First published on Thursday 5th March 2020, LAST UPDATED on Tuesday 31st March 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:
- 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?
- 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 suppressing your worry, expressing worry and anxiety, managing 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, 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 (e.g. dermatologist, rheumatologist, or biologics nurse) 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, or a new, continuous cough) you should follow the latest NHS advice and consult your prescriber on whether or not to continue taking your medication.
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 guidance on the NHS website
- Read the guidance on the Public Health England website
The latest NHS guidance states that everyone must stay at home to help stop the spread of COVID-19.
You should only leave the house for 1 of 4 reasons:
- Shopping for basic necessities (e.g. food and medicine), which must be as infrequent as possible
- One form of exercise a day (e.g. a run, walk or cycle - alone or with members of your household)
- Any medical need, or to provide care or to help a vulnerable person
- Travelling to and from work, but only where this absolutely cannot be done from home
These 4 reasons are exceptions – even when doing these activities, you should be minimising time spent outside of the home and ensuring you are 2 metres apart from anyone outside of your household.
There is separate advice about:
Staying at home if you're at high risk of getting seriously ill from COVID-19
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 or a soap substitute 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 2 metres apart)
Avoid non-essential use of 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' involves self-isolation for a period of 12 weeks and is intended to protect up to 1.5 million people in England who are deemed to be 'extremely vulnerable' to severe illness and hospitalisation from COVID-19. If you fall into this ‘extremely vulnerable' category, you will be contacted directly by the NHS, advised to stay at home for a period of at least 12 weeks and avoid any face-to-face contact.
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 you must continue to follow the latest NHS advice and stay at home nonetheless.
In the meantime, 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.
In psoriasis and psoriatic arthritis, people who will be advised to self-isolate 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 immunomodulatory drugs (please see the list below) for their psoriasis and psoriatic arthritis (except a single biologic in combination with methotrexate).
Definite high risk – to be advised to definitely self-isolate:
You will be asked to self-isolate if you are taking any TWO drugs from the following classes:
- 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), Ilumetri (Tildrakizumab), Kyntheum (Brodalumab), Infliximab originator (Remicade) or Infliximab biosimilar (e.g. Inflectra, Remsima), Simponi (Golimumab), Skyrizi (Risankizumab), Stelara (Ustekinumab), Taltz (Ixekizumab), Tremfya (Guselkumab)
- Small molecule immunosuppressants: Otezla (Apremilast), JAK inhibitors e.g. Xeljanz (Tofacitinib)
Advised to self-isolate only if there are other concerns, high-risk circumstances or comorbidities (to be decided by your clinician):
You will be asked to self-isolate 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 self-isolate:
There is no need to self-isolate, but you must continue to follow the latest NHS advice 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.
The full Public Health England ‘guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19’ can be found here.
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.
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: