Case study | 53-year-old patient experiencing psoriasis flare after COVID-19 vaccination

Previous studies have demonstrated that patients with generalized pustular psoriasis may experience disease flare after COVID-19 vaccination.¹ Here, we present a case report by Dayani et al.¹ of a patient experiencing two pustular psoriasis flares after vaccination with the BBIBP-CorV COVID-19 vaccine.

The patient’s psoriasis was managed by adalimumab and required additional treatments to resolve flares (Figure 1).¹

Figure 1. Patient history* 

*Data from Dayani, et al.¹

During their second admission to hospital (Figure 2), the patient presented with a fever of 39°C and was found to have leukocytosis (white blood cell count, 33,600/µL).¹ They also had a negative polymerase chain reaction COVID-19 test.

Figure 2. Patient timeline leading to psoriasis flare* 

Data from Dayani, et al.¹

The flares had a similar presentation to previous flares experienced by the patient after infection (Figure 3). The patient was diagnosed with generalized pustular psoriasis exacerbation caused by the BBIBP-CorV COVID-19 vaccine, which resolved after treatment.¹

Figure 3.  Affected areas during flare* 

*Data from Dayani, et al.¹ 

Question for expert

Expert Opinion

The published clinical case confirmed that the patient has a form of generalized pustular psoriasis who presented two flares after two SARS-CoV-2 vaccinations. This event is described because it is known that a generalized pustular psoriasis flare can be triggered by vaccination, as it represents a strong immunological stimulus.

The relevant clinical question is how to manage the patient in view of upcoming vaccinations.

Given that we do not have predictive criteria to establish whether the patient will develop a flare after any other vaccination, my common sense suggestion is to maintain a continuous biological treatment, such as the one that has been prescribed to control the last flare, and to avoid suspending it before vaccination.

Finally, it should also be considered that the drug spesolimab has recently been approved as an anti-IL-36 receptor monoclonal antibody for the management of flares; this could be used when needed.