Atopic dermatitis is a complex disease with an increased risk of respiratory comorbidities. Atopic dermatitis patients on systemic immune-modulating treatment are a high-risk category for COVID-19 disease.

The European Task Force on Atopic Dermatitis has given some recommendations for atopic dermatitis patients treated with immune-modulating therapy during the SARS-CoV-2 pandemic.

• Continue all immune-modulating treatments, including immunosuppressive therapy, since exacerbations of underlying diseases can have an enormous negative impact on patients’ immunity.
• Strict adherence to the recommendations for patients at risk issued by the local health authorities.
• Practice hygienic procedures using hand wash and disinfectants. Non-irritant soap substitutes should be used in the same way as directed for soap. Moisturizers should be applied afterward.

Considerations regarding comorbidities of atopic dermatitis and pausing systemic therapy in accordance with current guidelines on active infections and systemic therapy.

• Patients diagnosed with coronavirus disease (COVID-19) should undergo interdisciplinary risk assessment first. Immune modulating therapy may or may not be paused afterward, in accordance with current guidelines on active infections and systemic therapy.
• Immune modulating drugs used for treating atopic dermatitis also affect the severity of comorbidities such as asthma, chronic obstructive lung disease, eosinophilic oesophagitis, kidney disease, and severe allergies. The abrupt termination of a stable systemic treatment regimen may lead to exacerbations of atopic dermatitis and such comorbidities.
• If systemic treatment of atopic dermatitis needs to be paused, patients should be supplied with adequate topical therapy and guidance on the amount needed to prevent flares until systemic therapy can be reinstated. Monitoring and treatment of comorbidities such as asthma are required in such a situation.
• Patients with severe and complicated atopic dermatitis should ideally be managed in a specialized, tertiary center.

Predicting interactions of atopic dermatitis, its complications, immunosuppressive and immunomodulating therapies with COVID-19

• Severe and untreated atopic dermatitis is a known risk factor for disseminated viral skin disease. Currently, there is no information on how SARS-CoV-2 affects atopic dermatitis patients and specifically those on immune-modulating therapies.
• Disseminatedviral skin infections such as eczema herpeticum, herpes zoster infection, or seasonal nasopharyngitis observed in atopic dermatitis patients could serve as potential model diseases for assessing the handling of SARS-CoV-2 infection by atopic dermatitis patients on systemic therapy.
• Targeted treatment selectively interfering with type 2 inflammation (like dupilumab) is not considered to increase the risk for viral infections and might thus be preferred compared to conventional systemic immunosuppressive treatments, like cyclosporine, in the pandemic situation.

Resource: Wollenberg A. et al. European task force on atopic dermatitis statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and atopic dermatitis. Journal of the European Academy of Dermatology and Venereology. 2020; 34: e241-e242. Accessed from https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.16411