Psoriasis and infection. A clinical practice narrative

Area of Science:

• Dermatology
• Clinical Practice Guidelines
• Infectious Disease

Background:

• Psoriasis is linked to altered cutaneous microbiome, though its clinical significance is unclear.
• Various microorganisms are associated with psoriasis, but antimicrobial therapy shows limited efficacy in preventing flares.
• Psoriasis patients have an increased, though low absolute risk of serious infection.

Purpose of the Study:

• To provide a clinical practice narrative on the relationship between psoriasis, treatment, and infection.
• To guide healthcare professionals in managing infection risks associated with psoriasis and its treatments.
• To inform decisions regarding immune-modulatory treatment adjustments and vaccination in psoriasis patients.

Main Methods:

• Development of a clinical practice narrative by the Australasian Psoriasis Collaboration.
• Review of existing evidence on the association between psoriasis, its treatments, and infection risk.
• Consideration of factors influencing infection risk, including immune-modulatory therapies and surgical procedures.

Main Results:

• Immune-modulatory treatments for psoriasis increase the risk of serious infections.
• Management decisions post-infection require individualized risk assessment considering the infection, recurrence risk, and psoriasis control.
• Live vaccines are generally contraindicated with immune-modulatory agents, depending on immune suppression levels.

Conclusions:

• Wound healing in psoriasis is typically normal.
• Certain psoriasis treatments (e.g., infliximab, methotrexate) can continue during low-risk surgeries.
• Moderate-to-high risk surgeries necessitate a case-by-case approach for managing psoriasis treatments.