Summary of COVID-19 medicines guidance: Skin disorders

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and skin disorders.

Our advice is constantly reviewed as the pandemic situation evolves.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NICE: COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response

Last updated 30th April 2020

Our summary:

  • The decision to start/continue immunosuppressive therapy should be done on an individual patient basis taking into account the following:
    • Is it essential to continue or immediately start treatment?
    • If treatment is needed, is there an alternative with a better risk profile?
    • Is the required monitoring and review feasible?
    • Can monitoring be done remotely or at a frequency that minimises the risk to the patient’s safety and wellbeing?
    • Are there any changes to the dose, route of administration or mode of delivery that could make hospital attendance or admission less likely?
  • Patients with suspected or diagnosed COVID-19 infection can continue topical therapies for skin disorders.
  • Patients on steroid therapy should not have their steroids discontinued if COVID-19 infection is suspected or diagnosed.
  • Patients with suspected or confirmed COVID-19 infection can continue taking hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine. All other immunosuppressive therapy must be held and only restarted on the advice of the patient’s dermatology team.
  • The half-life of some drugs means that immunosuppression will continue for some time after stopping treatment.

NHS EnglandHelping prevent facial skin damage beneath tight fitting face piece respirators (FFP 2 and 3 masks)

Last updated October 2020

Our summary:

  • Skin should be kept well hydrated and moisturised. If creams are to be applied, they should be done at least 30 minutes prior to putting on PPE.
  • If PPE is likely to be worn for a prolonged period of time, consider using a barrier preparation to prevent irritation from moisture build-up. The barrier preparation should dry quickly and leave little residue.
  • Skin protectants and emollients containing white soft paraffin are flammable. People are not advised to smoke with these present on their skin.

British Association of Dermatologists: Statement on dry skin and frequent handwashing to reduce Covid-19 risk

Last updated 3rd March 2020

Our summary:

  • Emollients are important in the management of dermatitis, which may occur after frequent handwashing. They should be applied liberally after handwashing and if the skin feels dry

British Association of Dermatologists: Dermatology Advice Regarding Self-Isolation and Immunosuppressed Patients: Adults, Paediatrics and Young People

Last updated 1st August 2020

Our summary:

  • High risk patients that need to be shielded include those on 2 or more of the following:
    • immunosuppressants (excluding hydroxychloroquine, dapsone, acitretin, alitretinoin or sulfasalazine),
    • biological therapies and novel small cell immunosuppressants (e.g. apremilast)
  • Shielding also needs to take place in patients taking steroids for more than 4 weeks (equivalent to prednisolone 20mg daily if monotherapy or 5mg daily if in combination with other immunosuppressants), those who received cyclophosphamide within the past 6 months and those receiving infliximab or rituximab primarily for a skin condition
  • Moderate risk patients that should shield if any other risk factors (e.g. due to age or presence of certain co-morbidities) at present include patients with well controlled conditions and taking monotherapy of immunosuppressants (including biologics and novel small cell immunosuppressants), well controlled patients receiving a biological therapy in combination with standard dose methotrexate, and those on oral immunosuppression in combination with hydroxychloroquine or sulfasalazine

An update on the clinically extremely vulnerable (CEV) and clinically vulnerable patients (previously those who were shielding) has been produced by Royal College of Physicians. The dermatology-specific recommendations can be found via: https://www.bad.org.uk/healthcare-professionals/covid-19/covid-19-immunosuppressed-patients

British Association of Dermatologists: Covid-19: Guidance For Managing Patients On Isotretinoin During the Coronavirus Pandemic

Last updated 26th March 2020

Our summary:

  • If patients are taking isotretinoin and there is a chance of pregnancy, the Pregnancy Prevention Programme should be complied with. Patients can perform pregnancy test at home and send photographic evidence of the result to the dermatology department or show the dermatologist if teleclinics are being performed. It clinic visits or home testing is not possible, isotretinoin should be held

British Association of Dermatologists: Covid-19: Guidance For Managing Urticaria Patients on Omalizumab During the Coronavirus Pandemic

Last updated 26th March 2020

Our summary:

  • When omalizumab is used for the treatment of urticaria, the first 2 doses must be given in hospital but, after that, can be self-administered at home. If the first two doses cannot be administered in hospital during COVID-19 outbreak, treatment should be deferred

 

International Psoriasis Council: Statement On The Coronavirus (COVID-19) Outbreak

Last updated 1st September 2020

Our summary:

  • The extent to which COVID-19 will affect patients with psoriasis and those taking medication for psoriasis is unknown.
  • If a patient with psoriasis develops COVID-19, immunosuppressive therapy must be discontinued or postponed.
  • This is in line with advice from European Dermatology Forum and American Academy of Dermatology, which states immunosuppressive medicines must be stopped during active infections.
  • The decision to hold immunosuppressive treatment in at risk patients must be made on a case-by-case basis, following a risk-benefit analysis.

Last update (10th November 2020): link updated for new version of NHS England advice.