Advice regarding COVID‐19 and use of immunomodulators, in patients with severe dermatological diseases

Rademaker, Marius; Baker, Christopher; Foley, Peter; Sullivan, John; Wang, Charlie C. L.

doi:10.1111/ajd.13295

Cited by 32 publications

(49 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, there are some who recommend increasing the dose of corticosteroids in case of physiological stress caused by COVID‐19 infection, acute respiratory distress syndrome or another serious infection 12 . In cases, where their use may not be discontinued, the dose can be reduced to below 10 mg/day instead 13 . If the patient uses more than one immunosuppressive agents, it would be appropriate to at least discontinue the medications other than corticosteroids.…”

Section: Infection Risk In Immunomodulators and Immunosuppressants Usmentioning

confidence: 99%

See 1 more Smart Citation

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

Karadağ

Kayıran

Lotti

et al. 2020

Dermatologic Therapy

View full text Add to dashboard Cite

Immunosuppressive and immunomodulatory therapies are important in dermatology, but indications are influenced by SARS-CoV-2. We will focus on skin disorders such as autoimmune connective tissue disorders, neutrophilic dermatoses, and vasculitis. Immunomodulators such as colchicine and antimalarials can easily be preferred taking their beneficial effects on COVID-19 into consideration and also given their wide spectrum of action. Among the conventional therapies, methotrexate, azathioprine, and mycophenolate mofetil increase the risk of infection, and thus their use is recommended only when necessary and at low doses. On the other hand, use of cyclosporine is also not recommended as it increases the risk of hypertension, which is susceptible to COVID-19. Anti-TNF agents from among the biological therapies appear to be slightly risky in terms of susceptibility to infection. However, there are ongoing studies which suggest that some biological treatments may reduce cytokine storm impeding the COVID-19 progression as a result, in spite of their susceptibilities to COVID-19. Patients, who will be started on immunosuppressive therapy, should be tested for COVID-19 prior to the therapy, and in the event that COVID-19 is suspected, the therapy should be discontinued.

show abstract

Section: Infection Risk In Immunomodulators and Immunosuppressants Usmentioning

confidence: 99%

“…Therefore, it may not be very wise to start its administration in new patients during this period. When cyclosporine use is deemed necessary, it is recommended to reduce its dose down to 1 mg/kg/day and below 13 …”

Section: Infection Risk In Immunomodulators and Immunosuppressants Usmentioning

confidence: 99%

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

Karadağ

Kayıran

Lotti

et al. 2020

Dermatologic Therapy

View full text Add to dashboard Cite

show abstract

“…Up to now, cutaneous manifestations of Covid‐19 reports published in periodicals indexed in PubMed using the terms ‘cutaneous’ or ‘skin’ refer to economic impact, protective measures for the integumentary system during Covid‐19 exposure, dermatological medical education and care during this pandemic disease, the use of immunomodulators, 1 immunosuppressors and immunobiological agents in dermatology in rheumatology skin conditions, and skin damage among healthcare workers during the pandemic 3‐19 …”

Section: Introductionmentioning

confidence: 99%

Lessons from dermatology about inflammatory responses in Covid‐19

Criado

Pagliari

Carneiro

et al. 2020

Reviews in Medical Virology

View full text Add to dashboard Cite

Summary The SARS‐Cov‐2 is a single‐stranded RNA virus composed of 16 non‐structural proteins (NSP 1‐16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid‐19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid‐19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a ‘cytokine storm’. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D‐dimer, lactic dehydrogenase, reactive‐C‐protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug‐related intertriginous and flexural exanthema. This review describes the complexity of Covid‐19, its pathophysiological and clinical aspects.

show abstract

“…Note that systemic corticosteroids are part of many ARDS protocols, but are not currently recommended for SARS-CoV-2 infection, as there is weak evidence of harm when used in Influenza-associated ARDS. 24 Therefore, long-term use of high dosages during the pandemic should be avoided and, if reduction of corticosteroid therapy is indicated to mitigate infection risk during the pandemic, a graduated reduction is advised, aiming for a dose of ≤10 mg of predniso(lo)ne or equivalent. 22 We also recommend to temporary stop IMT in case of confirmed exposure to COVID-19, as it had been suggested for other previous pandemics.…”

mentioning

confidence: 99%

Active implications for dermatologists in ‘SARS‐CoV‐2 ERA’: Personal experience and review of literature

Campanati

Brisigotti

Diotallevi

et al. 2020

Acad Dermatol Venereol

View full text Add to dashboard Cite

On 31 December 2019 from the Chinese city of Wuhan, Hubei, comes the first case of 'atypical ARDS/interstitial pneumonia'. On 11 February 2020, the WHO officially announced the name of the emergent disease associated with new coronavirus identified as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): COVID-19 (Coronavirus Disease 2019). 1 On 13 February, 72 000 cases have been officially recorded in China, among which 15 000 were registered in Hubei province only, with 242 deaths in a single day. After that, Chinese republic has ordered drastic containment measures for fighting SARS-CoV-2 virus spreading. 1 On 11 March 2020, the World Health Organization (WHO) stated that the international outbreak of SARS-CoV-2 new coronavirus infection had to be considered a pandemic. 2 To date, 14 April 2020, 213 countries are affected worldwide with 1 812 734 confirmed cases and 113 675 deaths worldwide since the epidemic outbreak. 3 In this scenario, probably the most important strategic goal for dermatologists is to assess what their active involvement in this global pandemic might be. For this reason, our goal is to provide the 'state of the art' on this topic. Our personal experience, and a full extensive review of literature, led us to focus our attention on several topics in the management of dermatological patients during the SARS-CoV-2 pandemic, and four main topics have been identified. They are: (ⅰ) cutaneous manifestations related to COVID-19, (ⅰⅰ) the implications of SARS-CoV-2 infection for use of biological drugs and other immunosuppressive and immunomodulatory therapies in dermatological patients, (ⅰⅰⅰ) occupational skin diseases related to hygienic washing and use of personal protective equipment (PPE) to avoid SARS-CoV-2 infection among patients and clinicians, and (iv) strategic implications in planning dermatological clinical assistance to population during SARS-CoV-2 pandemic. Skin manifestations due to SARS-CoV-2 infection are different and often underestimated, since the general conditions of patients are critical, as in several cases of hospitalized COVID-19. However, the most common symptoms of COVID-19 disease are reported in Table 1. Validated studies encompassing a sufficiently large number of patients to fully describe the most frequent ongoing skin manifestations of COVID-19 are not yet available. However, many Myalgia or arthralgia 164 (14.9) Chills 126 (11.5)

show abstract

Advice regarding COVID‐19 and use of immunomodulators, in patients with severe dermatological diseases

Cited by 32 publications

References 3 publications

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

Lessons from dermatology about inflammatory responses in Covid‐19

Active implications for dermatologists in ‘SARS‐CoV‐2 ERA’: Personal experience and review of literature

Contact Info

Product

Resources

About