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Psoriasis is a chronic condition in which itchy, red patches appear on the skin. It happens when the immune system becomes dysfunctional, leading to increases in inflammation in the body and the rapid accumulation of skin cells.

Since psoriasis is an immune-mediated condition, its common treatments involve the use of drugs that suppress the immune system. These can include:

Because these drugs weaken the immune system, some people with psoriasis may be concerned about receiving COVID-19 vaccines. COVID-19 vaccines are both safe and effective for people with psoriasis.

Let’s dive deeper into what we know so far about COVID-19 vaccines and psoriasis medications.

Currently, all of the available evidence suggests that COVID-19 vaccines are safe for people taking psoriasis medications.

Let’s explore some of the concerns regarding vaccine safety for people with the condition.

Psoriasis medications can weaken the immune system. This makes people taking these medications more vulnerable to contracting and becoming seriously ill with various infections.

Similarly, vaccines containing live versions of a germ aren’t typically used in people with a weakened immune system, as they may replicate in the body and cause illness. Some examples are the flu nasal spray vaccine and the measles, mumps, and rubella (MMR) vaccine.

However, none of the currently available COVID-19 vaccines contain live virus. Instead, they contain either an mRNA molecule or a modified adenovirus that cannot replicate within the body.

While researchers continue to study COVID-19 vaccines in people with a weakened immune system, research indicates that other inactivated vaccines, such as the flu shot and the hepatitis B vaccine, are safe for people with immune-mediated inflammatory conditions like psoriasis.

However, vaccination may trigger a flare of any autoimmune condition, including psoriasis. It’s important to discuss this possibility with your doctor.

Immunosuppressants like methotrexate and COVID-19 vaccines

Methotrexate was initially used to treat cancer, but was approved to treat severe psoriasis in the 1970s. It works by inhibiting an enzyme that leads to rapid skin cell growth.

One of the potential side effects of taking methotrexate is a weakened immune system, specifically due to low levels of infection-fighting white blood cells. This increases infection risk.

Because of this, people taking methotrexate are at an increased risk of serious illness from COVID-19. This makes vaccination vital.

People taking methotrexate are not at an increased risk from the COVID-19 vaccine. However, it appears as if those taking methotrexate generate a reduced immune response to COVID-19 vaccination. More on that later.

According to the Centers for Disease Control and Prevention (CDC), researchers are still learning how well COVID-19 vaccines protect people with a weakened immune system, including those on immunosuppressive drugs.

In fact, people taking immunosuppressive drugs were excluded from the COVID-19 vaccine trials. This is actually a standard practice for vaccine trials. It allows researchers to evaluate the immune response to the vaccine without the confounding effects of immunosuppressive drugs.

Future research will examine those with weakened immune systems more closely. For now, we do have indications that the COVID-19 vaccine is effective for those taking psoriasis medications, particularly biologics.

Two 2021 reports on people taking biologics for psoriasis found that antibodies to the novel coronavirus spike protein were developed following vaccination. How long this protection lasts is currently unknown, though.

COVID-19 vaccines and methotrexate

Current data suggests that the immune response to COVID-19 vaccination may not be as strong in people taking methotrexate.

A 2021 study compared the immune response to the first dose of the Pfizer-BioNTech vaccine:

  • A total of 17 healthy individuals and 84 people with psoriasis were included in the study. Of the people with psoriasis, 17 were taking methotrexate and 67 were taking biologics.
  • Compared to the healthy individuals, immune response rates were lower in those taking psoriasis medications. The lowest immune response was seen in people taking methotrexate.
  • Healthy individuals and people taking biologics more readily produced antibodies that could neutralize the coronavirus.
  • The cellular immune response, which involves CD8 T cells that specifically target cells infected with the coronavirus, was preserved across all three groups.

Another 2021 study supported these findings. It compared the immune response to two doses of the Pfizer-BioNTech vaccine in both healthy individuals and people with immune-mediated inflammatory conditions, predominantly those with psoriasis:

  • Two groups were used in the study:
    • The first group included 26 healthy individuals and 51 people with immune-mediated inflammatory conditions.
    • The second group included 182 healthy individuals and 31 people with immune-mediated inflammatory conditions.
  • Healthy individuals and those taking biologics had a robust antibody response following vaccination 90 percent of the time.
  • Individuals taking methotrexate had an adequate antibody response only 62.2 percent of the time.
  • Unlike the previous study, activation of CD8 T cells did not increase in people taking methotrexate.

You may now be wondering why the immune response to the COVID-19 vaccine seems to be lower in people taking methotrexate compared to those taking biologics. The answer could be the ways that these medications impact the immune system.

Biologics only target very specific parts of the immune system. Traditional immunosuppressants like methotrexate are very general in their effects. It could be that this broader effect could be dampening the immune response to the COVID-19 vaccine in people taking methotrexate.

It’s important for people with psoriasis to receive the COVID-19 vaccine. The CDC recommends that everyone aged 12 and older get vaccinated for COVID-19.

Additionally, a task force organized by the National Psoriasis Foundation (NPF) recommends that all people who don’t have contraindications to the vaccines receive it as soon as it’s available to them.

Taking psoriasis medications is not a contraindication for COVID-19 vaccination. In fact, the NPF task force recommends that those receiving the COVID-19 vaccine continue to take their psoriasis medications in most cases.

They do note that some people taking methotrexate may, in consultation with their doctor, suspend their medication for 2 weeks after vaccination to help promote an improved immune response. This guidance applies to people who meet all of the following criteria:

  • are going to receive the Johnson and Johnson vaccine
  • are 60 or older
  • have at least one other health condition that increases their risk of serious complications from COVID-19

According to the CDC, the only contraindications for a COVID-19 vaccine are:

  • a severe allergic reaction, called anaphylaxis, to a previous dose of the COVID-19 vaccine or to an ingredient in the COVID-19 vaccine
  • an immediate allergic reaction, such as hives or wheezing, to a previous dose of the COVID-19 vaccine
  • a known allergy to an ingredient in the COVID-19 vaccine

People with a weakened immune system that have received both doses of either mRNA vaccine may not develop the same level of immunity as those with a healthy immune system.

This includes people that are actively taking immunosuppressive medications, such as psoriasis medications.

The CDC recommends that individuals who are moderately to severely immunocompromised receive a booster shot at least 28 days after their second dose. The aim is to improve the immune response from the initial vaccine series.

Currently, this only applies to the two mRNA vaccines: Pfizer-BioNTech and Moderna. Additional data is needed to determine the benefits of a vaccine booster in individuals who received the Johnson and Johnson vaccine.

The NPF task force also recommends that individuals with psoriasis or psoriatic arthritis that are currently taking immunosuppressive drugs should receive a booster shot.

They’ve also identified groups that are more likely to benefit from a booster, including people:

  • who are 50 years old or older
  • who are taking the following psoriasis medications:
  • who received their second dose over 6 months ago
  • who have additional health conditions that increase risk of serious COVID-19 illness

Now that we’ve discussed COVID-19 vaccinations and psoriasis, you may be curious if the COVID-19 vaccines can cause or exacerbate psoriasis.

Can COVID-19 vaccines cause psoriasis?

There’s currently no evidence that the COVID-19 vaccines can cause psoriasis.

Other vaccines, specifically the flu shots used between 2009 and 2010, have been linked with new-onset psoriasis.

However, the authors of the 2015 study reporting this finding note that in addition to it being very rare, they could not directly prove a direct causative relationship between the vaccine and psoriasis.

Can COVID-19 vaccines cause psoriasis flares?

Vaccine-related psoriasis flares are a concern for some. A 2021 study of 142 people who were reluctant to receive a COVID-19 vaccine found that 21 percent listed the risk of a psoriasis flare as a concern.

There have been reports of psoriasis flares following COVID-19 vaccination. However, researchers have been unable to directly link them to the vaccines themselves.

It’s important to note that, in these reports, people experiencing a flare after vaccination were reported to either not be taking any medications for their psoriasis or only be using topical treatments to manage their condition.

Three further reports have found that people taking psoriasis medications, specifically biologics, experienced no flares after COVID-19 vaccination. However, whether certain treatments affect the likelihood of a flare after vaccination is currently unknown.

Additionally, other factors may lead to psoriasis flares, with stress being one example. It’s possible that stress related to the pandemic or to receiving a vaccination could contribute to a flare after vaccination.

Trauma to the skin, including injections, can also lead to psoriasis symptoms at the injury site. This is called the Koebner phenomenon. The incidence of the Koebner phenomenon is estimated to be between 11 to 75 percent in people with psoriasis.

Medications for psoriasis can weaken the immune system. Because of this, people with psoriasis may be at an increased risk of serious illness from COVID-19.

The available evidence indicates that COVID-19 vaccines are safe and effective for people taking psoriasis medications. Additionally, taking psoriasis medications isn’t a contraindication for vaccination.

The NPF recommends that people with psoriasis receive the vaccine as soon as they can. Additionally, booster vaccines are now recommended for immunosuppressed people, including those taking certain psoriasis medications.

If you have concerns about receiving the COVID-19 vaccine or how your psoriasis medications will impact the vaccine, be sure to discuss them with a doctor.