Psoriasis and COVID-19 Vaccine: What to Know

Posted on | Posted on John Murphy

Authors: Christine Zink, MD  Updated on October 19, 2022 Medically reviewed by Casey Gallagher, MD Very Well Health Oct 19, 2022

Psoriasis is a skin disorder characterized by thick, inflamed patches with silvery scales. It is a complex autoimmune and inflammatory disorder in which immune cells inappropriately attack the skin cells, leading to rapid replacement and buildup.1

Psoriasis treatment depends on the disease severity. Sometimes, people with psoriasis and associated arthritis need to take medications to suppress the immune system. These medications can put people at risk for other diseases, including COVID-19. This immunosuppression underscores why it’s essential for people with psoriasis to obtain COVID-19 vaccination, which is safe for people with psoriasis.

This article discusses the benefits, risks, and complications of COVID-19 vaccination in people with psoriasis.

Psoriasis and COVID-19 Risks

According to the National Psoriasis Foundation COVID-19 Task Force, existing evidence suggests that people with psoriasis and psoriatic arthritis—a type of arthritis linked to psoriasis—have the same likelihood of contracting the SARS-CoV-2 infection as the general population.2

The likelihood of a poor outcome from a COVID-19 infection is mainly due to age and other co-occurring conditions like:2

Experts are currently unsure if treatments for psoriasis and psoriatic arthritis change a person’s risk of contracting SARS-CoV-2 or having a worse outcome from COVID-19.2

Healthcare providers agree that patients with psoriasis and COVID-19 should continue their current therapies. Should a person with psoriasis taking immunosuppressive therapies develop COVID-19, they should discuss stopping psoriasis treatment with their healthcare provider.

Preventing COVID-19 and Worsening Psoriasis

The best way to prevent COVID-19 is to wear a mask, wash your hands, and avoid crowded indoor areas. Since people with psoriasis can develop worsening skin lesions with frequent handwashing, dermatologists recommend washing with moisturizing soaps and avoiding alcohol-based sanitizers.3

People with psoriasis and psoriatic arthritis have several different immunosuppressive treatment options. These treatments can put people at risk for other infections, but it seems that experts are less concerned about poor COVID-19 outcomes in people who take targeted immunosuppressive biologic drugs.

Instead, the more concerning immunosuppressants include:4

Experts also recommend avoiding using systemic corticosteroids (those that affect the entire body) to manage psoriatic arthritis when a person has COVID-19.2 The use of corticosteroids during acute infection with SARS-CoV-2 may be associated with worse outcomes. Still, corticosteroids are also used to improve COVID-19 outcomes in hospitalized patients.2

Patients should speak with their healthcare provider about the best course of action for their disease state and COVID-19.

Are COVID-19 Vaccines Safe for People With Psoriasis?

Experts agree that COVID-19 vaccination is safe for all people, including people with psoriasis.5 This includes people who take immunosuppressive therapy for their disease.

Live vaccines can be troublesome for people with chronic illnesses that require immunosuppressive therapy, but none of the COVID-19 vaccines are live vaccines. People who receive vaccination do not develop the disease.

Even though the clinical trials for these vaccines did not include patients on immunosuppressive therapy for conditions like psoriasis, experts agree that these vaccines are still safe.5

Contraindications to COVID-19 Vaccination

The only contraindication (a reason not to take a specific course of action due to possible harm) to COVID-19 vaccination is an allergy to the first dose of vaccine or a component in the vaccine. The only component that could be of concern is polyethylene glycol, which is used as a stabilizer and emulsifier to help keep ingredients in the liquid vaccine mixed.6

Psoriasis and COVID-19 Vaccine Complications

Psoriasis is a lifelong illness that fluctuates in intensity. Acute exacerbations—also called flares or flare-ups—can be caused by new medications, an infection, stress, physical trauma, and possibly vaccination.7

A recent report shows that COVID-19 vaccination can also lead to a psoriasis flare.7 The worsening skin symptoms typically occurred 10 days after vaccination, and they usually happened after the first dose of a two-shot series. In the study, almost no one developed worsening psoriasis after receiving the second dose of vaccine.7

Other vaccines have caused psoriasis flares in people with the disease. Culprit vaccines include:7

  • Influenza (the flu)
  • Tetanus-diphtheria  (prevents illnesses from the Clostridium tetani and Corynebacterium diphtheriae bacteria)
  • Pneumococcal (prevents diseases caused by the Spretococcus pneumoniae bacterium)

The exact reason for a psoriasis flare after COVID-19 vaccination is unclear. No single COVID-19 vaccine is more likely to lead to an exacerbation than another. The good news is that patients have a rapid resolution of the skin flare with ongoing disease management.7

This potential side effect is something to consider regarding COVID-19 vaccination. Still, experts recommend complete COVID-19 vaccination for all patients with psoriasis, despite their autoimmune disease severity and current medication regimen. This recommendation is based on the effectiveness of the COVID-19 vaccines in preventing severe infection and death, which is a worse outcome than a psoriasis flare.7

Most people who develop psoriasis flare-ups after vaccination do so after the first shot, but not the second shot.7

COVID-19 Also Worsens Psoriasis

It’s important to remember that infection with COVID-19 can also lead to psoriasis exacerbation.7

Are COVID-19 Vaccines Effective in People With Psoriasis?

Experts agree that COVID-19 vaccination is not only safe but highly effective for all people, including people with psoriasis.5

The most important thing to remember is that all four vaccines are highly effective at preventing hospitalization and death.8

However, people with psoriasis might be taking immunosuppressive agents to control their disease. People who take these medicines were not included in the vaccine clinical trials.

Immunosuppressive agents prevent an effective immune response with vaccination. Experts suspect that the vaccines might not be as effective in people on immunosuppressive therapies, but they still recommend vaccination.5 

Continuing Taking Your Medications

People with psoriasis should continue their current biologic or immunosuppressive therapy when they are vaccinated. The only exception is in people age 60 and older who take methotrexate. This group should discuss whether to hold their medication with their healthcare provider.4

Although research studies have not been conducted, experts think that a person’s ability to develop immunity probably depends on the specific immunosuppressive agent being taken.5

For instance, patients who take methotrexate have a harder time building immunity with other vaccines, like influenza and pneumococcal, whereas people who take tumor necrosis factor-alpha inhibitors develop strong immunity with vaccination.5

Overall, experts recommend complete vaccination for people with psoriasis. Some immunity is better than none.

Which Vaccine to Get?

The Food and Drug Administration (FDA) has fully approved or granted emergency use authorization (EUA) to four COVID-19 vaccines in the United States:9

Due to possible side effects from the J&J COVID-19 vaccine, the Centers for Disease Control and Prevention (CDC) recommends that people seek one of the mRNA vaccines (Moderna or Pfizer) or the Novavax vaccine over the J&J vaccine.10 

People with psoriatic disease who take immunosuppressive or immune-modulating therapies are eligible for an additional dose of an mRNA vaccine 28 days after the completing the primary series.11 This is different from a booster shot. This third dose is offered to people who have difficulty building immunity because of their underlying disease or medications. 

People who are moderately or severely immunocompromised from their medication should consider getting this additional dose. Speak with your healthcare provider about this recommendation if you have additional risk factors for doing poorly with COVID-19 and are taking:4

  • Orencia (abatacept)
  • Sandimmune (cyclosporine)
  • Arava (leflunomide)
  • Trexall (methotrexate)
  • Xeljanz (tofacitinib)
  • Rinvoq (upadacitinib)
  • Glucocorticoids (e.g., prednisone)

The FDA recently granted EUAs for updated bivalent boosters of the Moderna and Pfizer COVID-19 vaccines.

Bivalent boosters have replaced all previous monovalent booster doses. Anyone who received a monovalent booster should also receive one bivalent booster two months after the second dose or last booster. 

The CDC recommends everyone 5 years and older get an updated bivalent booster. Children ages 5 years are only eligible to receive the bivalent Pfizer booster. Everyone ages 6 years and older can choose to get the Pfizer or Moderna bivalent booster.12

Summary

Psoriasis is a chronic autoimmune and inflammatory skin disorder that is often treated with immunosuppressive therapy. Healthcare providers have concerns that people on these medications are at higher risk of contracting and doing poorly with COVID-19.

Therefore, it is crucial to complete COVID-19 vaccination. The vaccines are safe and effective in people with psoriasis, and experts recommend complete immunization for all people. There is a chance that a person will develop a psoriasis flare as a result of the vaccine, but this is better than a poor outcome from COVID-19.

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