Should You Get the COVID Vaccine If You Have Psoriasis?
A top dermatologist answers all your questions about getting the new COVID vaccine when you have this chronic skin condition.
The COVID-19 vaccines are here, and they’re being distributed by the millions. Chances are, you know at least one person who has received one. But as welcome as these long-awaited shots are, they’re also stirring up some controversy—especially among those in the chronic community, who (understandably) have some questions. Like are these vaccines safe for everyone? And will they interact with my medications? Also, what are the side-effect risks?
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We hear you. And we’re taking your questions straight from our Facebook pages to the desks of top chronic disease experts as part of our original series #ChronicVaxFacts. Today’s expert is Lisa Zaba, M.D., Ph.D., a dermatologist with Stanford Health Care in Palo Alto, CA. We asked Dr. Zaba to answer questions from psoriasis patients about the COVID vaccine.
HealthCentral: Could the COVID vaccine cause a psoriasis flare?
Lisa Zaba, M.D., Ph.D.: Single-stranded mRNA molecules, like those contained in the Pfizer and Moderna COVID-19 vaccines, are activators of innate immune cells. Binding of mRNA to innate immune cells produces a potent type I interferon (IFN) response that is thought to play a central role in inflammation in some patients with autoimmune disorders. [Specifically,] type I IFN is thought to play a role in the initiation phase of psoriasis when people first develop the disease, although chronic psoriasis is perpetuated by overactivation of a different pathway, the Th17 adaptive immune response.
So in short, it is unknown how these mRNA vaccinations will affect patients with psoriasis, but major rheumatologic societies, including the National Psoriasis Foundation COVID-19 task force and the American College of Rheumatology, have put out statements indicating that the benefits of vaccination outweigh the risks for patients with psoriasis.
HC: Could the vaccine interact with my medications in any way?
Dr. Zaba: People taking immunosuppressive medications for their autoimmune diseases need those medications to stay in a remission. However, it is possible that those drugs may blunt the immune response to the COVID-19 vaccines, [possibly making them less effective]. It is not currently recommended that people stop their immunosuppressive medications prior to getting vaccinated; however, this is a discussion that should be had on a case-by-case basis with your treating doctor.
HC: Is one vaccine better than the other for people with psoriasis?
Dr. Zaba: Pfizer and Moderna mRNA vaccines are similar in composition and structure, and it is therefore unlikely that there will be a significant difference is the side-effect profile for patients with psoriasis.
HC: Will the vaccine side effects be more severe because of my condition?
Dr. Zaba: It is currently not known if the vaccine side effects will differ in those with autoimmune conditions. Immunocompromised individuals or those requiring immunosuppressive therapy were excluded from phase III SARS Cov-2 RNA vaccine trials. Therefore, safety and efficacy in this population is unknown.
HC: What are scientists doing to get that data on vaccine safety for people with our condition, and when will we have access to that information?
Dr. Zaba: Although mRNA vaccination is likely much safer for autoimmune patients than becoming infected with SARS CoV-2 virus, there are currently no NIH or pharmaceutical funded mRNA vaccine trials specifically looking at the question of safety and efficacy of mRNA vaccines in patients with autoimmunity. Our aim [at Stanford] is to conduct an observational study of mRNA vaccines in autoimmune patients under the close supervision of doctors specializing in autoimmunity.
National Psoriasis Foundation Statement on COVID Vaccine: National Psoriasis Foundation. (2020). “NPF COVID-19 Task Force Issues New Guidance Statements Regarding COVID-19 Vaccines Along with Updates to Prior Guidance.” psoriasis.org/covid-19-task-force-vaccine-statement/
American College of Rheumatology Statement on COVID Vaccine: American College of Rheumatology. (2021). “February 2021 update: Information from the American College of Rheumatology Regarding Vaccination Against SARS-CoV-2.” rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf