Changes in the clinical course of psoriasis post-COVID-19: a clinical case series

Abstract

During COVID-19 pandemic, researchers and clinicians worldwide have noted changes in the course of chronic disorders of various organs and systems, which are likely to be related to systemic effects of the pathogen. Specific heterogeneous skin lesions have been identified in SARS-CoV-2 infection, including those in the patients without any history of skin disorders and exacerbation of chronic dermatoses and/or changes in their clinical manifestation. Post-COVID-19 manifestation and exacerbation of psoriasis have been also described in the literature.
 We retrospectively analyzed medical files of 22 in-patients with exacerbation of psoriasis after mild or moderate SARS-CoV-2 infection in the Department of Dermatovenereology from April 2020 to April 2021. There were 7 male patients aged 42 to 74 (meanSD 57.714.1) years and 15 female patients aged 40 to 78 (59.210.3) years. The duration of psoriasis ranged from 1 to 15 (8.74.7) years. Their mean PASI before the coronavirus infection had been 10.25.2. In the majority of the patients the psoriasis exacerbation after COVID-19 was associated with a significant increase of PASI to 18.594.82 (n=12, p 0.05), 32.221.71 (n=5, p 0.01), and to 596 (n=2, p 0.01). In 3 patients, in addition to the increase of the rash area (PASI 10 to 17, mean 13.42.63), psoriatic arthritis was newly diagnosed after COVID-19.
 We present a clinical case of a 33-year old male patient with a 15-year history of psoriasis, dramatic worsening of his benign psoriasis vulgaris with its transformation to the Zumbusch type of generalized pustular psoriasis after SARS-CoV-2 infection and rapid clinical improvement after the initiation of treatment with an interleukin-17A inhibitor secukinumab.
 This clinical case series may contribute to the knowledge on the new coronavirus infection and its effects on the course of psoriasis.