A group of authors explored the relationship between coronavirus disease 2019 (COVID-19) vaccination and psoriasis onset or exacerbation, utilizing data from 49 studies, while emphasizing the importance of vaccination and the need for further research.
Study
The present study involved a comprehensive review of literature from databases such as PubMed, Embase, Cochrane Skin, MEDLINE, and Google Scholar until June 1, 2023. The research adhered to the preferred reporting items for systematic reviews as well as meta-analyses (PRISMA) guidelines, utilizing keywords related to COVID-19, vaccines, psoriasis, and specific vaccines.
The types of manuscripts analyzed ranged from reviews to case series. The aim was to include studies with at least one patient who showed new-onset or worsened psoriasis post- COVID-19 vaccination. Only four vaccines were considered, while studies relating to other vaccines or psoriatic arthritis were excluded. All clinical phenotypes of psoriasis were included.
The search was refined through text and abstract reviews of articles, along with a revision of bibliographies to capture possibly overlooked articles. This article didn’t involve any new studies with animal or human participants conducted by the authors.
Findings
The present review included 49 studies involving 134 patients. 27 cases of new-onset psoriasis post-COVID-19 vaccination were reported, with 37% male, 48.1% female, and 14.8% unreported gender. The average age was 54.4 ± 20.9 years. The prevalent phenotype was plaque psoriasis (33.3%), followed by guttate (25.9%), pustular (14.8%), nail (11.1%), and annular psoriasis (3.7%).
The most common vaccine associated with psoriasis onset was mRNABNT162b2 (55.5%), followed by AZD1222 (18.5%) and mRNA-1273 (11.1%). The average time between administration of the vaccine and new-onset psoriasis was 10.3 ± 6.4 days. Most cases were mild and managed with topical treatments (33.3%), systemic drugs (11.1%), biologics (18.5%), apremilast (7.4%), or no treatment (3.7%).
Regarding psoriasis exacerbation, a total of 107 cases were reported, with 57% male and 43% female, averaging 56.5 ± 13.4 years old. The most associated vaccine was mRNABNT162b2 (61.7%), followed by AZD1222 (19.6%) and mRNA-1273 (18.7%).
The average time between vaccination and psoriasis exacerbation was 13.7 ± 14.4 days. Biologic treatment was most commonly used (36.4%), with first-time biologic treatments making up 30.8% of cases. Moderate-to-severe forms of the disease were reported, leading to the use of systemic drugs and biologics in 44% of patients.
Conclusion
Despite reported cases of new or worsening psoriasis following COVID-19 vaccination, the campaign was successful with all cases effectively managed. Many studies in this review showed that the majority of new cases were treated topically, and systemic treatments primarily addressed flare-ups.
Globally, plaque psoriasis was most common in both new and exacerbated cases, with severe cases more prevalent in those with a history of the disease, likely due to self-medication of milder forms.
However, understanding potential pathogenic mechanisms to identify "at-risk" patients requires further study. The overall benefit-risk profile of COVID-19 vaccination affirms that vaccination should continue.
Source:
https://www.news-medical.net/news/20230807/Is-COVID-19-vaccination-linked-to-psoriasis-emergence-or-flare-ups.aspx