Management of Pemphigus in COVID-19 Pandemic Era; a Review Article

Abstract

The novel coronavirus is rapidly spreading around the world. Since the public announcement of the COVID-19 outbreak, several concerns have been raised by dermatologists as well as pemphigus patients who take immunosuppressive drugs. In this paper, we review the literature about the common treatment of pemphigus with a focus on the lessons from similar epidemics to find a proper suggestion to manage pemphigus in the COVID-19 pandemic era. The effect of many of the drugs used for treatment of Pemphigus vulgaris (PV) on COVID-19 is not clear. We also do not have data on the impact of this autoimmune disease, which may involve the mucous membranes, on the acquisition or course of COVID-19. We are currently in the midst of a pandemic and evaluating the effect of COVID-19 on the population of susceptible patients suffering from auto-immune diseases like pemphigus is essential. The evidence on best ways to manage patients with underlying conditions, such as pemphigus, during the outbreak of COVID-19 is evolving and the data is updated every day.

Keywords: COVID-19; pemphigus; severe acute respiratory syndrome coronavirus 2; therapy.

Figure1

The proposed algorithm for management of pemphigus patients during the outbreak of COVID-19. Off all systemic therapies: the patient has not been taking any systemic therapy for at least 2 months. Minimal therapy: the patient has been on maintenance therapy [prednisolone (or the equivalent) ≤ 10mg/d and/or minimal adjuvant therapy and/or topical corticosteroids for at least 2 months). Partial remission: There are transient lesions that heal within a week without additional treatment. Complete remission: There is no stable or new lesion. Relapse: The extension of stable lesion(s) and/or the development of ≥ 3 new lesions per month that do not disappear within 1 week without additional treatment IVIG: intravenous immunoglobulin(18)