By Dr. Vera Tengattini and Dr. Ilaria Denti
Vaccinations are important for everyone, but even more so for patients with psoriasis. Indeed, psoriasis and a number of treatments used to combat the disease can increase the risk of contracting certain illnesses, such as the flu; illnesses that vaccinations can prevent, at least in part.
Like all drugs, vaccines have their own contraindications. For the sake of clarity, a contraindication is defined:
A condition (a disease, for example) that the person receiving the vaccine has, and that increases the risk of severe reactions (1).
A vaccine should be administered with extreme caution when there is a contraindication, because the risk of adverse events may be greater than the potential advantages of the vaccination. Psoriasis itself is not an absolute contraindication to vaccination, but patients should consult their doctor before receiving any kind of vaccine, to evaluate the status of their illness, and the type of treatment they are receiving (2).
Generally, vaccines produced from inactive viruses or bacteria (the majority of vaccines, such as the split flu vaccine) cause no problems for people with psoriasis, while those obtained from live attenuated viruses or bacteria (such as the Rubella vaccine) must be used with extreme caution, particularly in patients taking systemic treatments (e.g. methotrexate, ciclosporin, or biological drugs) (3, 4). All vaccines should in any case be avoided during a flare-up of the disease (5); pricking the skin with a needle could cause a type of reaction called the Koebner response (named after the dermatologist who described it for the first time in the nineteenth century), regardless of the type of substance injected.
The Ministry of Health recommends that all patients in treatment with immunosuppressants (e.g. azathioprine, ciclosporin, methotrexate, systemic corticosteroids, biological drugs) should receive the flu vaccine, including, therefore, the patients with psoriasis who are being treated with these drugs (6), since the annual flu vaccine in psoriasis patients in treatment with biological drugs is a safe and effective means of preventing the flu syndrome and its complications, as stressed by the Medical Board of the National Psoriasis Foundation (7). At the doctor’s discretion, the seasonal flu vaccine can be associated with the anti-pneumococcal vaccine; these can be administered at the same time (one in each arm), with no need to suspend treatment. A 2011 study published in the journal Arthritis Research and Therapy showed that the anti-herpes zoster vaccine (consisting of a live attenuated virus) is also safe for those with autoimmune diseases in treatment with biological drugs or immunosuppressants, as long as the patient’s immune system is not severely compromised (8).
If a patient is scheduled to begin long-term immunosuppressant treatment (longer than 28 days), routine and additional vaccinations should ideally be given before beginning immunosuppressant treatment, to allow the best possible response to the vaccine (5). It is therefore vital for patients to consult their dermatologist, in order to draw up the most suitable vaccination schedule, taking the start of systemic treatment and disease status into account.
- WHO. Vaccine safety basic learning course.
- Epidemiology and Prevention of Vaccine-Preventable Diseases The Pink Book: Course Textbook – 13th Edition (2015) CDC- Centers for Disease Control and Prevention
- Rahier JF et al. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology (Oxford). 2010 Oct PMID: 20591834
- Rademaker M, at al. Psoriasis and infection. A clinical practice narrative. Australas J Dermatol. 2018 Aug 5. Review. PubMed PMID: 30079566
- Guida alle controindicazioni alle vaccinazioni. Quinta edizione – Febbraio 2018 A cura di Ministero della salute, Consiglio superiore di sanità
- Lebwohl m et al. From the medical Board of the Nation Psoriasis Foundation JAAS 2008
- Zhang J et al. The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study. Arthritis Res Ther. 2011 PMID: 22024532