Can we safely use systemic treatment in atopic dermatitis during the COVID-19 pandemic? Overview of selected conventional and biologic systemic therapies

ABSTRACT

Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the medical community has faced major challenges that affect disease management in all areas. Dermatologists and immunologists have to choose appropriate treatment strategy taking into consideration the risk of infection and possible exacerbation of the course of the disease in patients with confirmed infection. Management of atopic dermatitis (AD) in moderate to severe cases is based on systemic therapy such as cyclosporine, azathioprine, methotrexate and dupilumab.

Areas covered: A literature search in PubMed database was performed until 6 March 2021. In this review, the authors discuss non-biologic and biologic systemic medications for AD and provide an overview of therapeutic recommendations during COVID-19 pandemic.

Expert opinion: In case of an active COVID-19 infection, conventional systemic treatment and biological treatment needs to be stopped until clinical recovery. Noninfected patients with systemic treatment of AD should continue their therapy via self-application. The authors can conclude that understanding of dupilumab therapy is better recognized in context AD treatment during COVID-19 pandemic in comparison to cyclosporine, azathioprine and methotrexate. However, this systemic immunosuppressants still require further investigation and literature complementation.

KEYWORDS:

• Atopic dermatitis
• Covid-19
• dupilumab
• methotrexate
• cyclosporine
• azathioprine
• systemic treatment

Article highlights

• When COVID-19 pandemic broke out, data about skin symptoms was limited to the relationship of dermatology in the context of preventing the contact of the skin and mucous membranes with the infection.

• The interest of the dermatological community was aroused by the observations of biologically treated patients with inflammatory and autoimmune skin diseases such as atopic dermatitis.

• While dupilumab therapy is better recognized in the context of atopic dermatitis treatment during COVID-19 pandemic, cyclosporine, azathioprine and methotrexate are still poorly understood.

• Dupilumab treatment can be continued during COVID-19 pandemic in patient without confirmed infection and seems to be more preferred than cyclosporine, because is not considered to increase the risk for viral infections.

• Despite rapidly changing knowledge in COVID-19 issue more studies are needed to evaluate conventional and biologic systemic therapies in atopic dermatitis treatment during pandemic.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest This work was supported by grant 503/0-149-03/503-01-001-19-00 from the Medical University of Lodz

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was supported by grant 503/0-149-03/503-01-001-19-00 from the Medical University of Lodz.