Psoriasis and COVID 19: A narrative review with treatment considerations

Elmas, Ömer Faruk; DemirbaŞ, Abdullah; Kutlu, Ömer; BaĞcıer, Fatih; Metin, Mahmut Sami; Özyurt, Kemal; Akdeniz, Necmettin; Atasoy, Mustafa; Türsen, Ümit; Lotti, Torello

COVID‐19 is a highly contagious respiratory infection caused by severe acute respiratory syndrome coronavirus 2. COVID‐19 outbreak, has been declared a pandemic by the World Health Organization on March, 2020. The pandemic has affected the management of psoriasis, not only for those who are under treatment but also for those who are about to begin a new therapy to control their disease. An increasing number of studies in the current literature have focused on the relationship between psoriasis and COVID 19 from different perspectives. This narrative review includes searching the PubMed and Web of Science databases using the keywords "psoriasis,”, “psoriatic arthritis”, "coronavirus", "COVID 19" and "SARS‐Cov‐2". The search was supplemented by manual searching of reference lists of included articles. A total of 11 relevant original investigations and 6 case studies was identified. The search was updated in May 2019. Due to the absence of randomized controlled trials, it is not likely to have a robust evidence‐based approach to psoriasis management in the era of COVID‐19. However, current literature may provide some clues for safety considerations. Conventional immunosuppressive therapies such as methotrexate and cyclosporine, and anti TNF agents should not be preferred due to increased risk of infection, especially in high‐risk areas. The use of cyclosporine may pose additional risk due to the side effect of hypertension, which has been reported to be associated with susceptibility to severe COVID‐19. Considering that current literature has provide no conclusive evidence that biologics increase the risk of COVID‐19, withdrawal of these agents should be reserved for patients with COVID 19 symptoms. The treatment approach should be personalized, considering the advantages and disadvantages for each case separately. This article is protected by copyright. All rights reserved.