The impact of COVID‐19 pandemic on psoriasis patients in northern Greece

Dear Editor, Literature data regarding the impact of pandemic on psoriasis and the relationship between psoriasis and COVID-19 outcomes are emerging. The main aim of this study was to evaluate the impact of COVID19 on treatment maintenance, disease course, psychosocial status, and intention to vaccinate in patients with moderate to severe psoriasis under systemic treatment (biologic agents, conventional systemic treatments, small molecules, and combinations). Furthermore, we investigated the incidence and the outcomes of COVID-19 infection in the same population as compared to the general population. In this study, we created a questionnaire-based survey addressed to patients with moderate and severe psoriasis under systemic treatment. Patients eligible for inclusion were adults >18 years of age, suffering from moderate-to-severe plaque psoriasis that were in maintenance treatment with biologics, conventional systemic regimens, small molecules or combinations before the outbreak of COVID-19 in Greece (March 2020). Their demographics and disease characteristics were obtained by their medical records and they are shown in Table 1. The questionnaire was developed using triangulation techniques (15 participants completed draft questionnaires—pilot testing, provided comments in focus groups and these were combined with the observations of the physician present during the interview-questionnaire-completion). The survey was held via a phone-call interview and included questions about the impact of COVID-19 pandemic on patients' access to the hospital, treatment maintenance, psoriasis course, COVID-19 infection, and outcome and perception of vaccination. The protocol of the study received approval from the institutional ethics committee (6.340, 6/23.03.2021) and conformed with the principles of the seventh Helsinki declaration. All participants provided verbal consent before answering the questionnaire. The study was conducted in March 2021 and referred to the pandemic period that started from March 2020. The national digital COVID-19 registry was used to extract the incidence of COVID-19 in the general population and to exclude infection, hospitalization, or death due to COVID19 in patients of our cohort that were not reached by phone. Statistical analyses were performed using the statistical package for social sciences statistical software (version 24.0, IBM SPSS Statistics for Windows, Armonk, NY, USA: IBM Corp). A total of 561 (313 males, 248 females) out of 600 eligible patients were included (Table 1). The majority of the patients (343, 61.1%) were not able to access a dermatologist, during the studied period. A total of 139 patients (24.8%) temporarily or permanently suspended their treatment, mostly due to impaired access to the hospital (55/90, 61%). Increased fear of contracting COVID-19 was expressed by 195 patients (34.8%) and was correlated with autonomous discontinuation of treatment (rho = 0.220, p = 0.038). In total, 16 out of 561 of patients (2.9%) were infected with SarsCoV-2. Only four individuals necessitated hospitalization and no deaths were recorded. Three-hundred seventy-six individuals (67.2%) declared positive intention to vaccination, while 180 patients (32.2%) were reluctant, mostly due to fear of possible side effects (91.7%). Research in the NHS registry for SARS-CoV-2 showed that none of the patients we were not able to reach by phone had been diagnosed or had died from COVID-19. During the national lockdowns the majority of Greek hospitals suspended the regular workflow, including psoriasis outpatient clinics, due to their engagement in the fight against the pandemic. Hindered access of patients suffering from chronic diseases to the referral centers for their regular followup was expected to affect treatment maintenance and disease outcomes. In our cohort, as reported in many other studies, treatment maintenance in a large proportion of patients in our cohort (75.2%) was essentially feasible via the application of tele-counseling and tele-dermatology services, as also shown also in other studies. In our cohort, we observed a lower rate of COVID-19 diagnoses and hospitalizations as compared to the general population, which is in accordance with another study in the literature. Analytically, Polat et al., found 2.1% positivity and no deaths or intubations. In a multicenter Italian studies the reported hospitalization rate of psoriasis patients was similar to the general population, but lower than ours. Whether the immunomodulating effect of the anti-psoriatic drugs plays a role in controlling the “cytokine storm” of COVID-19 remains to be elucidated. Willingness to vaccinate against COVID-19 depends on various factors, such as perceived health vulnerability to COVID-19, educational status, political and other beliefs, course of the pandemic, as well as emerging news of possible adverse events linked to vaccination. The rate of positive intention in our cohort is similar to the one reported in the general population in US (62.2%), but relatively lower Zoe Apalla and Christina Fotiadou share the first authorship position Received: 24 April 2021 Revised: 19 November 2021 Accepted: 2 December 2021