Hello everyone. I am using some free time to share a series of questions posted by the HS Foundation in response to concerns following the outbreak of the coronavirus pandemic. Let's look at the main information to keep in mind when managing COVID-19 alongside Hidradenitis Suppurativa. This article provides general information, not medical advice. I am not a doctor, and HS has no definitive cure.
What is COVID-19, and why is it different from other types of flu?
- Coronaviruses are a large group of RNA viruses that cause respiratory illnesses. In most cases, COVID-19 causes mild symptoms affecting the upper respiratory tract. Most deaths, however, occur when the lower respiratory tract is involved and a buildup of cytokines leads to acute respiratory distress syndrome.
- The novel coronavirus (SARS-CoV-2) enters our bodies through the respiratory tract via droplets, either when they are inhaled or when a person touches their mouth, nose, or eyes, and causes the disease known as COVID-19.
- The coronavirus is structurally different from the influenza virus. Compared with seasonal flu, early evidence available when this article was published indicated that the novel coronavirus could cause more severe disease and had a higher mortality rate, estimated at the time to be 10 times higher.
- Symptoms of COVID-19 include fever, shortness of breath, cough, loss of smell, and loss of taste, as well as less common symptoms such as nausea, vomiting, and diarrhea. However, many people infected with the virus may have no symptoms.
How does COVID-19 affect Hidradenitis Suppurativa treatment?
- HS itself does not appear to be a specific risk factor for COVID-19.
- People whose HS is well controlled and monitored by a doctor should continue to follow their prescribed treatment plan, including immunomodulatory medications.
- Careful protective measures are essential for people taking immunomodulatory medications. These include physical distancing, staying at home, practicing good hand hygiene, avoiding touching the face, and avoiding anyone who has been exposed to COVID-19 or is unwell.
- If someone develops symptoms of COVID-19 or has had direct contact with a person who has COVID-19, they should call their doctor. Their healthcare professional may recommend delaying a dose of an immunomodulator during the illness.
- Some early reports suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) might worsen COVID-19. However, at the time this article was first published, the World Health Organization (WHO) stated that there was not enough evidence to recommend avoiding NSAIDs. Acetaminophen was considered a more cautious option than NSAIDs while evidence remained limited.
- The medical community was establishing a registry to study the risks and clinical course of COVID-19 infection in people with HS and to learn how best to care for those who developed COVID-19.
How should treatment with biologic medications be managed?
- If a person's HS is well controlled with biologic medications, they should continue their current treatment regimen unless their clinician advises otherwise. This includes anti-TNF medications such as adalimumab [Humira] and infliximab [Remicade], anti-IL-12/23 medications such as ustekinumab [Stelara], and anti-IL-17 medications such as secukinumab [Cosentyx].
- Healthcare professionals and patients should develop a coordinated plan to determine which symptoms might justify delaying a dose.
- Stopping biologic medications is not recommended unless there is a good reason, because there is a risk of an HS flare and a risk of developing anti-drug antibodies that could reduce how well the medication works in the future.
- Everyone with HS who takes biologic medication should understand the importance of hand hygiene and physical distancing.
How should immunosuppressive medications for HS be managed during the COVID-19 pandemic?
- Broad immunosuppressive treatments such as prednisone and methotrexate carry a theoretically higher risk of susceptibility to infection than more targeted immunomodulators. People with symptoms of COVID-19 or a COVID-19 diagnosis should contact their doctor because these medications may need to be paused.
- Some early evidence suggested that immunosuppressive and immunomodulatory medications might have a role in treating the COVID-19-induced cytokine storm that can cause severe respiratory complications, including acute respiratory distress syndrome (ARDS).
- Cytokines known to be involved in this cytokine storm include IL-6, IL-1, IL-18, and IFN-gamma. Medications that target these cytokines, such as IL-6 inhibitors, are not generally the same biologic treatments used for HS. IL-1 inhibitors have occasionally been used off-label for HS, but based on the knowledge available at the time, this did not appear to increase susceptibility to COVID-19.
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