Psoriasis and COVID-19 Vaccines: Side Effects and Risks

The Centers for Disease Control and Prevention (CDC) recommends the mRNA COVID-19 vaccine for people with psoriasis and psoriatic arthritis, with some additional recommendations regarding immunosuppression.

Psoriatic diseases can sometimes require treatments that suppress the immune system. These medications can put people at risk for other illnesses, including COVID-19. Because of this potential immunosuppression, people with psoriasis are encouraged to obtain COVID-19 vaccination.

Psoriasis and COVID-19 Vaccine Complications

Psoriasis is a lifelong illness that fluctuates in intensity. Acute exacerbations—also called flare-ups or flares—can be caused by new medications, an infection, stress, physical trauma, and possibly vaccination.

A 2021 report concluded that COVID-19 vaccination can lead to a psoriasis flare. The exact reason for a psoriasis flare after COVID-19 vaccination is unclear. No single COVID-19 vaccine is more likely to lead to an exacerbation than any other. The good news is that skin flares improve rapidly with ongoing disease management.

The worsening skin symptoms typically occurred 10 days after vaccination, usually after the first dose of a two-shot series. In the study, almost no one developed worsening psoriasis after receiving the second dose of vaccine.

Experts recommend complete COVID-19 vaccination for all people with psoriasis, regardless of their disease severity and current medication regimen, and despite a potential flare side effect. This recommendation is based on the effectiveness of the COVID-19 vaccines in preventing severe infection and death.

Are COVID-19 Vaccines Safe for People With Psoriasis?

Experts agree that COVID-19 vaccination is safe for all people, including people with psoriasis. This includes people who take immunosuppressive therapy for their disease.

Live vaccines can be troublesome for people with chronic illnesses that require immunosuppressive therapy, but none of the COVID-19 vaccines are live vaccines. People who receive vaccination do not develop the disease.

Even though the clinical trials for these vaccines did not include patients on immunosuppressive therapy for conditions like psoriasis, experts agree that these vaccines are still safe.

Are COVID-19 Vaccines Effective in People With Psoriasis?

Experts agree that COVID-19 vaccination is not only safe but highly effective for all people, including people with psoriasis.

The most important thing to remember is that all four vaccines are highly effective at preventing hospitalization and death.

However, people with psoriasis might be taking immunosuppressive agents to control their disease. People who take these medicines were not included in the vaccine clinical trials.

Immunosuppressive agents prevent an effective immune response with vaccination. Experts suspect that the vaccines might not be as effective in people on immunosuppressive therapies, but they still recommend vaccination. 

Although research studies have not been conducted, experts think that a person's ability to develop immunity probably depends on the specific immunosuppressive agent being taken.

For instance, people who take methotrexate have a harder time building immunity with other vaccines, like influenza and pneumococcal; those who take tumor necrosis factor-alpha inhibitors develop strong immunity with vaccination.

Overall, experts recommend complete vaccination for people with psoriasis. Some immunity is better than none.

Which Vaccine Is Best?

The Food and Drug Administration (FDA) has fully approved or granted emergency use authorization (EUA) to three COVID-19 vaccines in the United States:

• Pfizer-BioNTech, available to people 6 months and older
• Moderna, available to people 6 months and older
• Novavax, available to people 12 years and older
  

A fourth vaccine, produced by Janssen/Johnson & Johnson, was previously authorized in the U.S., but it is no longer available after the remaining supply expired in May 2023.

Each available vaccine has been updated to a formulation that provides protection against newer variants. For most people, you are considered up-to-date with your vaccines if you have received at least one dose of an updated mRNA vaccine.

People with psoriatic disease who take immunosuppressive or immune-modulating therapies are eligible for an additional vaccine dose. This dose is offered to people who have difficulty building immunity because of their underlying disease or medications.

People who are moderately or severely immunocompromised from their medication should consider getting an additional dose. Speak with your healthcare provider about this recommendation if you have additional risk factors for doing poorly with COVID-19 and are taking:

• Orencia (abatacept)
• Sandimmune (cyclosporine)
• Arava (leflunomide)
• Trexall (methotrexate)
• Xeljanz (tofacitinib)
• Rinvoq (upadacitinib)
• Glucocorticoids (e.g., prednisone)
  

Psoriasis and COVID-19 Risks

According to the National Psoriasis Foundation COVID-19 Task Force, existing evidence suggests that people with psoriasis and psoriatic arthritis—a type of arthritis linked to psoriasis—have the same likelihood of contracting the SARS-CoV-2 infection as the general population.

The likelihood of a poor outcome from a COVID-19 infection is mainly due to age and other co-occurring conditions like:

• Chronic heart disease
• Chronic lung disease
• Chronic kidney disease
• Diabetes
• Obesity

Experts are currently unsure if treatments for psoriasis and psoriatic arthritis change a person's risk of contracting SARS-CoV-2 or having a worse outcome from COVID-19.

Healthcare providers agree that people with psoriasis and COVID-19 should continue their current therapies. Should a person with psoriasis taking immunosuppressive therapies develop COVID-19, they should discuss stopping psoriasis treatment with their healthcare provider.

People with psoriasis and psoriatic arthritis have several different immunosuppressive treatment options. These treatments can put people at risk for other infections, but it seems that experts are less concerned about poor COVID-19 outcomes in people who take targeted immunosuppressive biologic drugs.

Instead, the more concerning immunosuppressants include:

• Orencia (abatacept)
• Sandimmune (cyclosporine)
• Arava (leflunomide)
• Trexall (methotrexate)
• Xeljanz (tofacitinib)

Experts also recommend avoiding using systemic corticosteroids (those that affect the entire body) to manage psoriatic arthritis when a person has COVID-19. The use of corticosteroids during acute infection with SARS-CoV-2 may be associated with worse outcomes in those cases.

You should speak with your healthcare provider about the best course of action for your disease state and COVID-19.

Summary

Psoriasis is a chronic autoimmune and inflammatory skin disorder that is often treated with immunosuppressive therapy. Healthcare providers have concerns that people on these medications are at higher risk of contracting and doing poorly with COVID-19.

Therefore, it is crucial to complete COVID-19 vaccination. The vaccines are safe and effective in people with psoriasis, and experts recommend complete immunization for all people. There is a chance that a person will develop a psoriasis flare as a result of the vaccine, but this is better than a poor outcome from COVID-19.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.