From Wiley via Jisc Publications RouterHistory: received 2021-03-02, accepted 2021-03-15, pub-electronic 2021-05-31Article version: VoRPublication status: Publishe

Griffiths, C.E.M.

Harding‐Oredugba, G.

Hunter, H.J.A.

McMullen, E.

Warren, R.B.

Yiu, Z.Z.N.

ChesterRep

Research letterRisk of COVID-19 infection in adult patientswith atopic eczema and psoriasis: a single-centre cross-sectional studyDOI: 10.1111/bjd.20062DEAR EDITOR, Many studies have investigated risk factors forpoor outcomes following COVID-19. These studies are impor-tant for planning targeted prevention and/or intervention. AUK cohort study found that a composite variable of autoim-mune diseases, representing rheumatoid arthritis, lupus orpsoriasis, was associated with an increased risk of death owingto COVID-19 [hazard ratio 119, 95% confidence interval (CI)111–127].1 In contrast, a case series of patients with COVID-19 in two US centres found that atopic eczema (AE) was asso-ciated with a reduction in the risk of hospitalization inpatients with COVID-19 [odds ratio (OR) 051, 95% CI 025–090].2 Most published studies investigated the risk of infec-tion with SARS-CoV-2 and poor COVID-19 outcomes associ-ated with oral or biological treatment for psoriasis/eczemarather than for the condition itself.3 Our aim was to investi-gate the risk of COVID-19 infection associated with havingpsoriasis or AE in a UK tertiary dermatology centre [SalfordRoyal NHS Foundation Trust (SRFT), Manchester, UK].We performed a cross-sectional study using data extractedfrom the SRFT electronic patient records (EPRs) of inpatientand outpatient visits. SRFT hosts one of the largest UK derma-tology departments; a tertiary psoriasis clinic; and one of thefew inpatient dermatology wards in the country. We includedall patients aged ≥ 18 years who had one or more visits to theSRFT dermatology service between June 2018 and February2021. Our exposure of interest was an inpatient or outpatientdiagnosis of psoriasis or AE. We excluded all individuals whodid not reside in Salford as they were unlikely to have pre-sented to SRFT for COVID-19 testing.Clinical diagnoses were coded using the International Classi-fication of Diseases, 10th Revision codes for inpatient admis-sions. Outpatient diagnoses [including comorbidities ofhypertension, chronic obstructive pulmonary disease and dia-betes mellitus (DM)] were extracted from letters. Data onimmunosuppressive treatments were extracted from letterswhen vulnerable adults were identified for targeted protectionmeasures (‘shielding’), during the COVID-19 pandemic, onthe advice of the UK government in March 2020.4 The mostup-to-date values for age, body mass index (BMI), ethnicityand sex were extracted from the EPR. Our outcome of interestwas patients who had a positive polymerase chain reactionSARS-CoV2 swab test. We also identified individuals who wereadmitted to hospital for management of COVID-19. Thedescriptive data were summarized by median and interquartilerange for continuous data, and by number and percentage fordichotomous/categorical variables. We fitted logistic regres-sion models with COVID-19 diagnosis as the outcome andpsoriasis or AE as the exposure, additionally adjusting forpotential confounders (median-centred age, sex, ethnicity,BMI) and potential mediators between the exposure and theoutcome (hypertension and DM) in separate complete-caseand multiply imputed (MI) (20 sets) models.Information for 56 835 patients was extracted; 13 162patients were eligible for inclusion. There were 1427 (108%)patients with psoriasis and 624 (47%) with AE. In total, 176(13%) of the eligible patients had COVID-19, 38 (216%) ofwhom were hospitalized [two with psoriasis (who recovered),none with AE]. Baseline demographic data are presented inTable 1. We did not find a statistically significant elevated riskfor infection with COVID-19 in patients with psoriasis [unad-justed OR 060 (95% CI 033–108), complete-case adjustedOR 098 (95% CI 046–208), MI adjusted OR 050 (95% CI028–092)] or AE [unadjusted OR 071 (95% CI 031–160),complete-case adjusted OR 060 (95% CI 022–164), MIadjusted OR 067 (95% CI 029–153)].A diagnosis of psoriasis or AE was not associated with anincrease in the risk of testing positive for COVID-19 com-pared with other patients attending the dermatology depart-ment for other conditions such as skin cancer. One of thestrengths of this study is the inclusion of a generalizablepopulation of patients with psoriasis and AE, regardless oftreatment. The limitations of this study include potential mis-classification of confounders (owing to missing informationfrom letters) and outcome (community COVID-19 test resultswere not available), lack of adjustment for potential con-founders such as smoking, and effect estimate imprecision.Additionally, patients with inflammatory skin diseases maypractice stricter shielding measures, which could explain thehalving in risk for psoriasis in the MI adjusted analysis. Ithas been shown that people with psoriasis receiving targetedbiological and systemic therapies are likely to follow themost stringent risk-mitigating behaviours.5 In conclusion,psoriasis and AE were not associated with an increased riskof testing positive for COVID-19. On this evidence, itappears that psoriasis and AE should not be considered asrisk factors for contracting COVID-19. Further research inlarger cohorts with representative denominators is needed toconfirm this finding.© 2021 The Authors. British Journal of Dermatologypublished by John Wiley & Sons Ltd on behalf of British Association of DermatologistsBritish Journal of Dermatology (2021) 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.Z.Z.N. Yiu iD ,1 G. Harding-Oredugba,2 C.E.M. Griffiths iD ,1R.B. Warren iD ,1 E. McMullen1 and H.J.A. Hunter11Centre for Dermatology Research, Salford Royal NHS Foundation Trust, TheUniversity of Manchester, Manchester Academic Health Science Centre,National Institute for Health Research (NIHR) Manchester BiomedicalResearch Centre and 2Business Information Department, Salford Royal NHSFoundation Trust, Manchester Academic Health Science Centre, Manchester,UKEmail: zenas.yiu@manchester.ac.ukReferences1 Williamson EJ, Walker AJ, Bhaskaran K et al. Factors associated withCOVID-19-related death using OpenSAFELY. Nature 2020; 584:430–6.2 Keswani A, Dhana K, Rosenthal JA et al. Atopy is predictive of adecreased need for hospitalization for coronavirus disease 2019. AnnAllergy Asthma Immunol 2020; 125:479–81.3 Gelfand JM, Armstrong AW, Bell S et al. National Psoriasis Founda-tion COVID-19 Task Force guidance for management of psoriaticdisease during the pandemic: version 2 - advances in psoriatic dis-ease management, COVID-19 vaccines, and COVID-19 treatments. JAm Acad Dermatol 2021; 84:1254–68.4 Khan SS, Marshall CL, Stylianou KA et al. An evaluation of dermatol-ogy patients shielding during the COVID-19 outbreak. Clin Exp Der-matol 2021; 46:193–4.5 Mahil SK, Yates M, Langan SM et al. Risk-mitigating behaviours inpeople with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patientsurvey. Br J Dermatol 2020; https://doi.org/10.1111/bjd.19755.Funding sources: none.Conflicts of interest: C.E.M.G. reported receiving honoraria and/orresearch grant support (University of Manchester) from AbbVie, Almi-rall, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, the LEOFoundation, Eli Lilly, Nestle Skin Health, Novartis, Pfizer, Sandoz, SunPharma and UCB Pharma. R.B.W. reported receiving honoraria and/orresearch grants from AbbVie, Almirall, Amgen, Arena, Avillion, Boeh-ringer Ingelheim, Bristol Myers Squibb, Celgene, GlaxoSmithKline,Janssen, LEO, Eli Lilly, Novartis, Pfizer, Sanofi, Xenoport and UCBPharma. H.J.A.H. reports receiving grants and personal fees from Pfi-zer, Janssen, Merck Serono, AbbVie, UCB, Sanofi Genzyme, Novartis,Almirall, Lilly and LEO.Peer review: the peer review history for this article is available athttps://publons.com/publon/10.1111/bjd.20062.Table 1 Characteristics of study population by COVID-19 infectionstatusPatient characteristicIndividuals withno history ofCOVID-19infection(N = 12 986)Individuals withhistory ofCOVID-19infection(N = 176)Age, years 550 (360–710) 750 (590–830)SexMale 5464 (421) 88 (500)Female 7522 (579) 88 (500)Body mass index 274 (240–316) 283 (249–329)Missing 7609 (572) 53 (301)EthnicityWhite 12 157 (936) 173 (983)Afro-Caribbean 69 (05) 0 (00)South Asian 154 (12) 3 (17)Other Asian 144 (11) 0 (00)Mixed 65 (05) 0 (00)Other ethnicgroups159 (12) 0 (00)Not recorded 238 (18) 0 (00)Disease exposuresPsoriasis 1415 (109) 12 (68)Atopic eczema 618 (48) 6 (34)Hypertension 100 (08) 6 (34)Chronic obstructivepulmonary disease16 (01) 0 (00)Diabetes 63 (05) 1 (06)Systemic treatment historyTumour necrosisfactor inhibitor68 (05) 0 (00)Interleukin 17/23inhibitor41 (03) 0 (00)Prednisolone 20 (02) 0 (00)Dupilumab 18 (01) 0 (00)Admission owingto COVID-190 (00) 38 (216)Continuous data are presented as median and interquartile range;dichotomous/categorical variables are presented as n (%).© 2021 The Authors. British Journal of Dermatologypublished by John Wiley & Sons Ltd on behalf of British Association of DermatologistsBritish Journal of Dermatology (2021)2 Research letter

Risk of COVID‐19 infection in adult patients with atopic eczema and psoriasis: a single‐centre cross‐sectional study

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Risk of COVID‐19 infection in adult patients with atopic eczema and psoriasis: a single‐centre cross‐sectional study

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