First published on Thursday 5th March 2020, LAST UPDATED on Thursday 21st May 2020.
Information for people living with psoriasis and psoriatic arthritis, including those taking immunosuppressive medicines
For the most up-to-date advice on COVID-19 (Coronavirus), you should read the guidance on the NHS website.
- Video - Professor Chris Griffiths on COVID-19 and psoriasis
- Resource - Hints and tips for coping well with the COVID-19 pandemic from Professor Chris Bundy
- Am I at higher risk of catching COVID-19 if I have psoriasis?
- What about if I take immunosuppressant medication?
- How can I lower the risk of catching COVID-19?
- What is 'shielding' and does this apply to me?
- What if frequent handwashing irritates my psoriasis?
- Guidance on face coverings and avoiding irritation of psoriasis
- What research is taking place? Introducing PsoProtect & PsoProtectMe
- Resource - Eating well during this challenging time
- Reporting suspected side effects from medicines
- Useful resources
Video - Professor Chris Griffiths on COVID-19 and psoriasis
The current situation with COVID-19 (coronavirus) has created a significant amount of uncertainty for us all. Now more than ever, access to clear and accurate information is vital to help us to make informed decisions about our own health and wellbeing. With that in mind, we're honoured to bring you information from a world-leading psoriasis expert, Professor Chris Griffiths (Professor of Dermatology at the University of Manchester and Honorary Consultant Dermatologist at Salford Royal NHS Foundation Trust).
In the video below, our Chief Executive, Helen McAteer, puts some of your most frequently asked questions about psoriasis and COVID-19 to Professor Griffiths.
Please note that the information in this video is correct as of 30th March 2020.
Resource - Hints and tips for coping well with the COVID-19 pandemic
With the current Coronavirus outbreak dominating the headlines it is not surprising that people are feeling anxious and worried about what may happen next. For some people with psoriasis, stress can make the condition flare, so looking after your psychological wellbeing is as important as caring for your physical health.
With this in mind, we have teamed up with Professor Chris Bundy (Professor in Behavioural Medicine at Cardiff University) to create a resource for people living with psoriasis and psoriatic arthritis on how to manage their worry about their condition and its treatment, as well as their concerns about COVID-19.
The tips cover a range of topics including managing your worry, expressing worry and anxiety, coping with isolation and when to access help and support. There is also a daily schedule, to help people to structure their day and stay engaged and active whilst spending more time at home.
Click below to access the relevant documents;
Hints and tips for people with psoriasis and psoriatic arthritis
Am I at higher risk of catching COVID-19 if I have psoriasis?
There is currently
no evidence to suggest that people with psoriasis are at any more or less risk
of catching COVID-19 than the rest of the population. As such, you should
follow the same precautions as issued by the NHS.
What about if I take immunosuppressant medication?
As far as we are aware, if you take an immunosuppressant medication (e.g. methotrexate and ciclosporin) or biologics to treat your psoriasis or psoriatic arthritis, you may be at extra risk of complications from the virus if you are infected. The specific risk for each individual depends on a number of factors, including: which immunosuppressant medications you are taking; whether you are taking just one of these medications, or more than one; and whether you are also living with other medical issues. You can find out more in our 'shielding' section.
It is not necessary for you to stop taking your systemic/biologic medication unless specifically told to do so by your prescriber (e.g. dermatologist, rheumatologist, or biologics nurse), and actually to do so could cause a flare in your condition.
If you do have concerns about continuing your medication, you should speak to your prescriber about the risks and benefits before deciding whether or not to stop your treatment.
If you are taking an immunosuppressant medication for psoriasis and/or psoriatic arthritis, and you do develop the symptoms of an infection or virus (such as a high temperature, a new, continuous cough, or loss or change to your sense of smell or taste) you should follow the latest NHS advice and consult your prescriber on whether or not to continue taking your medication.
If at any stage you do need to seek treatment for the symptoms of COVID-19, it is a good idea to make a note of the different medicines you take and the different conditions that you have, and give this to the healthcare staff who are treating you.
The following guidelines from the National Institute for Health and Care Excellence (NICE) and the Scottish Government may be helpful for reference. They are based on the latest evidence and expert opinion, and have been verified as far as possible.
From the National Institute for Health and Care Excellence (NICE):
COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response
COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders
COVID-19 rapid guideline: children and young people who are immunocompromised
From the Scottish Government:
Coronavirus (COVID-19) – Important advice for people with dermatological conditions (not cancerous)
Coronavirus (COVID-19) – Important advice for people with rheumatic conditions
How can I lower the risk of catching COVID-19?
For the most up-to-date advice on COVID-19 (Coronavirus), you should read the following guidance from:
According to the latest NHS guidance, to stop the spread of coronavirus (COVID-19), you should try to avoid close contact with anyone you do not live with. This is called social distancing.
It's very important to stay at home as much as possible. There are only a few specific reasons to leave your home, including:
- For work, if you cannot work from home
- Going to shops to get things like food and medicine, or to collect things you've ordered
- To exercise or spend time outdoors
- For any medical reason, to donate blood, avoid injury or illness, escape risk of harm, provide care or help a vulnerable person
When outside your home, it's important to try to stay 2 metres (3 steps) away from anyone you do not live with.
For more detailed information about when you can leave your home, please refer to the UK Government's full guidance on social distancing.
There is separate advice about:
What to do if you're at very high risk from coronavirus (extremely vulnerable)
To stop COVID-19 from spreading, you should:
Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel.
Wash your hands with soap and water often (for at least 20 seconds), especially after getting home, into work or using public transport.
Use a sanitiser gel if soap and water are not available. Emollients can be applied following hand sanitiser use if necessary.
Avoid touching your eyes, nose and mouth with unwashed hands.
Avoid close contact with anyone outside of your household (ensure you are at least 2 metres apart)
Avoid non-essential use of public transport.
If you can, wear something that covers your nose and mouth when it's hard to stay away from people, such as on public transport.
Work from home, if you can.
Avoid gatherings of friends and family, and instead stay in touch using remote technology such as phone, via messaging or over social media.
Use the phone or online services to get in touch with your GP or other NHS services.
What is 'shielding' and does this apply to me?
'Shielding' is a measure which is intended to protect people who are deemed to be 'extremely vulnerable' to severe illness and hospitalisation from COVID-19 by minimising their interaction with others. If you fall into this ‘extremely vulnerable' category, you should have been contacted directly by the NHS, advised to stay at home for a period of at least 12 weeks (until 30th June 2020) and avoid any face-to-face contact with others.
If you are only taking a single medication that affects your immune system and have no other medical issues, it is unlikely that you will fall into the ‘extremely vulnerable’ category requiring shielding, but very careful social distancing is advised.
We have put together the following information to help make it clearer for people who are living with psoriasis or psoriatic arthritis whether or not they fall into this ‘extremely vulnerable’ category. If you think you fall into the 'extremely vulnerable' category but you have not received a letter or been contacted by your GP, you should discuss your concerns with your GP or hospital clinician.
In psoriasis and psoriatic arthritis, people who will be advised to 'shield' for 12 weeks are:
- Those who have the comorbidities listed by NHS England in addition to their psoriasis or psoriatic arthritis, including being aged 70+, Diabetes Mellitus, pregnancy, any pre-existing lung disease (e.g. asthma on medication), chronic kidney disease, any history of Ischaemic Heart Disease or hypertension or other factor deemed to be risk factors by the supervising doctor, OR;
- People who are taking TWO or more immunosuppressive or biologic medicines (please see the list below) for their psoriasis and psoriatic arthritis (except a single biologic in combination with methotrexate, hydroxychloroquine or sulphasalazine).
- People who take either Infliximab originator (Remicade) or biosimilars (e.g. Flixabi, Inflectra, Remsima, Zessly), which are given by infusion.
- People who take ONE immunosuppressive or biologic medicine (or a biologic combined with methotrexate, hydroxychloroquine or sulphasalazine) who are ALSO over the age of 70 or pregnant or have another medical problem.
'Extremely vulnerable' - Definite high risk – to be advised to definitely 'shield':
You will be asked to 'shield' if you take either Infliximab originator (Remicade) or biosimilars (e.g. Flixabi, Inflectra, Remsima, Zessly).
You will also be asked to 'shield' if you are taking any TWO drugs from the following classes (except a single biologic in combination with methotrexate, hydroxychloroquine or sulphasalazine):
- Immunosuppressive medications: Ciclosporin, Fumaric Acid Esters (FAE, Fumaderm and Skilarence – Dimethyl Fumarate), Leflunomide, Methotrexate. This does NOT include Acitretin or Sulphasalazine.
- Biologics: Any Adalimumab biosimilar (e.g. Amgevita, Hulio, Hyrimoz, Imraldi) or Adalimumab originator (Humira), Anakinra (Kineret), Cimzia (Certolizumab pegol), Cosentyx (Secukinumab), Etanercept originator (Enbrel) or Etanercept biosimilars (e.g. Benepali, Erelzi), Ilumetri (Tildrakizumab), Kyntheum (Brodalumab), Infliximab originator (Remicade) or Infliximab biosimilar (e.g. Flixabi, Inflectra, Remsima, Zessly), Simponi (Golimumab), Skyrizi (Risankizumab), Stelara (Ustekinumab), Taltz (Ixekizumab), Tremfya (Guselkumab)
- Small molecule immunosuppressants: Otezla (Apremilast), JAK inhibitors e.g. Xeljanz (Tofacitinib)
'Vulnerable' - Very careful social distancing is advised - Advised to 'shield' only if there are other concerns, high-risk circumstances or comorbidities (to be decided by your clinician):
You will be asked to 'shield' if you meet any of the following criteria AND you are recommended to do so by your clinician:
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking only ONE of the following: an immunosuppressive medication, a biologic, or a small molecule immunosuppressant (please see the list above for specific examples).
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking ONE biologic (see list above) in combination with methotrexate.
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking ONE immunosuppressive medication (see list above) plus Hydroxychloroquine or Sulphasalazine.
No need to 'shield' but should still follow social distancing mesaures:
There is no need to 'shield', but you must continue to follow the latest NHS advice, including social distancing measures, as per the rest of the UK population, if you are taking any of the following medications, either alone or in combination:
- Topical skin treatments (creams, gels etc.)
The British Association of Dermatologists have put together a useful FAQ section here that includes the following examples:
Examples of the type of patient who would NOT be advised to self-isolate are:
- A person with hidradenitis on Humira (adalimumab) who is 45 and has none of the described comorbidities.
- A person who is 50, on methotrexate up to 25 mg per week, and Humira (adalimumab).
- A person who is 57, on hydroxychloroquine and mycophenolate mofetil and has no other comorbidities.
Examples of the type of patient who WOULD be advised to self-isolate
- A person on any single agent biologic - e.g. you are only using one biologic such as Humira (Adalimumab) or Cosentyx (Secukinumab) at a standard dose, who is more than 70 years old.
- A person on any single agent biologic at a standard dose, who is on medication for hypertension or diabetes or asthma or Ischaemic Heart Disease, or who is pregnant.
- A person on a single agent biologic at a standard dose, with renal (kidney) impairment.
- A person on a single agent biologic at a standard dose, and up to 25mg weekly of methotrexate, who develops any medical problems described in the above three points.
Guy's and St Thomas' NHS Foundation Trust have also put together some Dermatology and coronavirus frequently asked questions. These include a number of FAQs specifically about immunosuppressant medications, social distancing, shielding, and a handy self-assessment risk calculator. Please note, while this resource contains really useful information for everyone, please only contact Guy's and St Thomas' if you are already one of their patients.
If you have psoriatic arthritis, you may also find this risk stratification guide from the British Society for Rheumatology useful if you are taking an immunosuppressant medication and you are unsure whether or not you fall into the 'extremely vulnerable' category requiring 'shielding'.
NHS England has produced FAQs for people at highest clinical risk from COVID-19.
Finally, full guidance on shielding to protect 'extremely vulnerable' people can be found here:
- Public Health England guidance (England)
- Northern Ireland Executive guidance (Northern Ireland)
- Scottish Government guidance (Scotland)
- Welsh Government guidance (Wales)
What if frequent handwashing irritates my psoriasis?
Unfortunately it is likely that increased handwashing will have an impact on people with psoriasis on their hands. In order to minimise this impact, we have compiled the advice below;
Wash hands with soap and water, then re-wash with an emollient soap substitute
You should follow government guidance and wash your hands regularly with soap and water for 20 seconds. You may find it helpful to wash them a second time with an emollient soap substitute to help moisturise the skin and prevent it from drying and cracking. A list of soap substitutes or emollient cleaners can be obtained from the Psoriasis Association.
Dry hands gently, and moisturise them afterwards.
Keep tubes of moisturiser by the sink at home, as well as in your handbag or pocket.
Wear cotton gloves with moisturiser at night
Cotton gloves can help moisturiser to penetrate the skin and work more effectively, so consider purchasing a pair and wearing at night, or whilst at home.
Use gloves when washing up
Use plastic or rubber gloves with cotton linings when doing the washing up or hand washing clothes, this will help to prevent unnecessary drying resulting from activities other than washing your hands.
Wear gloves during cold weather
Wear warm gloves when you go out in cold weather, as the cold can be particularly drying to the skin.
Wearing rings, watches and other jewellery may aggravate your skin if your psoriasis is already sore from handwashing. Try removing your jewellery for a few days, and see what effect (if any) this has.
Handwashing instructions from the NHS can be found here.
Guidance on face coverings and avoiding irritation of psoriasis
As part of the gradual changes in lockdown restrictions, people in England are now being recommended to wear face coverings in a number of enclosed spaces. In particular, face coverings are advised in areas where you come into contact with people that you do not normally meet and where social distancing is not possible, for example on public transport or in some shops. Similar recommendations have also been made by the Northern Ireland Executive and Scottish Government. At the time of writing, the Chief Medical Officer for Wales is not recommending face coverings but is supportive of the public’s right to choose whether or not to wear them.
Why are we being advised to wear a face covering?
While evidence suggests that face coverings will not protect you against COVID-19, they may help protect others if you are infected but do not know it. Please note that face coverings do not replace social distancing and if you have symptoms of COVID-19 your whole household must stay at home.
Children under the age of 2 or individuals who find it difficult to wear face coverings, such as people with breathing difficulties or primary school children who cannot use a covering without help, are not advised to wear them.
Wearing a face covering
A face covering can simply be a scarf or bandana tied behind your head – the most important thing is that it covers your nose and mouth but allows you to breathe comfortably. The government has provided advice on how to wear and make your own face covering, which can be found here.
Face coverings and psoriasis
If you feel that your face covering is irritating your psoriasis, you could try the following:
- Make sure that the covering is made of a breathable fabric that your skin can tolerate. As with many aspects of psoriasis, this may be a process of trial and error.
- Whilst the covering needs to be secure, make sure that it is not rubbing or causing injury to the skin as this could trigger psoriasis through Koebner’s phenomenon.
- Keep your skin clean and well moisturised
- Wash the covering after each use with a detergent that doesn’t irritate your skin.
- Try to take regular breaks from wearing the face covering.
For further information and advice on scalp or facial psoriasis, please do get in contact with us.
What research is taking place? Introducing PsoProtect and PsoProtectMe
In the video below, psoriasis experts, Professor Catherine Smith and Dr Satveer Mahil of St John’s Institute of Dermatology in London introduce PsoProtectMe – a new survey to support vital research into COVID-19 and psoriasis.
Questions answered in this video include:
- What is PsoProtectMe, and why is it important? (0:20)
- Who should take part in PsoProtectMe? (1:25)
- How can people take part and what will they need to do? (2:17)
- Can patients revisit the survey if they catch COVID-19 after completing it initially? (4:12)
- How will participants’ data be stored and can they withdraw it if they change their mind at a later date? (5:02)
Psoriasis Association is honoured to be collaborating once more with
world leading experts on psoriasis at the St John’s Institute of
Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London
and the University of Manchester on a vital piece of research
regarding psoriasis and COVID-19 (coronavirus).
is an online survey for people with psoriasis to complete,
irrespective of whether you have symptoms of COVID-19 or not.
are asking everyone with psoriasis to complete this important online
survey, or to ask a friend or family member to complete it on your
behalf. The online PsoProtectMe survey takes only 5-10 minutes to complete and asks about your symptoms,
psoriasis treatments and any underlying health conditions you may
have. If you have suffered from COVID-19, you will be asked how this
has affected you and your psoriasis. If in the future you develop
COVID-19 we would ask that you revisit the survey (you will be
provided with a unique reference number at the end) and let us know
of your experience.
do complete the survey irrespective of the type or severity of
psoriasis you have, whether you are currently treating your psoriasis
or not. We need all ages to complete the survey in order to build an
information will help us understand how the COVID-19 pandemic is
affecting people with psoriasis, and whether the treatments used for
psoriasis increase or decrease the risk of severe COVID-19 infection.
This will help healthcare professionals make important decisions
about the clinical care of people with psoriasis during the pandemic.
Which is why, even if you are well and have not had any symptoms of
COVID-19 we really need you to answer this survey call. It could be
that your treatment is beneficial in helping protect people from
COVID-19 or it could be that one type, or severity of psoriasis
affects the body’s response to this virus.
contribution will benefit everyone – please help by completing the
PsoProtectMe survey today.
McAteer, Chief Executive of the Psoriasis Association commented, “Whilst the COVID-19 pandemic
has been a worrying time for us all, it has again shown the strength
of the psoriasis community that registries such as PsoProtect and now
PsoProtectMe have been established so quickly to help further our
understanding and treat people with psoriasis and COVID-19. The
commitment of the teams at the St John’s Institute of Dermatology
and the University of Manchester, with support from the Psoriasis
Association is essential to the understanding not just of psoriasis,
but all health events that may affect people living with the
condition. Please do give 5-10 minutes to complete the survey –
your information really is important.”
The Psoriasis Association is pleased to announce its support for PsoProtect, an international registry where health care professionals can report outcomes of COVID-19 infection in people with psoriasis.
PsoProtect has been set up by world-leading psoriasis researchers at Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, and the University of Manchester to capture de-identified information about the outcomes and experiences of individuals with psoriasis who have had COVID-19. This will provide real world information for clinicians to help them assess risk in people with psoriasis. The registry will also help researchers to investigate whether different medicines or co-morbidities of psoriasis affect the outcome of COVID-19 infection.
This registry will provide a vital clinical and research resource to help in our collective fight against COVID-19 but please note that the registry is for clinicians to submit de-identified data, not patients. However, if you or a family member with psoriasis have had, or get Coronavirus, please do ask your clinician to submit your data to PsoProtect.
PsoProtect will publish regular summaries and insights from the registry, however, they are unable to provide information on request. The latest data can be found here.
Resource - Eating well during this challenging time
In this challenging time, it is understandable that people with psoriasis and psoriatic arthritis may be concerned about their diet or have questions about nutritional issues. If you are stressed or outside of your usual routine then your diet can suffer, but it's important to try and maintain a healthy, balanced diet for your general health and wellbeing if possible.
Using information from the British Dietetic Association, we've put together a handy resource to help you continue to eat well. The tips included range from supporting your immune system to planning your food shops, and considering how you store and use your food.
Download the resource here
Reporting suspected side effects from medicines
Due to the COVID-19 outbreak, patients are currently being asked to submit all suspected side effects of their medicines using the Yellow Card scheme electronically instead of paper. This is because all Medicines and Healthcare products Regulatory Agency (MHRA) staff are working remotely and no longer have access to the MHRA building (since 23rd March) due to the pandemic.
Please note that once the MHRA regains access to its building, it will process any paper suspected side effects reported to the Yellow Card scheme. If you have sent a side effect Yellow Card after 17th March 2020, and you haven’t received an acknowledgement of your report, you may wish to resubmit your suspected side effect electronically.
You can report suspected side effects electronically via:
From the National Institute for Health and Care Excellence (NICE):
- COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response
- COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders
- COVID-19 rapid guideline: children and young people who are immunocompromised
From the British Association of Dermatologists:
- Dermatology advice regarding self-isolation and immunosuppressed patients
- Statement on dry skin and frequent handwashing to reduce COVID-19 risk
From Guy's and St Thomas' NHS Foundation Trust
- Dermatology and coronavirus: frequently asked questions - includes a number of FAQs specifically about immunosuppressant medications, social distancing, shielding, and a handy self-assessment risk calculator. Please note, while this resource contains really useful information for everyone, please only contact Guy's and St Thomas' if you are already one of their patients.
From the British Society for Rheumatology:
- A risk stratification guide which may be useful if you have psoriatic arthritis, are taking an immunosuppressant medication and you are unsure whether or not you fall into the 'extremely vulnerable' category requiring 'shielding'.
Someone to talk to:
- Samaritans - Confidential support for people experiencing feelings of distress or despair. Phone: 116 123 (free to call service 24 hours a day, 365 days a year), website: www.samaritans.org
- Silver Line - Free, 24 hour confidential helpline for people aged 55 and over. Phone: 0800 4 70 80 90, website: https://www.thesilverline.org.uk
- CALM - CALM is the Campaign Against Living Miserably, for men aged 15 to 35. Phone: 0800 58 58 58, webchat also available (5pm-midnight, 365 days a year). Calls free from landlines, pay phones and all mobiles. Website: www.thecalmzone.net
- Coronavirus and your wellbeing
From Acas, the Advisory, Conciliation and Arbitration Service: