Huang Yi-Wei, Tsai Tsen-Fang
Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Front Med (Lausanne). 2021 Dec 23;8:812010. doi: 10.3389/fmed.2021.812010. eCollection 2021.
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 ( = 0.047). The mean post-vaccination severity of the worsening episodes increased from PASI 3.1 to 8.0 ( < 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.
疫苗接种与银屑病病情加重之间的时间关联已有报道，近期银屑病发作还被归因于新冠疫苗。我们招募了32名未接种疫苗的对照者和51名接种疫苗的银屑病患者，其中49人正在接受生物治疗，他们定期门诊就诊，共接种了63剂疫苗，包括30剂莫德纳mRNA-1273和33剂阿斯利康-牛津AZD1222。15次病情加重发作发生在9.3±4.3天内，高于对照组的2次发作（P = 0.047）。病情加重发作的疫苗接种后平均严重程度从银屑病面积和严重程度指数（PASI）3.1升至8.0（P < 0.001）。3例患者出现形态学变化，从慢性斑块型转变为点滴状银屑病。新冠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、红皮病病史、当前生物制剂使用情况、合并症、疫苗类型、人类白细胞抗原（HLA）-C基因型、基线PASI或接种前PASI均无关。对于接种两剂疫苗的人，除1例患者外，所有患者在第一剂接种后病情加重，但第二剂接种后未加重。免疫个体中银屑病加重的机制尚不清楚，但新冠疫苗诱导的辅助性T细胞17（Th17）细胞可能起作用。在大流行时代，银屑病患者和医生应认识到接种新冠疫苗时疾病活动度波动的可能性。然而，与一种可治疗且病情加重能迅速缓解的皮肤病相比，无疫苗接种禁忌证的银屑病患者应能从新冠疫苗预防严重新冠感染和死亡中获益。
