PracticalDermatology

With a resurgence of cases of COVID-19 across the country, the pandemic remains a serious public health concern and continues to have considerable impact on care for patients with psoriasis. Numerous medical societies called for special caution when using immunomodulators for psoriasis treatment in the beginning of the pandemic. Initially it made sense for patients living with psoriasis to delay routine visits. However, everyone is now adjusting to the “new normal.” Dermatology offices are operating differently, with reduced patient schedules and increased cleaning and disinfecting of surfaces, making it safer for all of our patients to come in.

Helping psoriasis patients optimize care during the pandemic

Emerging data from the global PsoProtect registry show that patients who are taking biologics or traditional immunosuppressants have high rates of survival from COVID-19.¹ The study found that risk factors for COVID-19 infection for psoriasis patients were similar to those for the general population. Specifically, patients who were older, male, of non-white ethnicity and with other health conditions, such as chronic lung disease, were more likely to require hospital admission for their COVID-19 infection. In fact, psoriasis patients treated with biologics had a lower risk of being hospitalized due to COVID-19 than those treated with non-biologic systemic therapies. These results have important implications for treatment decisions regarding the management of psoriasis patients and suggest that the decision to start or continue systemic therapy can be made independently of the COVID-19 pandemic.

As the US begins to distribute a COVID-19 vaccine, the International Psoriasis Council (IPC) released guidance suggesting that the vaccine will be safe for psoriasis patients who do not have a contraindication or a known allergy to a vaccine component.² “We anticipate that most patients with psoriasis who do not have a contraindication or a known allergy to a vaccine component will be recommended to receive one of these SARS-CoV-2 vaccines as soon as possible based on local availability and guidance from local public health bodies,” the IPC stated.

Considering Lifestyle Modification

The medical community is continuing to understand the interaction of COVID-19 infection, psoriasis, and its treatments, and there has never been a better time to encourage psoriasis patients to embrace healthier habits to optimize their health.

Here are our top five lifestyle recommendations.

1. Diet. While no diet will cure psoriatic disease, there are many ways in which eating healthful foods may reduce the severity of symptoms and lower the risk of comorbidities. A low-calorie diet and/or so-called Mediterranean diet characterized by a high proportion of fruits, vegetables, legumes, cereals, breads, fish, nuts, and extra-virgin olive oil with low-to-moderate consumption of meat, dairy, eggs, and alcohol can decrease the severity of psoriasis.³ This is likely due to the anti-inflammatory properties of dietary fiber, antioxidants, and polyphenols found in the Mediterranean diet.

2. Exercise. It is important to stay active. Increased BMI and weight gain are risk factors for psoriasis and possibly COVID-19. Overweight/obese patients with moderate-to-severe plaque psoriasis who were given dietary and physical exercise plans for weight loss achieved a PASI reduction of 48 percent, compared to 25.5 percent reduction in the group who received simple informative counseling alone.⁴ Walking is a great way to keep in shape, maintain a healthy lifestyle, decrease blood pressure, improve cardiovascular health and even reduce depression and anxiety.

3. Mindfulness. Psychological and emotional stress have been consistently implicated by patients as potential triggers in the onset and/or exacerbation of psoriasis. Psoriasis itself also causes stress—increasing levels of depression and anxiety. With the current pandemic, there is even more uncertainty about our physical, social, and financial security. Feeling anxious, fearful, and/or frustrated are all normal and natural reactions to this abnormal situation and mindfulness—paying attention to the here and now—can help patients acknowledge this situation and remain calm.

4.Probiotics. Oral administration of probiotics such as B. infantis (10 million CFU) reduced plasma TNF-a in psoriatic patients demonstrating that the immunomodulatory effects of the microbiome may extend to the systemic immune system.⁵

5.Turmeric. Turmeric powder (a spice commonly used in Asian foods) contains curcumin, which is a complementary therapy that may be helpful for the treatment of psoriasis due to its anti-inflammatory, antiangiogenic, antioxidant, and antiproliferative effects. In 2015, a study comparing the effectiveness of lecithin-delivered curcumin with topical steroids vs. topical steroids alone, the curcumin plus steroids group achieved higher PASI reduction and significantly reduced IL-22 serum levels. Adding two teaspoons of turmeric powder along with black pepper to improve the bioavailability may be an adjuvant therapy for treatment of psoriasis.⁶

Seeking Control

There’s no doubt that the coronavirus pandemic has changed the way we live.

While there are certainly many changes that we are not in control of, adopting new healthy lifestyle habits during this challenging time can give you and your patients some kind of control over life.

1. Mahil SK, Dand N, Mason KJ, et al. Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry-based study. J Allergy Clin Immunol. 2020 Oct 16:S0091-6749(20)31413-5. Epub

2. International Psoriasis Council .” IPC Statement On SARS-CoV-2 Vaccines And Psoriasis.” https://www.prnewswire.com/in/news-releases/ipc-statement-on-sars-cov-2-vaccines-and-psoriasis-885562032.html

3. Phan C, Touvier M, Kesse-Guyot E, et al. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. JAMA Dermatol. 2018;154(9):1017-1024.

4. Naldi L, Conti A, Cazzaniga S, et al. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol. 2014 Mar;170(3):634-42.

5. Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013;4(4):325-339.

6. Antiga E, Bonciolini V, Volpi W, et al. “Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris”, BioMed Research International, 2015, Article ID 283634.