New Onset and Exacerbation of Psoriasis Following COVID-19 Vaccination: A Review of the Current Knowledge
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. New-Onset Psoriasis
Authors | Country | Cases | Age/Sex | Type of Psoriasis | Vaccines/Doses | Days * | After |
---|---|---|---|---|---|---|---|
Tran et al. [33] | Vietnam | 3 | Pt1: 51/M | Pt1: plaque | Pt1: AZD1222/3 | Pt1: 7 | Calcip/betam + antihistamines |
Pt2: 68/F | Pt2: plaque | Pt2: BNT162b2/3 | Pt2: 30 | ||||
Pt3: 73/M | Pt3: guttate | Pt3: BNT162b2/1 | Pt3: 30 | ||||
Català A et al. [35] | Spain | 3 | NR | NR | NR | NR | NR |
Nagrani et al. [36] | India | 2 | Pt1: 56/F | Pt1: plaque | Pt1: AZD1222/1-2 | Pt1: 7-2 | Apremilast + antihistamines + emollients |
Pt2: 65/M | Pt2: plaque | Pt2: AZD1222/2 | Pt2: 10 | ||||
Ouni et al. [37] | Tunisia | 2 | Pt1: 59/M | Pt1: guttate | Pt1: BNT16B2b2/1-2-3 | Pt1: 7-7-7 | Pt1: TCS |
Pt2: 23/F | Pt2: guttate | Pt2: Ad26.COV2.S/1 | Pt2: 2 | Pt2: TCS | |||
Gargiulo et al. [34] | Italy | 2 | Pt1: 82/F | Pt1: plaque | Pt1: BNT162b2/3 | NR | Pt1: secukinumab |
Pt2: 29/M | Pt2: pustular | Pt1: BNT162b2/2 | Pt2: guselkumab | ||||
Cortonesi et al. [38] | Italy | 1 | 82/F | Plaque | BNT162b2/1 | 7 | Ixekizumab |
Wei et al. [39] | USA | 1 | 24/M | Plaque | mRNA-1273/2 | 24 | Ixekizumab + acitretin 25 mg/die |
Ständer et al. [40] | Germany | 1 | 50/F | Plaque | BNT162b2/2 | 7 | None |
McMahon et al. [41] | USA | 1 | 67/NR | Plaque | mRNA-1273/NR | NR | NR |
Song et al. [42] | Korea | 1 | 23/F | Guttate | BNT162b2/1 | 2 | Calcip/betam |
Magro et al. [43] | USA | 1 | 58/M | Guttate | BNT162b2/2 | 14 | NR |
Pesqué et al. [44] | Spain | 1 | 72/M | Guttate | mRNA-1273/2 | 6 | Calcip/betam |
Lehmann et al. [45] | Switzerland | 1 | 79/F | Guttate | BNT162b2/1 | 10 | Calcip/betam + nbUVB |
Frioui et al. [46] | Tunisia | 1 | 20/M | Pustular | BNT162b2/1 | 4 | Acitretin 25 mg/die + TCS |
Elamin et al. [47] | United Kingdom | 1 | 66/F | Pustular | AZD1222/1 | 21 | Acitretin 20 mg/die |
Romagnuolo et al. [48] | Italy | 1 | 64/F | Pustular | BNT162b2/1 | NR | Methotrexate 15 mg per week |
Ricardo et al. [49] | USA | 1 | 76/F | Nail | BNT162b2/2 | 7 | TCS |
Ruggiero et al. [50] | Italy | 1 | 47/F | Nail | BNT162b2/2 | 17 | Ixekizumab |
Lamberti et al. [51] | Italy | 1 | 45/F | Naile | BNT162b2/2 | 3 | NR |
Chhabra et al. [52] | India | 1 | NR/M | Annular | AZD1222/1 | 14 | NR |
3.2. Psoriasis Exacerbation
Authors | Cases | Age/Sex | Type of Psoriasis | Vaccines/Doses | Days * | Treatment ** | After *** |
---|---|---|---|---|---|---|---|
Gargiulo et al. [34] | 16 | Pt1: 40/F | Pt1: plaque | Pt1: BNT162b2/3 | NR | NR | Pt1: tildrakizumab |
Pt2: 50/M | Pt2: plaque | Pt2: BNT162b2/2 | Pt2: tildrakizumab | ||||
Pt3: 25/M | Pt3: plaque | Pt3: BNT162b2/2 | Pt3: ixekizumab | ||||
Pt4: 40/F | Pt4: plaque | Pt4: mRNA-1273/3 | Pt4: tildrakizumab | ||||
Pt5: 53/M | Pt5: plaque | Pt5: BNT162b2/2 | Pt5: risankizumab | ||||
Pt6: 50/M | Pt6: plaque | Pt6: BNT162b2/2 | Pt6: guselkumab | ||||
Pt7: 38/M | Pt7: plaque | Pt7: BNT162b2/2 | Pt7: risankizumab | ||||
Pt8: 56/M | Pt8: plaque | Pt8: BNT162b2/1 | Pt8: secukinumab | ||||
Pt9: 50/M | Pt9: plaque | Pt9: mRNA-1273/2 | Pt9: brodalumab | ||||
Pt10: 78/M | Pt10: plaque | Pt10: BNT162b2/3 | Pt10: risankizumab | ||||
Pt11: 67/F | Pt11: plaque | Pt11: BNT162b2/3 | Pt11: risankizumab | ||||
Pt12: 57/M | Pt12: guttate | Pt12: BNT162b2/2 | Pt12: guselkumab | ||||
Pt13: 53/M | Pt13: plaque | Pt13: BNT162b2/2 | Pt13: bimekizumab | ||||
Pt14: 61/M | Pt14: plaque | Pt14: mRNA-1273/2 | Pt14: risankizumab | ||||
Pt15: 72/F | Pt15: plaque | Pt15: BNT162b2/2 | Pt15: ustekinumab | ||||
Pt16: 76/M | Pt16: plaque | Pt16: BNT162b2/3 | Pt16: guselkumab | ||||
Huang et al. [53] | 15 | NR/8M-7F | 8 plaque 7 guttate | AZD1222/1 (3) AZD1222/2 (4) AZD1222/1-2 (1) mRNA-1273/1 (1) mRNA-1273/2 (6) | 9.3 | NR | NR |
Sotiriou et al. [54] | 14 | Pt1: 69/F | Plaque | Pt1: AZD1222/2 | Pt1: 8 | NR | Pt1: PUVA |
Pt2: 82/F | Pt2: mRNA-1273/2 | Pt2: 10 | Pt2: calcip/betam | ||||
Pt3: 62/F | Pt3: BNT162b2/2 | Pt3: 6 | Pt3: calcip/betam | ||||
Pt4: 73/M | Pt4: BNT162b2/2 | Pt4: 7 | Pt4: calcip/betam | ||||
Pt5: 66/M | Pt5: AZD1222/1 | Pt5: 22 | Pt5: risankizumab | ||||
Pt6: 62/F | Pt6: AZD1222/2 | Pt6: 13 | Pt6: apremilast | ||||
Pt7: 78/F | Pt7: BNT162b2/2 | Pt7: 5 | Pt7: calcip/betam | ||||
Pt8: 64/F | Pt8: AZD1222/2 | Pt8: 6 | Pt8: PUVA | ||||
Pt9: 69/M | Pt9: AZD1222/1 | Pt9: 32 | Pt9: nbUVB | ||||
Pt10: 83/M | Pt10: BNT162b2/2 | Pt10: 9 | Pt10: calcip/betam | ||||
Pt11: 61/F | Pt11: AZD1222/2 | Pt11: 3 | Pt11: nbUVB | ||||
Pt12: 49/M | Pt12: BNT162b2/2 | Pt12: 10 | Pt12: ixekizumab | ||||
Pt13: 55/F | Pt13: BNT162b2/2 | Pt13: 7 | Pt13: cyclosporine | ||||
Pt14: 64/F | Pt14: AZD1222/2 | Pt14: 7 | Pt14: guselkumab | ||||
Koumaki et al. [55] | 12 | Pt1: 34/F | Pt1: plaque | Pt1: BNT162b2/2 | Pt1: 10 | Pt1: secukinumab | Pt1: secukinumab + emollients |
Pt2: 61/M | Pt2: plaque | Pt2: AZD1222/1 | Pt2: 14 | Pt2: TCS | Pt2: apremilast | ||
Pt3: 45/F | Pt3: plaque | Pt3: BNT162b2/2 | Pt3: 10 | Pt3: calcip/betam | Pt3: TCS + calcip/betam | ||
Pt4: 56/F | Pt4: plaque | Pt4: BNT162b2/2 | Pt4: 2 | Pt4: adalimumab | Pt4: adalimumab + TCS | ||
Pt5: 53/F | Pt5: pustular | Pt5: BNT162b2/1 | Pt5: 20 | Pt5: adalimumab | Pt5: TCS+ OCS | ||
Pt6: 56/F | Pt6: plaque | Pt6: BNT162b2/1-2 | Pt6: 3 | Pt6: secukinumab | Pt6: secukinumab | ||
Pt7: 34/F | Pt7: plaque | Pt7: BNT162b2/1-2 | Pt7:7 | Pt7: secukinumab | Pt7: secukinumab | ||
Pt8: 61/F | Pt8: pustular | Pt8: BNT162b2/2 | Pt8: 4 | Pt8: methotrexate | Pt8: methylprednisolone | ||
Pt9: 66/F | Pt9: plaque | Pt9: BNT162b2/1 | Pt9: 20 | Pt9: ustekinumab | Pt9: ustekinumab + TCS | ||
Pt10: 67/F | Pt10: plaque | Pt10: BNT162b2/2 | Pt10: 20 | Pt10: OCS | Pt10: TCS + OCS | ||
Pt11: 56/M | Pt11: plaque | Pt11: BNT162b2/2 | Pt11: 20 | Pt11: calcip/betam | Pt11: calcip/betam | ||
Pt12: 51/M | Pt12: plaque | Pt12: BNT162b2/2 | Pt12: 25 | Pt12: TCS | Pt12: calcip/betam | ||
Megna et al. [56] | 11 | Pt1: 55/M | Pt1: plaque | Pt1: BNT162b2/2 | Pt1: 5 | Pt1: none | Pt1: methotrexate |
Pt2: 49/M | Pt2: plaque | Pt2: BNT162b2/2 | Pt2: 6 | Pt2: none | Pt2: adalimumab | ||
Pt3: 45/M | Pt3: plaque | Pt3: AZD1222/1 | Pt3: 10 | Pt3: secukinumab | Pt3: secukinumab + calcip/betam | ||
Pt4: 61/M | Pt4: plaque | Pt4: BNT162b2/2 | Pt4: 12 | Pt4: adalimumab | Pt4: ixekizumab | ||
Pt5: 62/M | Pt5: plaque | Pt5: mRNA-1273/2 | Pt5: 8 | Pt5: none | Pt5: brodalumab | ||
Pt6: 47/M | Pt6: guttate | Pt6: BNT162b2/2 | Pt6: 9 | Pt6: ixekizumab | Pt6: ixekizumab + calcip/betam | ||
Pt7: 70/F | Pt7: plaque | Pt7: BNT162b2/2 | Pt7: 8 | Pt7: calcip/betam | Pt7: adalimumab | ||
Pt8: 39/F | Pt8: plaque | Pt8: AZD1222/2 | Pt8: 7 | Pt8: guselkumab | Pt8: guselkumab + calcip/betam | ||
Pt9: 58/M | Pt9: plaque | Pt9: BNT162b2/2 | Pt9: 5 | Pt9: secukinumab | Pt9: secukinumab + calcip/betam | ||
Pt10: 55/F | Pt10: plaque | Pt10: AZD1222/2 | Pt10: 10 | Pt10: nbUVB | Pt10: risankizumab | ||
Pt11: 59/M | Pt11: plaque | Pt11: BNT162b2/1 | Pt11: 14 | Pt11: etanercept | Pt11: ixekizumab | ||
Wei et al. [39] | 6 | Pt1: 76/M | Pt1: plaque | Pt1: mRNA-1273/2 | Pt1: 62 | Pt1: NR | Pt1: apremilast + nbUVB |
Pt2: 69/M | Pt2: plaque | Pt2: mRNA-1273/2 | Pt2: 21 | Pt2: NR | Pt2: apremilast + tildrakizumab | ||
Pt3: 68/F | Pt3: plaque | Pt3: mRNA-1273/2 | Pt3: 6 | Pt3: NR | Pt3: risankizumab | ||
Pt4: 67/M | Pt4: plaque | Pt4: mRNA-1273/2 | Pt4: 60 | Pt4: NR | Pt4: tildrakizumab + TCS | ||
Pt5: 52/F | Pt5: plaque | Pt5: mRNA-1273/2 | Pt5: 7 | Pt5: NR | Pt5: risankizumab + TCSt | ||
Pt6: 27/F | Pt6: plaque | Pt6: BNT162b2/2 | Pt6: 90 | Pt6: NR | Pt6: TCS | ||
Ständer et al. [40] | 4 | Pt1: 35/M | Pt1: guttate | Pt1: BNT162b2/2 | Pt1: 7 | Pt1: NR | Pt1: none |
Pt2: 62/M | Pt2: guttate | Pt2: mRNA-1273/2 | Pt2: 10 | Pt2: NR | Pt2: ustekinumab | ||
Pt3: 58/F | Pt3: plaque | Pt3: BNT162b2/2 | Pt3: 5 | Pt3: NR | Pt3: ixekizumab | ||
Pt4: 54/M | Pt4: plaque | Pt4: BNT162b2/3 | Pt4: 7 | Pt4: NR | Pt4: ixekizumab | ||
Ruggiero et al. [50] | 4 | Pt1: 55/M | Pt1: nail | Pt1: BNT162b2/2 | Pt1: 19 | Pt1: none | Pt1: methotrexate |
Pt2: 66/M | Pt2: nail | Pt2: mRNA-1273/1 | Pt2: 21 | Pt2: apremilast | Pt2: ixekizumab | ||
Pt3: 41/M | Pt3: nail | Pt3: BNT162b2/2 | Pt3: 16 | Pt3: adalimumab | Pt3: brodalumab | ||
Pt4: 52/F | Pt4: nail | Pt4: BNT162b2/2 | Pt4: 25 | Pt4: secukinumab | Pt4: secukinumab + TCS +TK | ||
Durmaz et al. [57] | 3 | Pt1:64/M | Pt1: plaque | Pt1: BNT162b2/3 | Pt1: 42 | None | NR |
Pt2: 64/M | Pt2: palmoplantar | Pt2: BNT162b2/2 | Pt2: 7 | ||||
Pt3: 25/F | Pt3: pustular | Pt3: BNT162b2/1 | Pt3: 3 | ||||
Piccolo et al. [58] | 2 | Pt1: 57/M | Pt1: palmoplantar | Pt1: BNT162b2/1 | Pt1: 30 | Pt1: TCS | Pt1: acitretin |
Pt2: 63/F | Pt2: palmoplantar | Pt2: BNT162b2/1 | Pt2: 30 | Pt2: TCS | Pt2: acitretin | ||
Tran et al. [59] | 2 | Pt1: 30/F | Pt1: Erythrodermic | Pt1: BNT162b2/2 | Pt1: 7 | Pt1: secukinumab | Pt1: acitretin |
Pt2: 45/F | Pt2: Erythrodermic | Pt2: BNT162b2/2 | Pt2: 7 | Pt2: calcip/betam | Pt2: NR | ||
Bostan et al. [60] | 1 | 51/M | Plaque | BNT162b2/2 | 14 | NR | NR |
Krajewski et al. [61] | 1 | 46/M | Plaque | BNT162b2/2 | 5 | Deucravacitinib | NR |
Fang et al. [62] | 1 | 34/F | Plaque | AZD1222/1 | 7 | Ustekinumab + cyclosporine | TCS |
Mieczkowska et al. [63] | 1 | 65/M | Plaque | BNT162b2/1 | 7 | Apremilast + calcip/betam | NR |
Niebel et al. [64] | 1 | 62/M | Plaque | BNT162b2/2 | 20 | None | Balneophototherapy |
Kabbani et al. [65] | 1 | 53/M | Plaque | BNT162b2/1 | 7 | None | Cyclosporine |
Burlando et al. [66] | 1 | 56/M | Plaque | BNT162b2/2 | 16 | NR | NR |
Pesqué et al. [44] | 1 | 30/F | Plaque | mRNA-1273/1 | 10 | TCS | Calcip/betam |
Phuan et al. [67] | 1 | 80/F | Guttate | BNT162b2/3 | 7 | Cyclosporine | Cyclosporine + TCS |
Quattrini et al. [68] | 1 | 83/F | Palmoplantar | BNT162b2/2 | 2 | Methotrexate | OCS + methotrexate |
Onsun et al. [69] | 1 | 72/M | Pustular | AZD1222/1 | 4 | TCS | Infliximab |
Perna et al. [70] | 1 | NR/M | Pustular | BNT162b2/1 | 5 | None | Infliximab + cyclosporine |
Yatsuzuka et al. [71] | 1 | 65/M | Pustular | BNT162b2/2 | 12 | Infliximab | Secukinumab + OCS |
Pavia et al. [72] | 1 | 47/F | Pustular | BNT162b2/2 | 10 | Ustekinumab | Risankizumab |
Rouai et al. [73] | 1 | 66/M | Pustular | BNT162b2/1 | 4 | None | TCS |
Durmus et al. [74] | 1 | 42/M | Erythrodermic | BNT162b2/1 | 28 | Secukinumab | Ixekizumab + OCS |
Lopez et al. [75] | 1 | 58/M | Erythrodermic | BNT162b2/2 | 4 | None | TCS |
Nia et al. [76] | 1 | 58/M | Erythrodermic | BNT162b2/1 | 2 | None | Cyclosporine + nbUVB + TCS |
4. Discussion
5. Strengths and Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Boehncke, W.-H.; Schön, M.P. Psoriasis. Lancet 2015, 386, 983–994. [Google Scholar] [CrossRef]
- Langley, R.G.B. Psoriasis: Epidemiology, clinical features, and quality of life. Ann. Rheum. Dis. 2005, 64 (Suppl. S2), ii18–ii23, discussion ii24–ii25. [Google Scholar] [CrossRef]
- Griffiths, C.E.; Barker, J.N.W.N. Pathogenesis and clinical features of psoriasis. Lancet 2007, 370, 263–271. [Google Scholar] [CrossRef]
- Megna, M.; Ocampo-Garza, S.S.; Potestio, L.; Fontanella, G.; Gallo, L.; Cacciapuoti, S.; Ruggiero, A.; Fabbrocini, G. New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge? Biomedicines 2021, 9, 1482. [Google Scholar] [CrossRef]
- Takeshita, J.; Grewal, S.; Langan, S.M.; Mehta, N.N.; Ogdie, A.; Van Voorhees, A.S.; Gelfand, J.M. Psoriasis and comorbid diseases: Epidemiology. J. Am. Acad. Dermatol. 2017, 76, 377–390. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Takeshita, J.; Grewal, S.; Langan, S.M.; Mehta, N.N.; Ogdie, A.; Van Voorhees, A.S.; Gelfand, J.M. Psoriasis and comorbid diseases: Implications for management. J. Am. Acad. Dermatol. 2017, 76, 393–403. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Camela, E.; Potestio, L.; Fabbrocini, G.; Ruggiero, A.; Megna, M. New frontiers in personalized medicine in psoriasis. Expert Opin. Biol. Ther. 2022, 22, 1431–1433. [Google Scholar] [CrossRef] [PubMed]
- Camela, E.; Potestio, L.; Fabbrocini, G.; Pallotta, S.; Megna, M. The holistic approach to psoriasis patients with comorbidities: The role of investigational drugs. Expert Opin. Investig. Drugs 2023, 32, 537–552. [Google Scholar] [CrossRef]
- Megna, M.; Potestio, L.; Fabbrocini, G.; Cinelli, E. Tildrakizumab: A new therapeutic option for erythrodermic psoriasis? Dermatol. Ther. 2021, 34, e15030. [Google Scholar] [CrossRef]
- Megna, M.; Camela, E.; Battista, T.; Genco, L.; Martora, F.; Noto, M.; Picone, V.; Ruggiero, A.; Monfrecola, G.; Fabbrocini, G.; et al. Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part II: Focus on elderly patients. Expert Opin. Drug Saf. 2023, 22, 43–58. [Google Scholar] [CrossRef]
- Bakshi, H.; Nagpal, M.; Singh, M.; Dhingra, G.A.; Aggarwal, G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr. Drug Saf. 2020, 15, 82–104. [Google Scholar] [CrossRef] [PubMed]
- Tokuyama, M.; Mabuchi, T. New Treatment Addressing the Pathogenesis of Psoriasis. Int. J. Mol. Sci. 2020, 21, 7488. [Google Scholar] [CrossRef]
- Armstrong, A.W.; Read, C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA 2020, 323, 1945–1960. [Google Scholar] [CrossRef]
- Ruggiero, A.; Camela, E.; Potestio, L.; Fabbrocini, G.; Megna, M. Drug safety evaluation of tildrakizumab for psoriasis: A review of the current knowledge. Expert Opin. Drug Saf. 2022, 21, 1445–1451. [Google Scholar] [CrossRef] [PubMed]
- Ruggiero, A.; Potestio, L.; Cacciapuoti, S.; Gallo, L.; Battista, T.; Camela, E.; Fabbrocini, G.; Megna, M. Tildrakizumab for the treatment of moderate to severe psoriasis: Results from a single center preliminary real-life study. Dermatol. Ther. 2022, 35, e15941. [Google Scholar] [CrossRef]
- Megna, M.; Battista, T.; Potestio, L.; Ruggiero, A.; Ventura, V.; Fabbrocini, G.; Picone, V. A case of erythrodermic psoriasis rapidly and successfully treated with Bimekizumab. J. Cosmet. Dermatol. 2022, 22, 1146–1148. [Google Scholar] [CrossRef] [PubMed]
- Ruggiero, A.; Picone, V.; Martora, F.; Fabbrocini, G.; Megna, M. Guselkumab, Risankizumab, and Tildrakizumab in the Management of Psoriasis: A Review of the Real-World Evidence. Clin. Cosmet. Investig. Dermatol. 2022, 15, 1649–1658. [Google Scholar] [CrossRef]
- Marasca, C.; Fornaro, L.; Martora, F.; Picone, V.; Fabbrocini, G.; Megna, M. Onset of vitiligo in a psoriasis patient on ixekizumab. Dermatol. Ther. 2021, 34, e15102. [Google Scholar] [CrossRef]
- Lytras, T.; Tsiodras, S. Lockdowns and the COVID-19 pandemic: What is the endgame? Scand. J. Public Health 2021, 49, 37–40. [Google Scholar] [CrossRef]
- Kaul, V.; de Moraes, A.G.; Khateeb, D.; Greenstein, Y.; Winter, G.; Chae, J.; Stewart, N.H.; Qadir, N.; Dangayach, N.S. Medical Education During the COVID-19 Pandemic. Chest 2021, 159, 1949–1960. [Google Scholar] [CrossRef]
- Ilgen, O.; Saatli, B.; Timur, T.; Kula, H.; Kandemir, S.; Kurt, S.; Cagliyan, E. Measures against COVID-19 pandemic—A single tertiary center experience. J. Obstet. Gynaecol. 2022, 42, 1532–1538. [Google Scholar] [CrossRef] [PubMed]
- Wollina, U. Challenges of COVID-19 pandemic for dermatology. Dermatol. Ther. 2020, 33, e13430. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ruggiero, A.; Martora, F.; Fabbrocini, G.; Villani, A.; Marasca, C.; Megna, M.; Fornaro, L.; Comune, R.; Potestio, L. The Role of Teledermatology During the COVID-19 Pandemic: A Narrative Review. Clin. Cosmet. Investig. Dermatol. 2022, 15, 2785–2793. [Google Scholar] [CrossRef] [PubMed]
- Marasca, C.; Annunziata, M.C.; Camela, E.; Di Guida, A.; Fornaro, L.; Megna, M.; Napolitano, M.; Patruno, C.; Potestio, L.; Fabbrocini, G. Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J. Clin. Med. 2022, 11, 1511. [Google Scholar] [CrossRef]
- Hassine, I.H. Covid-19 vaccines and variants of concern: A review. Rev. Med. Virol. 2022, 32, e2313. [Google Scholar] [CrossRef]
- Brüssow, H. COVID-19: Vaccination problems. Environ. Microbiol. 2021, 23, 2878–2890. [Google Scholar] [CrossRef]
- Fiolet, T.; Kherabi, Y.; MacDonald, C.-J.; Ghosn, J.; Peiffer-Smadja, N. Comparing COVID-19 vaccines for their characteristics, efficacy and effectiveness against SARS-CoV-2 and variants of concern: A narrative review. Clin. Microbiol. Infect. 2022, 28, 202–221. [Google Scholar] [CrossRef]
- Soiza, R.L.; Scicluna, C.; Thomson, E.C. Efficacy and safety of COVID-19 vaccines in older people. Age Ageing 2021, 50, 279–283. [Google Scholar] [CrossRef]
- Kricorian, K.; Civen, R.; Equils, O. COVID-19 vaccine hesitancy: Misinformation and perceptions of vaccine safety. Hum. Vaccines Immunother. 2022, 18, 1950504. [Google Scholar] [CrossRef]
- Megna, M.; Potestio, L.; Battista, T.; Camela, E.; Genco, L.; Noto, M.; Fabbrocini, G.; Martora, F. Immune response to COVID-19 mRNA vaccination in patients with psoriasis undergoing treatment with biologics. Clin. Exp. Dermatol. 2022, 47, 2310–2312. [Google Scholar] [CrossRef]
- Ruggiero, A.; Martora, F.; Picone, V.; Potestio, L.; Camela, E.; Battista, T.; Fabbrocini, G.; Megna, M. The impact of COVID-19 infection on patients with psoriasis treated with biologics: An Italian experience. Clin. Exp. Dermatol. 2022, 47, 2280–2282. [Google Scholar] [CrossRef] [PubMed]
- Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gotzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Healthcare Interventions: Explanation and Elaboration. BMJ Clin. Res. Ed. 2009, 339, b2700. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tran, T.N.A.; Nguyen, T.T.P.; Pham, N.N.; Pham, N.T.U.; Vu, T.T.P.; Nguyen, H.T. New onset of psoriasis following COVID-19 vaccination. Dermatol. Ther. 2022, 35, e15590. [Google Scholar] [CrossRef]
- Gargiulo, L.; Ibba, L.; Vignoli, C.A.; Piscazzi, F.; Cortese, A.; Fiorillo, G.; Toso, F.; Pavia, G.; Valenti, M.; Avagliano, J.; et al. New-onset and flares of psoriasis after COVID-19 infection or vaccination successfully treated with biologics: A case series. J. Dermatol. Treat. 2023, 34, 2198050. [Google Scholar] [CrossRef]
- Català, A.; Muñoz-Santos, C.; Galván-Casas, C.; Roncero Riesco, M.; Revilla Nebreda, D.; Solá-Truyols, A.; Giavedoni, P.; Llamas-Velasco, M.; González-Cruz, C.; Cubiró, X. Cutaneous reactions after SARS-CoV-2 vaccination: A cross-sectional Spanish nationwide study of 405 cases. Br. J. Derm. 2022, 186, 142–152. [Google Scholar] [CrossRef] [PubMed]
- Nagrani, P.; Jindal, R.; Goyal, D. Onset/flare of psoriasis following the ChAdOx1 nCoV-19 Corona virus vaccine (Oxford-AstraZeneca/Covishield): Report of two cases. Dermatol. Ther. 2021, 34, e15085. [Google Scholar] [CrossRef]
- Ouni, N.; Korbi, M.; Chahed, F.; Ben Fadhel, N.; Bellalah, A.; Belhadjali, H.; Aouam, K.; Zili, J. New-onset guttate psoriasis following coronavirus disease 2019 vaccination: About two cases. Dermatol. Ther. 2022, 35, e15617. [Google Scholar] [CrossRef]
- Cortonesi, G.; Orsini, C.; Rubegni, P.; Trovato, E. New-onset psoriasis after Comirnaty (BNT162b2, BioNTech /Pfizer) vaccine successfully treated with ixekizumab. Dermatol. Ther. 2022, 35, e15606. [Google Scholar] [CrossRef]
- Wei, N.; Kresch, M.; Elbogen, E.; Lebwohl, M. New onset and exacerbation of psoriasis after COVID-19 vaccination. JAAD Case Rep. 2022, 19, 74–77. [Google Scholar] [CrossRef]
- Ständer, S.; Zirpel, H.; Bujoreanu, F.; Tatu, A.L.; Ludwig, R.J.; Thaçi, D. Case report: Clinical features of COVID-19 vaccine-induced exacerbation of psoriasis—A case series and mini review. Front. Med. 2022, 9, 995150. [Google Scholar] [CrossRef]
- McMahon, D.E.; Kovarik, C.L.; Damsky, W.; Rosenbach, M.; Lipoff, J.B.; Tyagi, A.; Chamberlin, G.; Fathy, R.; Nazarian, R.M.; Desai, S.R.; et al. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study. J. Am. Acad. Dermatol. 2022, 86, 113–121. [Google Scholar] [CrossRef] [PubMed]
- Song, W.J.; Lim, Y.; Jo, S.J. De novo guttate psoriasis following coronavirus disease 2019 vaccination. J. Dermatol. 2022, 49, e30–e31. [Google Scholar] [CrossRef]
- Magro, C.; Crowson, A.N.; Franks, L.; Schaffer, P.R.; Whelan, P.; Nuovo, G. The histologic and molecular correlates of COVID-19 vaccine-induced changes in the skin. Clin. Dermatol. 2021, 39, 966–984. [Google Scholar] [CrossRef] [PubMed]
- Pesqué, D.; Lopez-Trujillo, E.; Marcantonio, O.; Giménez-Arnau, A.M.; Pujol, R.M. New-onset and exacerbations of psoriasis after mRNA COVID-19 vaccines: Two sides of the same coin? J. Eur. Acad. Dermatol. Venereol. 2021, 36, e80–e81. [Google Scholar] [CrossRef] [PubMed]
- Lehmann, M.; Schorno, P.; Hunger, R.; Heidemeyer, K.; Feldmeyer, L.; Yawalkar, N. New onset of mainly guttate psoriasis after COVID-19 vaccination: A case report. J. Eur. Acad. Dermatol. Venereol. 2021, 35, e752–e755. [Google Scholar] [CrossRef]
- Frioui, R.; Chamli, A.; Zaouak, A.; Hlel, I.; Khanchel, F.; Fenniche, S.; Hammami, H. A case of new-onset acute generalized pustular psoriasis following Pfizer-BioNTech COVID-19 vaccine. Dermatol. Ther. 2022, 35, e15444. [Google Scholar] [CrossRef]
- Elamin, S.; Hinds, F.; Tolland, J. De novo generalized pustular psoriasis following Oxford-AstraZeneca COVID-19 vaccine. Clin. Exp. Dermatol. 2022, 47, 153–155. [Google Scholar] [CrossRef]
- Romagnuolo, M.; Pontini, P.; Muratori, S.; Marzano, A.V.; Moltrasio, C. De novo annular pustular psoriasis following mRNA COVID-19 vaccine. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e603–e605. [Google Scholar] [CrossRef]
- Ricardo, J.W.; Lipner, S.R. Case of de novo nail psoriasis triggered by the second dose of Pfizer-BioNTech BNT162b2 COVID-19 messenger RNA vaccine. JAAD Case Rep. 2021, 17, 18–20. [Google Scholar] [CrossRef]
- Ruggiero, A.; Potestio, L.; Battista, T.; Fabbrocini, G.; Megna, M. Reply to ‘Nail psoriasis: A rare mRNA COVID-19 vaccine reaction’ by Lamberti A et al. J. Eur. Acad. Dermatol. Venereol. 2022, 37, e41–e42. [Google Scholar] [CrossRef]
- Lamberti, A.; Lora, V.; Graceffa, D.; Bonifati, C.; Cota, C. Nail psoriasis: A rare mRNA COVID-19 vaccine reaction. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e745–e746. [Google Scholar] [CrossRef]
- Chhabra, N.; George, A. A case of de novo annular-plaque type psoriasis following Oxford-AstraZeneca COVID-19 vaccination. Curr. Drug Saf. 2023, 18, 584–588. [Google Scholar] [CrossRef] [PubMed]
- Huang, Y.-W.; Tsai, T.-F. Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center. Front. Med. 2021, 8, 812010. [Google Scholar] [CrossRef] [PubMed]
- Sotiriou, E.; Tsentemeidou, A.; Bakirtzi, K.; Lallas, A.; Ioannides, D.; Vakirlis, E. Psoriasis exacerbation after COVID-19 vaccination: A report of 14 cases from a single centre. J. Eur. Acad. Dermatol. Venereol. 2021, 35, e857–e859. [Google Scholar] [CrossRef]
- Koumaki, D.; Krueger-Krasagakis, S.; Papadakis, M.; Katoulis, A.; Gkiaouraki, I.; Zografaki, K.; Mylonakis, D.; Krasagakis, K. Psoriasis flare-up after AZD1222 and BNT162b2 COVID-19 mRNA vaccines: Report of twelve cases from a single centre. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e411–e415. [Google Scholar] [CrossRef]
- Megna, M.; Potestio, L.; Gallo, L.; Caiazzo, G.; Ruggiero, A.; Fabbrocini, G. Reply to “Psoriasis exacerbation after COVID-19 vaccination: Report of 14 cases from a single centre” by Sotiriou E et al. J. Eur. Acad. Dermatol. Venereol. 2021, 36, e11–e13. [Google Scholar] [CrossRef] [PubMed]
- Durmaz, I.; Turkmen, D.; Altunisik, N.; Toplu, S.A. Exacerbations of generalized pustular psoriasis, palmoplantar psoriasis, and psoriasis vulgaris after mRNA COVID-19 vaccine: A report of three cases. Dermatol. Ther. 2022, 35, e15331. [Google Scholar] [CrossRef] [PubMed]
- Piccolo, V.; Russo, T.; Mazzatenta, C.; Bassi, A.; Argenziano, G.; Cutrone, M.; Darlington, M.E.S.D.; Grimalt, R. COVID vaccine-induced pustular psoriasis in patients with previous plaque type psoriasis. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e330–e332. [Google Scholar] [CrossRef]
- Tran, T.B.; Pham, N.T.U.; Phan, H.N.; Nguyen, H.T. Generalized erythrodermic psoriasis triggered by vaccination against severe acute respiratory syndrome Coronavirus 2. Dermatol. Ther. 2022, 35, e15464. [Google Scholar] [CrossRef]
- Bostan, E.; Elmas, L.; Yel, B.; Yalici-Armagan, B. Exacerbation of plaque psoriasis after inactivated and BNT162b2 mRNA COVID-19 vaccines: A report of two cases. Dermatol. Ther. 2021, 34, e15110. [Google Scholar] [CrossRef]
- Krajewski, P.K.; Szepietowski, J.C. Psoriasis flare-up associated with second dose of Pfizer-BioNTech BNT16B2b2 COVID-19 mRNA vaccine. J. Eur. Acad. Dermatol. Venereol. 2021, 35, e632–e634. [Google Scholar] [CrossRef]
- Fang, W.; Chiu, L.; Hu, S.C. Psoriasis exacerbation after first dose of AstraZeneca coronavirus disease 2019 vaccine. J. Dermatol. 2021, 48, e566–e567. [Google Scholar] [CrossRef] [PubMed]
- Mieczkowska, K.; Kaubisch, A.; McLellan, B.N. Exacerbation of psoriasis following COVID-19 vaccination in a patient previously treated with PD-1 inhibitor. Dermatol. Ther. 2021, 34, e15055. [Google Scholar] [CrossRef] [PubMed]
- Niebel, D.; Wenzel, J.; Wilsmann-Theis, D.; Ziob, J.; Wilhelmi, J.; Braegelmann, C. Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines. Dermatopathology 2021, 8, 463–476. [Google Scholar] [CrossRef]
- Kabbani, M.; Poskin, M.; Benhadou, F. Psoriasis exacerbation after COVID-19 vaccination in high-risk group: How to manage it? Dermatol. Ther. 2022, 35, e15368. [Google Scholar] [CrossRef]
- Burlando, M.; Herzum, A.; Micalizzi, C.; Cozzani, E.; Parodi, A. Cutaneous reactions to COVID-19 vaccine at the dermatology primary care. Immun. Inflamm. Dis. 2022, 10, 265–271. [Google Scholar] [CrossRef] [PubMed]
- Phuan, C.Z.Y.; Choi, E.C.-E.; Oon, H.H. Temporary exacerbation of pre-existing psoriasis and eczema in the context of COVID-19 messenger RNA booster vaccination: A case report and review of the literature. JAAD Int. 2022, 6, 94–96. [Google Scholar] [CrossRef] [PubMed]
- Quattrini, L.; Verardi, L.; Caldarola, G.; Peluso, G.; De Simone, C.; D’agostino, M. New onset of remitting seronegative symmetrical synovitis with pitting oedema and palmoplantar psoriasis flare-up after Sars-Cov-2 vaccination. J. Eur. Acad. Dermatol. Venereol. 2021, 35, e727–e729. [Google Scholar] [CrossRef]
- Onsun, N.; Kaya, G.; Işık, B.G.; Güneş, B. A generalized pustular psoriasis flare after CoronaVac COVID-19 vaccination: Case report. Health Promot. Perspect. 2021, 11, 261–262. [Google Scholar] [CrossRef]
- Perna, D.; Jones, J.; Schadt, C.R. Acute generalized pustular psoriasis exacerbated by the COVID-19 vaccine. JAAD Case Rep. 2021, 17, 1–3. [Google Scholar] [CrossRef]
- Yatsuzuka, K.; Murakami, M.; Kuroo, Y.; Fukui, M.; Yoshida, S.; Muto, J.; Shiraishi, K.; Sayama, K. Flare-up of generalized pustular psoriasis combined with systemic capillary leak syndrome after coronavirus disease 2019 mRNA vaccination. J. Dermatol. 2022, 49, 454–458. [Google Scholar] [CrossRef] [PubMed]
- Pavia, G.; Gargiulo, L.; Spinelli, F.; Avagliano, J.; Valenti, M.; Borroni, R.G.; Costanzo, A.; Narcisi, A. Generalized pustular psoriasis flare in a patient affected by plaque psoriasis after BNT162b2 mRNA COVID-19 vaccine, successfully treated with risankizumab. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e502–e505. [Google Scholar] [CrossRef] [PubMed]
- Rouai, M.; Ben Slimane, M.; Sassi, W.; Alaoui, F.; Chelly, I.; Mokni, M. Pustular rash triggered by Pfizer-BioNTech COVID-19 vaccination: A case report. Dermatol. Ther. 2022, 35, e15465. [Google Scholar] [CrossRef] [PubMed]
- Durmus, O.; Akdogan, N.; Karadag, O.; Gokoz, O. Erythroderma related with the first dose of Pfizer-BioNTech BNT16B2b2 COVID-19 mRNA vaccine in a patient with psoriasis. Dermatol. Ther. 2022, 35, e15363. [Google Scholar] [CrossRef]
- Lopez, E.D.; Javed, N.; Upadhyay, S.; Shekhar, R.; Sheikh, A.B. Acute exacerbation of psoriasis after COVID-19 Pfizer vaccination. Bayl. Univ. Med. Cent. Proc. 2022, 35, 199–201. [Google Scholar] [CrossRef] [PubMed]
- Nia, A.M.; Silva, M.M.; Spaude, J.; Gonzalez-Fraga, J.D. Erythrodermic psoriasis eruption associated with SARS-CoV-2 vaccination. Dermatol. Ther. 2022, 35, e15380. [Google Scholar] [CrossRef]
- Rendon, A.; Schäkel, K. Psoriasis Pathogenesis and Treatment. Int. J. Mol. Sci. 2019, 20, 1475. [Google Scholar] [CrossRef] [Green Version]
- De Alcantara, C.C.; Reiche, E.M.V.; Simão, A.N.C. Cytokines in psoriasis. Adv. Clin. Chem. 2021, 100, 171–204. [Google Scholar] [CrossRef]
- Baliwag, J.; Barnes, D.H.; Johnston, A. Cytokines in psoriasis. Cytokine 2015, 73, 342–350. [Google Scholar] [CrossRef] [Green Version]
- Megna, M.; Potestio, L.; Camela, E.; Fabbrocini, G.; Ruggiero, A. Ixekizumab and brodalumab indirect comparison in the treatment of moderate to severe psoriasis: Results from an Italian single-center retrospective study in a real-life setting. Dermatol. Ther. 2022, 35, e15667. [Google Scholar] [CrossRef]
- Megna, M.; Potestio, L.; Fabbrocini, G.; Camela, E. Treating psoriasis in the elderly: Biologics and small molecules. Expert Opin. Biol. Ther. 2022, 22, 1503–1520. [Google Scholar] [CrossRef] [PubMed]
- Megna, M.; Ruggiero, A.; Battista, T.; Marano, L.; Cacciapuoti, S.; Potestio, L. Long-Term Efficacy and Safety of Risankizumab for Moderate to Severe Psoriasis: A 2-Year Real-Life Retrospective Study. J. Clin. Med. 2023, 12, 3233. [Google Scholar] [CrossRef]
- De Lucia, M.; Potestio, L.; Costanzo, L.; Fabbrocini, G.; Gallo, L. Scabies outbreak during COVID-19: An Italian experience. Int. J. Dermatol. 2021, 60, 1307–1308. [Google Scholar] [CrossRef]
- Martora, F.; Battista, T.; Marasca, C.; Genco, L.; Fabbrocini, G.; Potestio, L. Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature. Clin. Cosmet. Investig. Dermatol. 2022, 15, 2369–2382. [Google Scholar] [CrossRef] [PubMed]
- Martora, F.; Marasca, C.; Fabbrocini, G.; Ruggiero, A. Strategies adopted in a southern Italian referral centre to reduce adalimumab discontinuation: Comment on ‘Can we increase the drug survival time of biologic therapies in hidradenitis suppurativa?’. Clin. Exp. Dermatol. 2022, 47, 1864–1865. [Google Scholar] [CrossRef] [PubMed]
- Megna, M.; Camela, E.; Villani, A.; Tajani, A.; Fabbrocini, G.; Potestio, L. Teledermatology: A useful tool also after COVID-19 era? J. Cosmet. Dermatol. 2022, 21, 2309–2310. [Google Scholar] [CrossRef]
- Huang, Z.; Su, Y.; Zhang, T.; Xia, N. A review of the safety and efficacy of current COVID-19 vaccines. Front. Med. 2022, 16, 39–55. [Google Scholar] [CrossRef]
- Potestio, L.; Fabbrocini, G.; D’Agostino, M.; Piscitelli, I.; Martora, F. Cutaneous reactions following COVID-19 vaccination: The evidence says “less fear”. J. Cosmet. Dermatol. 2023, 22, 28–29. [Google Scholar] [CrossRef]
- Ghasemiyeh, P.; Mohammadi-Samani, S.; Firouzabadi, N.; Dehshahri, A.; Vazin, A. A focused review on technologies, mechanisms, safety, and efficacy of available COVID-19 vaccines. Int. Immunopharmacol. 2021, 100, 108162. [Google Scholar] [CrossRef]
- Potestio, L.; Villani, A.; Fabbrocini, G.; Martora, F. Cutaneous reactions following booster dose of COVID-19 mRNA vaccination: What we should know? J. Cosmet. Dermatol. 2022, 21, 5339–5340. [Google Scholar] [CrossRef]
- Martora, F.; Villani, A.; Marasca, C.; Fabbrocini, G.; Potestio, L. Skin reaction after SARS-CoV-2 vaccines Reply to ‘cutaneous adverse reactions following SARS-CoV-2 vaccine booster dose: A real-life multicentre experience’. J. Eur. Acad. Dermatol. Venereol. 2023, 37, e43–e44. [Google Scholar] [CrossRef] [PubMed]
- Martora, F.; Fabbrocini, G.; Nappa, P.; Megna, M. Reply to ‘Development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2’ by Solimani et al. J. Eur. Acad. Dermatol. Venereol. 2022, 36, e750–e751. [Google Scholar] [CrossRef] [PubMed]
- Martora, F.; Villani, A.; Battista, T.; Fabbrocini, G.; Potestio, L. COVID-19 vaccination and inflammatory skin diseases. J. Cosmet. Dermatol. 2023, 22, 32–33. [Google Scholar] [CrossRef] [PubMed]
- Ebrahimi, A.; Sayad, B.; Rahimi, Z. COVID-19 and psoriasis: Biologic treatment and challenges. J. Dermatol. Treat. 2022, 33, 699–703. [Google Scholar] [CrossRef]
- Wack, S.; Patton, T.; Ferris, L.K. COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: Review of available evidence. J. Am. Acad. Dermatol. 2021, 85, 1274–1284. [Google Scholar] [CrossRef]
- Ewer, K.J.; Barrett, J.R.; Belij-Rammerstorfer, S.; Sharpe, H.; Makinson, R.; Morter, R.; Flaxman, A.; Wright, D.; Bellamy, D.; Bittaye, M.; et al. T cell and antibody responses induced by a single dose of ChAdOx1 nCoV-19 (AZD1222) vaccine in a phase 1/2 clinical trial. Nat. Med. 2021, 27, 270–278. [Google Scholar] [CrossRef]
- Farkas, A.; Tonel, G.; Nestle, F. Interferon-α and viral triggers promote functional maturation of human monocyte-derived dendritic cells. Br. J. Dermatol. 2008, 158, 921–929. [Google Scholar] [CrossRef] [Green Version]
- Takayama, K.; Satoh, T.; Hayashi, M.; Yokozeki, H. Psoriatic Skin Lesions Induced by BCG Vaccination. Acta Derm. Venereol. 2008, 88, 621–622. [Google Scholar] [CrossRef]
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Potestio, L.; Battista, T.; Cacciapuoti, S.; Ruggiero, A.; Martora, F.; Fornaro, L.; Camela, E.; Megna, M. New Onset and Exacerbation of Psoriasis Following COVID-19 Vaccination: A Review of the Current Knowledge. Biomedicines 2023, 11, 2191. https://doi.org/10.3390/biomedicines11082191
Potestio L, Battista T, Cacciapuoti S, Ruggiero A, Martora F, Fornaro L, Camela E, Megna M. New Onset and Exacerbation of Psoriasis Following COVID-19 Vaccination: A Review of the Current Knowledge. Biomedicines. 2023; 11(8):2191. https://doi.org/10.3390/biomedicines11082191
Chicago/Turabian StylePotestio, Luca, Teresa Battista, Sara Cacciapuoti, Angelo Ruggiero, Fabrizio Martora, Luigi Fornaro, Elisa Camela, and Matteo Megna. 2023. "New Onset and Exacerbation of Psoriasis Following COVID-19 Vaccination: A Review of the Current Knowledge" Biomedicines 11, no. 8: 2191. https://doi.org/10.3390/biomedicines11082191