Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center.
Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center.
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DOI：
10.3389/fmed.2021.812010
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发表时间：
2021
影响因子：
3.9
通讯作者：
Tsai TF
中科院分区：
文献类型：
--
作者：
Huang YW;Tsai TF
据报道，疫苗接种与牛皮癣恶化之间存在时间关联，最近牛皮癣发作被归因于COVID-19疫苗。我们招募了32名未接种疫苗的对照组和51名接种过疫苗的牛皮癣患者，其中49名正在接受生物治疗，定期门诊共接种63针疫苗，包括30剂Moderna mRNA-1273和33剂阿斯利康-牛津AZD1222。在9.3±4.3 d内发作15次，高于对照组2次（p = 0.047）。接种疫苗后恶化发作的平均严重程度从PASI 3.1增加到8.0 （p < 0.001）。3例患者表现为从慢性斑块型到点滴型银屑病的形态学改变。COVID-19疫苗接种后银屑病恶化与年龄、性别、病程、银屑病关节炎、银屑病家族史、红皮病史、当前生物制剂使用、合并症、疫苗类型、人白细胞抗原(HLA)-C基因型、基线PASI和接种前PASI无关。对于那些接种了两剂疫苗的人，除了一名患者外，所有患者在第一次注射后都加重了，而第二次没有。免疫个体银屑病恶化的机制尚不清楚，但COVID-19疫苗诱导的Th17细胞可能起作用。在大流行时代，牛皮癣患者和医生在接种COVID-19疫苗时应认识到疾病活动性波动的可能性。然而，与一种可治疗且病情恶化可迅速缓解的皮肤病相比，无疫苗禁忌症的牛皮癣患者应受益于COVID-19疫苗，以预防COVID-19严重感染和死亡。
The temporal association had been reported between vaccination and exacerbation of psoriasis, and episodes of psoriasis flare-up have recently been attributed to COVID-19 vaccines. We recruited 32 unimmunized controls and 51 vaccinated psoriasis patients, 49 of whom were under biological therapy, with regular clinic visits receiving a total of 63 shots of vaccines, including 30 doses of Moderna mRNA-1273 and 33 doses of AstraZeneca-Oxford AZD1222. Fifteen episodes of exacerbation attacked within 9.3 ± 4.3 days, which is higher than two episodes in the control group (p = 0.047). The mean post-vaccination severity of the worsening episodes increased from PASI 3.1 to 8.0 (p < 0.001). Three patients showed morphologic change from chronic plaque-type to guttate psoriasis. Deterioration of psoriasis following COVID-19 vaccination was not associated with age, sex, disease duration, psoriatic arthritis, family history of psoriasis, history of erythroderma, current biologics use, comorbidities, vaccine types, human leukocyte antigen (HLA)-C genotypes, baseline PASI nor pre-vaccination PASI. For those who received two doses of vaccination, all but one patient aggravated after the first shot but not the second. The mechanism of psoriasis exacerbation in immunized individuals is unclear, but Th17 cells induced by COVID-19 vaccines may play a role. In the pandemic era, psoriasis patients and physicians should acknowledge the possibility of fluctuation of disease activity when vaccinated against COVID-19. Nevertheless, compared to a treatable dermatologic disease with rapid resolution of exacerbation, psoriasis patients who do not have contraindications to vaccination should benefit from COVID-19 vaccines in the prevention of severe COVID-19 infection and fatality.