Psoriasis and infection. A clinical practice narrative

Marius Rademaker, Karen Agnew, Nicholas Anagnostou, Megan Andrews, Katherine Armour, Christopher Baker, Peter Foley, Kurt Gebauer, Monisha Gupta, Gillian Marshman, Diana Rubel, John Sullivan, Li Chuen Wong

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on risk assessment for that patient, taking into account the infection being treated, the risk of recurrent infection, any interventions that can modify the risk and the need for psoriasis control. Live vaccines (e.g. MMR, varicella, zoster and yellow fever) are generally contraindicated in patients with psoriasis on immune-modulatory agents, but this depends on the degree of immune suppression and individual risk factors. Wound healing in psoriasis is normal. Treatment with infliximab, adalimumab, etanercept, methotrexate and ciclosporin can safely be continued through low-risk surgical procedures. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.

Original languageEnglish
Pages (from-to)91-98
Number of pages8
JournalAustralasian Journal of Dermatology
Volume60
Issue number2
DOIs
Publication statusPublished - 1 May 2019

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Psoriasis
Infection
Measles-Mumps-Rubella Vaccine
Chlamydophila psittaci
Yellow Fever
Therapeutics
Porphyromonas gingivalis
Chickenpox
Microbiota
Herpes Zoster
Streptococcus
Candida albicans
Methotrexate
Hepacivirus
Wound Healing
Cyclosporine
Staphylococcus aureus
Comorbidity
HIV
Skin

Cite this

Rademaker, M., Agnew, K., Anagnostou, N., Andrews, M., Armour, K., Baker, C., ... Wong, L. C. (2019). Psoriasis and infection. A clinical practice narrative. Australasian Journal of Dermatology, 60(2), 91-98. https://doi.org/10.1111/ajd.12895
Rademaker, Marius ; Agnew, Karen ; Anagnostou, Nicholas ; Andrews, Megan ; Armour, Katherine ; Baker, Christopher ; Foley, Peter ; Gebauer, Kurt ; Gupta, Monisha ; Marshman, Gillian ; Rubel, Diana ; Sullivan, John ; Wong, Li Chuen. / Psoriasis and infection. A clinical practice narrative. In: Australasian Journal of Dermatology. 2019 ; Vol. 60, No. 2. pp. 91-98.
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Rademaker, M, Agnew, K, Anagnostou, N, Andrews, M, Armour, K, Baker, C, Foley, P, Gebauer, K, Gupta, M, Marshman, G, Rubel, D, Sullivan, J & Wong, LC 2019, 'Psoriasis and infection. A clinical practice narrative' Australasian Journal of Dermatology, vol. 60, no. 2, pp. 91-98. https://doi.org/10.1111/ajd.12895

Psoriasis and infection. A clinical practice narrative. / Rademaker, Marius; Agnew, Karen; Anagnostou, Nicholas; Andrews, Megan; Armour, Katherine; Baker, Christopher; Foley, Peter; Gebauer, Kurt; Gupta, Monisha; Marshman, Gillian; Rubel, Diana; Sullivan, John; Wong, Li Chuen.

In: Australasian Journal of Dermatology, Vol. 60, No. 2, 01.05.2019, p. 91-98.

Research output: Contribution to journalReview article

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AU - Armour, Katherine

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AU - Foley, Peter

AU - Gebauer, Kurt

AU - Gupta, Monisha

AU - Marshman, Gillian

AU - Rubel, Diana

AU - Sullivan, John

AU - Wong, Li Chuen

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Rademaker M, Agnew K, Anagnostou N, Andrews M, Armour K, Baker C et al. Psoriasis and infection. A clinical practice narrative. Australasian Journal of Dermatology. 2019 May 1;60(2):91-98. https://doi.org/10.1111/ajd.12895