.

I am about to start taking an immunosuppressant or biologic medication for the first time - can I receive the COVID-19 vaccine?

Yes. Your doctor may offer you the COVID-19 vaccination before you start your treatment to give your immune system enough time to respond to the vaccine.

Ideally, the time between receiving your vaccine and starting treatment is at least 2 weeks. Where possible, it is also preferable for the two-dose schedule to be completed before starting treatment, which may mean that the second dose of the vaccine needs to be given at the recommended dosing interval for that particular vaccine (3-4 weeks after the first dose). However, this may not be possible depending on the severity of your psoriasis and the type of immunosuppressant or biologic medication you are about to start taking. Your doctor will discuss this with you.

https://www.psoriasis-association.org.uk/news/covid-19-vaccine-and-psoriasis

What to know about COVID-19 vaccines and psoriasis

From medicalnewstoday.com

Psoriasis is a skin condition in which dry, itchy patches of skin develop. As the treatment options for psoriasis include immunosuppressants, some people with this condition may have concerns about COVID-19 vaccination. However, current evidence suggests that the vaccines are safe and effective for those living with psoriasis, and experts recommend that they receive the vaccine as soon as it is available to them.

Psoriasis is a chronic skin condition involving an overproduction of skin cells that form plaques and scales on the skin. The symptoms can be painful, and ongoing treatment may be necessary.

Some people may have concerns that psoriasis medications could reduce the effectiveness of the vaccine or that the vaccine may cause psoriasis flares. However, no current evidence supports this. As COVID-19 can cause severe problems in people with psoriasis, expert guidance advises that people get the vaccine when it becomes available to them.

In this article, we discuss the safety and effectiveness of COVID-19 vaccinations in people living with psoriasis.

Should people with psoriasis get the vaccine?

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Both the National Psoriasis Foundation (NPF) and the Psoriasis and Psoriatic Arthritis Alliance recommend that people living with psoriasis receive the COVID-19 vaccine. Additionally, the NPF Covid-19 Task ForceTrusted Source advises that those with psoriatic disease who do not have contraindications to vaccination should receive the vaccine as soon as it becomes available to them.

People with chronic health conditions, including those with psoriasis, have a higher riskTrusted Source of severe illness if they develop COVID-19. People with psoriasis may also take medications that suppress their immune system, such as cyclosporin or methotrexate. People taking these types of medications have an increased likelihood of experiencing severe COVID-19.

COVID-19 vaccination can significantly reduceTrusted Source a person’s risk of developing the disease and experiencing severe complications. Although the vaccines may not be as effectiveTrusted Source in people with psoriasis taking immunosuppressant drugs, they are still likely to provide some degree of protection against COVID-19, which is better than none.

In some cases, it may be advisableTrusted Source for those who are moderately or severely immunocompromised to receive an additional dose. Regardless, experts recommend that people living with psoriasis undergo COVID-19 vaccination to prevent the potentially severe complications of the disease.

Vaccine effectiveness

According to the Centres for Disease Control and Prevention (CDC),Trusted Source all COVID-19 vaccines that have received approval in the United States effectively reduce the risk of COVID-19. They can help protect people from becoming sick or requiring hospitalization due to the virus. Trusted SourceThree vaccines are available in the U.S.:

• Johnson & Johnson
• Pfizer-BioNTech
• Moderna

Evidence indicates that these vaccines are effectiveTrusted Source in both clinical trial and real world settings. Although there is little evidence specifically investigating the vaccines in people with psoriasis, a 2021 article suggests that they are safe and effective for these individuals.

Vaccine safety

The CDCTrusted Source states that the COVID-19 vaccines are safe and effective. However, as with any medicine, the vaccines can cause side effects. These may includeTrusted Source:

• swelling, discoloration, and pain at the injection site
• fever
• headaches
• tiredness
• muscle pain
• chills
• nausea

Possible severe side effects include anaphylaxis in people who are allergic to a substance in the vaccine. However, the CDC states that any serious health problems are rare following the COVID-19 vaccine.

According to the NPF, there is no evidence that people with psoriasis are at an increased risk of side effects or complications due to the COVID-19 vaccination.

Psoriasis medication

Various treatments are available for treating psoriasis. Doctors will determine the right kind of treatment depending on factors that include the type and severity of psoriasis. The standard types of psoriasis medications include:

• Topical treatments: These are medications that a person applies directly to the skin. For example, a doctor may prescribe topical steroids, which can reduce inflammation of the skin.
• Phototherapy: This is a type of therapy that involves applying UV light to the skin. The treatment may take place at home or at a clinic.
• Systemic therapies: Systemic drugs can manipulate the immune system to help reduce symptoms of psoriasis.
• Complementary and integrative medications: Some people make lifestyle changes, such as following a more nutritious diet and increasing physical activity, to treat some symptoms of psoriasis.

According to the NPF, it is unclear whether psoriasis treatment reduces the effectiveness of COVID-19 vaccinations. However, due to the dosing schedule of the vaccine, the organization advises that people continue with their psoriasis treatment plan when getting the vaccine. Anyone with any concerns can discuss them with their doctor.

Will the vaccine make psoriasis worse?

There is no evidence that COVID-19 vaccination worsens psoriasis and no theory to suggest that it would.

However, illness is a potential trigger of a psoriasis flare. Due to the immunosuppressant nature of some psoriasis treatments, people taking them may have a higher risk of a potential infection and ensuing flare. As a result, doctors may recommend receiving some vaccinations, such as those against singles or pneumococcal infections, before starting a systemic therapy. However, evidence does not suggest that this applies to COVID-19 vaccines.

While some research acknowledges case reportsTrusted Source of psoriasis exacerbation after COVID-19 vaccination, experts still recommend this preventive treatment and advise people to contact their healthcare provider if they notice a flare.

Which vaccine to get?

The Johnson & Johnson, Pfizer-BioNTech, and Moderna vaccines have all received approval for use in the U.S. These vaccines are all effectiveTrusted Source in preventing COVID-19.

The NPF recommends that people with psoriasis take the first vaccine available to them because none of the vaccines are less safe or effective for people with psoriasis than they are for people without this condition.

Summary

Evidence indicates that the COVID-19 vaccines are safe and effective for people living with psoriasis. Experts advise people to get the vaccine as soon as it becomes available to them. While some research suggests that the vaccines may be less effective in immunocompromised individuals, they are still likely to provide some degree of protection.

Although the vaccines may cause some mild side effects and, in rare cases, exacerbate symptoms, they can protect people with psoriasis against severe complications from COVID-19. A person should contact their doctor about any concerns they have regarding the vaccine.

https://www.medicalnewstoday.com/articles/psoriasis-and-covid-vaccine

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

From everydayhealth.com

Psoriasis drugs that work by suppressing the body’s immune response may raise the risk of COVID-19 complications. If you’re already immunized, can a booster shot help? Here’s what to know before getting that extra jab.

In mid-August, the Centres for Disease Control and Prevention (CDC) recommended that people who have compromised immune systems get an additional dose of the COVID-19 vaccine.

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.

Here are some answers to your most pressing questions, with insights from two leading psoriasis experts.

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 co-chair 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.

Since the J&J vaccine has only been available since March 2021, the CDC is waiting for more data before making a recommendation about additional doses for people who are immune-compromised, as well as for the general population.

Preliminary data released by J&J on August 25 suggest that a booster shot could be highly protective.

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.

If I Take an Immunosuppressive Medication, Does That Mean the COVID-19 Vaccine Won’t Protect Me?

“Not necessarily,” says Gelfand. “Of the treatments commonly used for psoriasis, only methotrexate has been found to result in modest reductions in antibody response to the mRNA [messenger RNA] vaccines [from Pfizer and Moderna]. And the clinical significance of this finding is not known.”

Gelfand also notes that the U.S. Food and Drug Administration (FDA) authorized expanded use of two-dose Pfizer and Moderna vaccines on the basis of data from patients who received an organ transplant and, as a result, were significantly immunosuppressed.

Research has shown that these patients were not able to mount a significant immune response to the initial two-dose vaccine and that a third dose could help increase the amount of protective antibodies in their blood.

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.

If they are already immunized, they too will be eligible for a third shot beginning on September 20. That’s when the federal government is planning to roll out boosters for all Americans who received their second vaccine dose at least eight months prior.

https://www.everydayhealth.com/psoriasis/do-you-need-a-covid-19-vaccine-booster-if-you-have-psoriasis/