## 3 Results
### Impact of SARS-CoV-2 Vaccines on Patients with Psoriasis
Following immunization, five cases of psoriasis flare were treated with topical calcipotriol/betamethasone and nine cases with systemic drugs or phototherapy [84]. Psoriasis aggravation following SARS-CoV-2 vaccination can be related to the activation of humoral and cell-mediated immune responses, with Th17 playing a critical role [85, 86]. Following that, [PERSON] et al. documented 11 occurrences of psoriasis aggravation (8 male 72.7%, mean age 54.5 \(\pm\) 8.9 years) following COVID-19 immunization with Pfizer mRNABNT162b2, Moderna mRNA-1273, or AstraZeneca-Oxford AZD1222 from February to July 2021, in contrast to [PERSON]. Contrary to [PERSON] et al., 54.5% of psoriasis flares associated with the COVID-19 vaccination occurred in individuals receiving biologic therapy. To control flares in these patients, topical calcipotriol/betamethasone and/or phototherapy were added to existing biologic therapy in four cases, while switching biologic agents was essential in the other two cases [87]. [PERSON] et al. conducted a survey to determine the safety of SARS-CoV-2 vaccinations in patients with psoriasis who were receiving biologic therapy. Over a three-month period, 150 patients with stable plaque psoriasis who had been treated with biologics for at least two months were examined. Fifty patients (22 females and 28 males; ages ranged from 33 to 83 years) received just the first and second doses of SARS-CoV-2 vaccination. All patients were instructed to abstain from biological agents for ten days prior to and ten days following each dose of vaccination. A total of 24 patients received anti-TNF therapy, 14 got anti-IL17, 7 underwent anti-IL12-23 treatment, and 5 received anti-IL23. Following vaccination, all patients were examined for local and/or systemic side effects and/or potential adverse drug responses to SARS-CoV-2 vaccinations on days 2, 7, and 14. There were no adverse effects or psoriatic flares in any of the individuals. Only one patient treated with an infliximab biosimilar was referred to for psoriasis aggravation following vaccination. The remaining 100 patients stated they had not received the immunization as of yet [88]. [PERSON] et al. described two episodes of aggravation of plaque psoriasis following administration of COVID-19 vaccines inactivated and BNT162b2 mRNA. One instance occurred one month after the second dose of vaccination was administered (CoronaVac, China), and another happened after the first dosage was administered (Pfizer/Biontech, Germany), with extensive plaque expansion two weeks following the second dose of vaccine. Both individuals did not get systemic psoriasis therapy [89]. [PERSON] et al. described the beginning of generalized pustular psoriasis four days after receiving the first dose of the inactivated SARS-CoV-2 vaccine (CoronaVac, China) in a 72-year-old man who had previously been treated with topicals [90]. [PERSON] et al. described a case of new-onset guttate psoriasis in a 79-year-old female following the BNT162b2 mRNA vaccination. The rash began 10 days after the first dosage and flared up following the second treatment. Topical calcipotriol/betamethasone ointment and UVB phototherapy have been used to treat flares [91]. [PERSON] et al. described an aggravation of plaque psoriasis in a patient who had previously obtained full remission following deucravacitinib treatment during a clinical study. Five days after receiving the second dose of BNT162b2 mRNA SARS-CoV-2 vaccination, the patient developed psoriasis [92]. However, [PERSON] et al. observed that, in a group of 131 individuals with psoriatic arthritis, the PASI value remained constant in the majority of cases following immunization [93].