Children with psoriasis and COVID‐19: factors associated with an unfavourable COVID‐19 course, and the impact of infection on disease progression (Chi‐PsoCov registry)

Abstract

Background The COVID‐19 pandemic has raised questions regarding the management of chronic skin diseases, especially in patients on systemic treatments. Data concerning the use of biologics in adults with psoriasis are reassuring, but data specific to children are missing. Moreover, COVID‐19 could impact the course of psoriasis in children. Objectives The aim of this study was therefore to assess the impact of COVID‐19 on the psoriasis of children, and the severity of the infection in relation to systemic treatments. Methods We set up an international registry of paediatric psoriasis patients. Children were included if they were under 18 years of age, had a history of psoriasis, or developed it within 1 month of COVID‐19 and had COVID‐19 with or without symptoms. Results One hundred and twenty episodes of COVID‐19 in 117 children (mean age: 12.4 years) were reported. The main clinical form of psoriasis was plaque type (69.4%). Most children were without systemic treatment (54.2%); 33 (28.3%) were on biologic therapies, and 24 (20%) on non‐biologic systemic drugs. COVID‐19 was confirmed in 106 children (88.3%) and 3 children had two COVID‐19 infections each. COVID‐19 was symptomatic for 75 children (62.5%) with a mean duration of 6.5 days, significantly longer for children on non‐biologic systemic treatments ( P = 0.02) and without systemic treatment ( P = 0.006) when compared with children on biologics. The six children who required hospitalization were more frequently under non‐biologic systemic treatment when compared with the other children ( P = 0.01), and particularly under methotrexate ( P = 0.03). After COVID‐19, the psoriasis worsened in 17 cases (15.2%). Nine children (8%) developed a psoriasis in the month following COVID‐19, mainly a guttate form ( P = 0.01). Discussion Biologics appear to be safe with no increased risk of severe form of COVID‐19 in children with psoriasis. COVID‐19 was responsible for the development of psoriasis or the worsening of a known psoriasis for some children.

COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID‐19?

“…26 While monoclonal antibodies such as rituximab can lead to hypogammaglobulinemia and consequently impaired humoral response against SARS-CoV-2, resulted in severe forms of infection, increased hospitalization, ICU admission and mortality, 27,28 some authors believe in even protective effect of biologic therapeutics on COVID-19 outcome. 29,30 It has been shown that cytokine storm following an excessive stimulation of immune system has an important role in predicting the severity and prognosis of COVID-19. 31 Thus, suppressing this over-activation of immune system by the use of biologic agents would be resulted in a milder benign clinical course of disease.…”

Psoriasis in children and adolescents

“…Auch Virusinfektionen können eine Psoriasis triggern. Als „neueste“ wird die SARS-CoV-2-Infektion vermutet, die laut Daten eines internationalen Registers von Kindern und Jugendlichen mit Psoriasis bei 8 % der Fälle innerhalb eines Monats nach Infektion zur Erstmanifestation und bei 15 % zur Verschlechterung der Erkrankung führte [ 31 ].…”

Coronavirus disease 2019 (COVID-19) in pediatric patients with autoimmune disorders

“…In 17 patients (15.2%) after COVID-19, psoriasis got worse. In the month after COVID-19, nine children (8%) developed psoriasis (P = 0.01) [ 192 ]. The COVID-19 treatment course in psoriasis patients of all ages has been evaluated by the PsoProtect registry.…”

“…Biologic treatment for psoriasis in children does not seem to increase their chance of getting COVID-19 severe. For some, COVID-19 caused psoriasis to develop or worsen in people who already had it [ 192 ].…”