Abstract
Psoriasis is a chronic inflammatory skin disease usually treated with immunomodulatory/immunosuppressive agents. The use of these agents has been associated with an increased susceptibility to infections. Vaccination might represent a critical aspect in the management of patients with psoriasis treated with immunomodulatory/immunosuppressive therapies. This narrative review aimed to provide an overview on the immune response to vaccines in subjects treated with systemic agents used to treat patients with moderate to severe psoriasis. Publications appearing in PubMed, Scopus, and ISI–Web of Knowledge database were selected using Medical Subject Headings key terms. Overall, published data confirmed that vaccination with attenuated live vaccines during therapy with immunomodulatory/immunosuppressive therapies should be avoided. For nonlive vaccines, a more favorable safety profile of biologic agents compared to conventional systemic agents is described as the humoral response to vaccines is in general well-preserved. Treatment with cyclosporine and methotrexate is associated with lower antibody titers to vaccines, and thus these agents are better discontinued during vaccination. In contrast, treatment with biological agents is not associated with lower antibody response and can thus be continued safely.
Highlights
Psoriasis is a chronic inflammatory skin disease affecting 2–4% of the population in Western countries [1]
Even if nonlive vaccines can be safely administered during treatment, vaccination programs are apparently not successful among patients affected by psoriasis
Vaccination coverage rates are reported to be low in patients with moderate to severe psoriasis
Summary
Psoriasis is a chronic inflammatory skin disease affecting 2–4% of the population in Western countries [1]. Small molecule systemic agents include conventional (i.e., methotrexate, dimethyl fumarate, and cyclosporine) as well as a novel (namely apremilast) molecule. Some of these agents are indicated in children—in particular, TNF-α inhibitors and ustekinumab are labeled for use in children older than 4 years and 12 years, respectively. Vaccines 2020, 8, 769 it is very important to know whether systemic antipsoriatic agents alter the immune response to vaccines. This is even more important that extremely large populations will be soon vaccinated for the Sars-2 Covid infection
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