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Reynolds SD, Mathur AN, Chiu YE, Brandling-Bennett HA, Pope E, Siegel MP, Holland KE, Paller AS, Siegfried EC, Tom WL, Lara-Corrales I, Tollefson MM, Maguiness S, Eichenfield LF, Sugarman J, Frieden IJ, Oza VS, Cipriano SD, Huang JT, Shah SD, Lauren CT, Castelo-Soccio L, McMahon P, Cordoro KM. Systemic immunosuppressive therapy for inflammatory skin diseases in children: Expert consensus-based guidance for clinical decision-making during the COVID-19 pandemic. Pediatr Dermatol 2020; 37:424-434. [PMID: 32320494 DOI: 10.1111/pde.14202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES The COVID-19 pandemic has raised questions about the approach to management of systemic immunosuppressive therapies for dermatologic indications in children. Change to: Given the absence of data to address concerns related to SARS-CoV-2 infection and systemic immunosuppressive therapies in an evidence-based manner, a Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to offer time-sensitive guidance for clinicians. METHODS A survey was distributed to an expert panel of 37 pediatric dermatologists on the PDCRTF to assess expert opinion and current practice related to three primary domains of systemic therapy: initiation, continuation, and laboratory monitoring. RESULTS Nearly all respondents (97%) reported that the COVID-19 pandemic had impacted their decision to initiate immunosuppressive medications. The majority of pediatric dermatologists (87%) reported that they were pausing or reducing the frequency of laboratory monitoring for certain immunosuppressive medications. In asymptomatic patients, continuing therapy was the most popular choice across all medications queried. The majority agreed that patients on immunosuppressive medications who have a household exposure to COVID-19 or test positive for new infection should temporarily discontinue systemic and biologic medications, with the exception of systemic steroids, which may require tapering. CONCLUSIONS The ultimate decision regarding initiation, continuation, and laboratory monitoring of immunosuppressive therapy during the pandemic requires careful deliberation, consideration of the little evidence available, and discussion with families. Consideration of an individual's adherence to COVID-19 preventive measures, risk of exposure, and the potential severity if infected must be weighed against the dermatological disease, medication, and risks to the patient of tapering or discontinuing therapies.
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Affiliation(s)
- Sean D Reynolds
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Anubhav N Mathur
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather A Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael P Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana, USA
| | - Kristen E Holland
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | | | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Vikash S Oza
- Ronald O Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah D Cipriano
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer T Huang
- Dermatology Program, Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonal D Shah
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Christine T Lauren
- Departments of Dermatology and Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Patrick McMahon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
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