Those who prescribe biologic therapies for psoriasis are aware that patients using these agents may be at increased risk for certain infections. In the midst of the escalating COVID-19 pandemic, the International Psoriasis Council (IPC) advises physicians to be alert to the potentially harmful effects of COVID-19 infection on patients with psoriasis and counsel all their patients on how to prevent transmission of the virus. 

For psoriasis patients diagnosed with COVID-19 disease, the IPC recommends physicians discontinue or postpone use of immunosuppressant medications. The recommendation echoes established psoriasis treatment guidelines, which state immunosuppressive psoriasis treatments are contraindicated in patients with active infections. Patients who are not diagnosed with COVID-19 should continue therapy and should communicate with their physicians before making a change, according to new guidance from the AAD.

A new publication highlights the potential effect of tropical infections on patients receiving biologic therapies. Writing in the International Journal of Dermatology, Luna Azulay-Abulafia, MD, PhD and colleagues published findings from a retrospective cohort study, including 56 consecutive patients with psoriasis receiving biologic therapy between 2016 and 2018. All included patients were actively screened for arbovirus infections during the study period. Six patients (10.7 percent) presented with confirmed arbovirus infection, and the presence of arbovirus infections significantly correlated with exacerbation of psoriasis.

Three patients (75 percent) with arbovirus infection and psoriasis exacerbation were managed conservatively without discontinuing biologic therapy, the team reports. “The results of this study suggested that arbovirus infections were significantly associated with psoriasis exacerbation,” the authors conclude, and urge further study of the effects of dengue, Zika, or chikungunya infections on psoriasis in patients receiving biologic therapy.

Dr. Azulay-Abulafia says that biologic therapy does not appear to increase the risk of contracting arbovirus. “The exposure is everywhere here in Rio, particularly where my patients live,” she says. However, “[infections] worsen their psoriasis and also develop arthritis if it is the case of chikungunya.”

With her patients, Dr. Azulay-Abulafia talks, “about the risk of many other diseases, here in Rio, especially tuberculosis.” As for travelers to tropical locales? “Travelers must use repellents, of course,” she says.