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

Abstract

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.

Management of patients with Behçet's disease during the COVID ‐19 pandemic

“…During this period, it is recommended to reduce its dose to below 0.5 mg/kg/ day. 12 We reduced the azathioprine doses in seven of our patients in line with the recommendations.…”

“…7 Discussions continue about the use of these treatments during the COVID-19 pandemic period. 4,12 It is known that the risk of upper respiratory infections increases with the use of these agents. This condition can be a risk for the pandemic period.…”

Psoriasis andCOVID‐19: A narrative review with treatment considerations

“…However, the main adverse effects of cyclosporine, such as hypertension and renal dysfunction, may pose more severe risks for patients contracted COVID‐19. It should be noted that patients with hypertension are more prone to develop severe COVID‐19 infection 23 . Unexpectedly, Wilde reported that cyclosporine strongly inhibits in vitro replication of MERS‐coronavirus, while its in vivo effects remain unknown 24 …”

“…It should be noted that patients with hypertension are more prone to develop severe COVID-19 infection. 23 Unexpectedly, Wilde reported that cyclosporine strongly inhibits in vitro replication of MERS-coronavirus, while its in vivo effects remain unknown. 24 Despite the impact of these immunosuppressive agents on the course of COVID-19 is clearly unknown, several dermatology societies have recommended to withdrawn or suspend immunosuppressive treatments in the case of COVID-19 diagnosis until the patient recovers from the infection.…”

Autoimmune connective tissue diseases in the COVID-19 pandemic

“…If not responsive to CS, switch to IVIG, anakinra, cyclosporine, or adalimumab. 70 Scleroderma Avoid systemic CS, MTX. Discontinue biologics if possible.…”