Impact of COVID-19 disease and vaccination on dermatological immune-mediated inflammatory diseases atopic dermatitis, psoriasis, and vitiligo: a Target2B! substudy

Abstract

During the COVID-19 pandemic, the daily life of many patients with dermatological immune-mediated inflammatory diseases (DIMIDs), such as atopic dermatitis (AD), psoriasis, and vitiligo, was impacted by social restrictions caused by (fear of) morbidity, mortality associated with COVID-19, and vaccine hesitancy. This prospective observational, multicenter, multidisciplinary cohort study explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo. Data from patients with DIMIDs were collected as part of the Target2B! study (between February 2021 and October 2022). We analyzed the differences in baseline characteristics, risk of developing COVID-19, proportion of DIMIDs in patients reaching seroconversion upon vaccination per DIMID, and self-reported increase in DIMID activity by multivariable logistic regression and sensitivity analyses. A total of 424 patients with DIMID were included. COVID-19 disease commonly occurred in patients with vitiligo (51.1%), AD (42.0%), and psoriasis (34.3%) (p = 0.038). COVID-19 was not associated with the use of immunosuppressive therapy. Three patients (two with AD and one with vitiligo) were hospitalized due to COVID-19. Nearly all patients with DIMIDs exhibited effective seroconversion after regular vaccination regimens (vitiligo 100%, psoriasis 97.9%, AD 96.5%). Increased DIMID activity after COVID-19 (6.6%) or severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) vaccination (12.26%) was reported in a minority of patients, with baseline progressive disease (disease activity 3 months preceding baseline survey) being the only associated risk factor (COVID-19: odds ratio [OR], 4.27 [p = 0.02]; vaccination OR, 3.45 [p = 0.002]). In conclusion, no alarming signs were shown in this study regarding (severe) COVID-19 in patients with AD, psoriasis, or vitiligo. Vaccination against COVID-19 is advised in patients with DIMIDs. Moreover, patients with DIMIDs can safely continue their immunosuppressant therapy, since this does not increase the risk of COVID-19, while vaccination-induced humoral responses are adequate. In only a minority of patients, increased DIMID activity after COVID-19 or SARS-CoV-2 vaccination occurred.

Keywords: COVID‐19; atopic dermatitis; psoriasis; vitiligo.

FIGURE 1

(a) Antibody concentration after severe acute respiratory syndrome–related coronavirus (SARS‐CoV‐2) vaccinations. (b–d) Antibody concentration after the first, second, and third vaccinations. Density = number of participants. *4 AU/mL mark is illustrated with black bar (clinically significant seroconversion at 4 AU/mL).

FIGURE 2

Gantt chart with the timeframe of the study and the reported increased disease activity after COVID‐19, severe acute respiratory syndrome–related coronavirus (SARS‐CoV‐2) vaccination, or outside of these periods in all patients with dermatological immune‐mediated inflammatory diseases (DIMIDs). All the participants (y axis) with registered SARS‐CoV‐2 vaccination dates (green circle), COVID‐19 development dates (black box), and dates of registered DIMID activity (red X). After SARS‐CoV‐2 vaccination and COVID‐19 development, a period of 90 days was taken as the COVID‐19 period (gray line), SARS‐CoV‐2 vaccination period (green line), and COVID‐19 + SARS‐CoV‐2 period (purple line). If an increase in DIMID activity was registered in this period, it was linked to COVID‐19 development or SARS‐CoV‐2 vaccination. Moreover, COVID‐19–free periods are shown with the blue lines. The dashed vertical lines represent the turning points from the Alpha‐dominant to Delta‐dominant wave and the Delta‐dominant to Omicron‐dominant wave, respectively.