Psoriasis and infection. A clinical practice narrative

Abstract

The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on risk assessment for that patient, taking into account the infection being treated, the risk of recurrent infection, any interventions that can modify the risk and the need for psoriasis control. Live vaccines (e.g. MMR, varicella, zoster and yellow fever) are generally contraindicated in patients with psoriasis on immune-modulatory agents, but this depends on the degree of immune suppression and individual risk factors. Wound healing in psoriasis is normal. Treatment with infliximab, adalimumab, etanercept, methotrexate and ciclosporin can safely be continued through low-risk surgical procedures. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.

Psoriasis Patients Suffer From Worse Periodontal Status—A Meta-Analysis

“…For example, P. gingivalis can colonize the brain and play a central role in the pathogenesis of Alzheimer's disease (34). Infections are also well-known triggers for psoriasis (6, 35). More importantly, there have been studies that have shown an increased concentration of bacterial DNA in the synovial fluid of patients with psoriatic arthritis compared to controls (36).…”

“…It is a common disease affecting 0.4–4% of the general population (3, 4). However, the exact cause of psoriasis is unclear, and it is generally believed that genetic factors, environmental risk factors and infections play important roles (5, 6). More importantly, no cure is available for psoriasis at present, and it may last lifelong, which may have a negative impact on the quality of life of the affected people.…”

COVID‐19 and the use of immunomodulatory and biologic agents for severe cutaneous disease: An Australian/New Zealand consensus statement

“…severe psoriasis) are inherently at increased risk of developing pneumonias, of any cause. 17 Furthermore, discontinuation of biologic therapy may result in a loss of treatment response when rechallenged and/or development of drug antibodies. If cessation of a biologic is being considered due to the pandemic, patients should be unambiguously counselled on the aforementioned risks.…”

Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations

“…Of special importance is the possible impact of this pandemic in the management of patients with chronic inflammatory conditions of the skin due to the interruption of activities at many dermatology clinics. This type of patients might also be at higher risk for SARS-CoV-2 infection, as demonstrated before in the case of patients with psoriasis, which is a condition independently associated with an increased risk of serious infections [80]. A special attention should be paid to patients under biological therapies for inflammatory cutaneous disorders [85,116], such as those receiving anti-tumor necrosis factor therapy.…”