Hydroxychloroquine effects on psoriasis: A systematic review and a cautionary note for COVID-19 treatment

Abstract

Background: While evidence suggests that hydroxychloroquine (HCQ) may decrease the viral load in patients with a COVID-19 infection, a number of case reports indicate adverse dermatologic effects of this potential treatment.Objective: To conduct a systematic review of previously reported cases of psoriasis onset, exacerbation, or relapse after HCQ treatment.Methods: Embase and MEDLINE were comprehensively searched for original studies examining adverse effects of HCQ treatment related to psoriasis. Participant demographics and details of HCQ administration and psoriasis diagnosis were extracted from 15 articles representing 18 patients.Results: Women accounted for a significantly larger number of cases of psoriasis compared with men and unreported sex (14 [77.8%] vs 2 [11.1%] vs 2 [11.1%], respectively). In addition, 50% (n = 9) of the patients did not have a history of psoriasis before taking HCQ. Of the 18 patients, 9 (50.0%) experienced de novo psoriasis, 5 (27.8%) experienced exacerbation of psoriatic symptoms, and 4 (22.2%) had a relapse of psoriasis after HCQ administration. Conclusion:HCQ treatment may result in induction, exacerbation, or relapse of psoriasis. Monitoring for adverse effects of HCQ treatment is necessary, and clinical trials are essential in characterizing the safety profile of HCQ use in patients with a COVID-19 infection.

Pustular psoriasis exacerbated by COVID ‐19 in a patient with the history of psoriasis

“…So far (August 2020), two cases of plaque psoriasis and one case of guttate psoriasis have been reported secondary to COVID-19. [4][5][6] Ozaras et al, who reported one case of plaque psoriasis, found that after COVID-19 treatment, the patient's psoriatic lesions also regressed without any specific treatment 4 ; in other words, COVID-19 was responsible for these lesions. Here, we reported the first case of pustular psoriasis, exacerbated by COVID-19.…”

“…She had been treated with methotrexate for 1 year (12.5 mg weekly for 3 months and 7.5 mg weekly for the next 9 months), and review, it is mentioned that many of the patients who developed psoriasis also had other inflammatory diseases, which may be a source for F I G U R E 2 Subcorneal pustules covered by a thin layer of orthokeratosis and the exocytosis of neutrophils into spongiotic areas (spongiform pustules), dilated tortuous capillaries in the edematous dermal papillae, and infiltration of mixed inflammatory cells, including lymphocytes and neutrophils F I G U R E 1 Generalized pustular lesions and erythematous scaly lesions concomitant psoriasis, due to cytokine dysregulations such as IL17 and 23. 4 COVID-19 may also cause theses cytokine dysregulations and predispose patients to inflammatory diseases in susceptible patients.…”

Psoriasis andCOVID‐19: A narrative review with treatment considerations

“…Besides well‐known adverse effects of HCQ, including prolonged QT and cardiomyopathy, it is also crucial to recognize the possible impact of HCQ on worsening, recurrence, or new onset of psoriatic lesions. However, given the absence of clear evidence, more extensive studies are needed to validate the findings reported so far 16 …”

“…However, given the absence of clear evidence, more extensive studies are needed to validate the findings reported so far. 16 Azithromycin is a macrolide antimicrobial agent with documented in vitro antiviral and anti-SARS-CoV-2 effects. It may modify SARS-CoV-2 entry by interfering between its spike protein and host ACE2 receptor.…”

What we have learned from the COVID-19 pandemic: Time to think outside the box, maybe far outside

“…The most important is probably a serious cardiac arrhythmia, occurring especially in patients with a prolonged Q–T interval on their electrocardiogram, which may be fatal. 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 Others include blindness, renal failure, worsening of psoriasis, 61 and an occasional severe cutaneous adverse drug reaction, known as generalized pustular figurate erythema. 11 , 12…”