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People with severe psoriasis, especially those who are on immunosuppressive therapies or have other medical conditions, are likely to face a higher risk of COVID-19 infection and severe symptoms. On World Psoriasis Day, experts discuss the impact of COVID-19 in patients with psoriasis.
Psoriasis is a chronic skin condition that causes red, itchy scaly patches, usually on the knees, elbows, trunk and scalp. It commonly affects individuals in their third or fourth decade with males being affected 2 times more common than females. The prevalence of psoriasis in India is estimated to be around 0.44-2.8 per cent, ENTOD Pharmaceuticals noted in a press release.
The International Psoriasis Council (IPC) recommends that psoriasis patients who are diagnosed with COVID-19 discuss with their doctor about discontinuing or postponing their use of immunosuppressant medications. However, the IPC also recommends that doctors need to carefully weigh the benefit-to-risk ratio of immunosuppressive treatments on an individual basis. It doesn't advise stopping the medications unless there is an active infection.
Nikkhil K Masurkar, Executive Director of ENTOD Pharmaceuticals, said, "It is presently unknown whether psoriasis increases the risk of contracting COVID-19 virus. It's also currently unclear if having psoriasis increases the risk of having a more severe case of COVID-19. However, there are some factors like age and underlying health conditions like heart diseases, obesity, type 2 diabetes, chronic kidney disease and others that can increase the risk of severe illness or complications if one contracts coronavirus and do develop COVID-19."
People with psoriasis usually take medications that can suppress the immune system. Commonly used immunosuppressive therapies for psoriasis include conventional immunosuppressive therapy that makes use of drugs like methotrexate and cyclosporine and Biologic therapy. In Biologic therapy, drugs are used to target and suppress very specific parts of the immune system associated with psoriasis symptoms. As a result, such patients may become more susceptible to certain infections.
However, scientists are still unclear about the overall effect of immunosuppressive drugs on the risk of developing serious COVID-19 illness. A recent study revealed that the overall rate of hospitalization for individuals taking immunosuppressive drugs like methotrexate and biologics was similar to that of the general population. More research and clinical trials are underway to address this very topic.
Psoriasis is an autoimmune disease in which the risk for diabetes, hypertension, chronic lung disease, cardiovascular disease and premature mortality increases with increasing severity of skin disease. "Therefore, as a population, patients with psoriasis, especially those with more severe disease, are at risk for worse outcomes from COVID-19," said Dr. Shweta Rajput, MBBS DDV, Disha Skin Institute, Thane West, Medical Consultant, ENTOD Pharmaceuticals.
"What we do not know about psoriasis treatment and the risk for COVID-19 far outweighs what we do know currently. One model about COVID-19 is that immunosuppression is harmful during the early phases, making a person more susceptible to and at risk for progression of infection with SARS-CoV-2, but immunosuppression may be helpful later in the course of the illness by suppressing the dysregulated immune response in the lungs which can cause acute respiratory distress syndrome and death," she added.
There's no specific treatment for coronavirus. So, it is best to reduce the risk of contracting the disease by maintaining physical distance from others, avoiding unnecessary public outings, and practicing good hygiene, the experts noted.
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