Management of pemphigus vulgaris and bullous pemphigoid in times of COVID-19 pandemic

Abstract

Background: The pandemic the world is facing today started in the city of Wuhan, central China, in December 2019, and presented as unexplained lower respiratory infections. On February 11, 2020, the World Health Organization announced that the disease caused by the severe acute respiratory syndrome coronavirus 2 virus be called “corona virus disease 2019 (COVID-19).” Since the beginning of the pandemic there has been quite some debate regarding starting or continuing the treatment of diseases requiring immunosuppression. The major issues arise with management of dermatological diseases, such as vesiculobullous disorders, moderate-to-severe psoriasis, acute severe drug reactions, and connective tissue diseases which would require high level of immune-suppression or immune-modulation as treatment. In this article, we discuss the management strategies adopted for the management of pemphigus vulgaris (PV) and bullous pemphigoid (BP) as the prototypical examples. We will discuss the algorithm we evolved in our department for managing such cases during COVID-19 pandemic to give optimum benefit for our patients along with decreasing their risk for increased vulnerability for severe COVID-19 infection. The same principle can be used for other diseases requiring immunosuppressive or immunomodulatory therapies. Objectives: The management of the patients suffering from BP and PV that came to our department during the national lockdown during COVID-19 pandemic. Materials and Methods: It was a prospective study of 30 consecutive patients that came to our outpatient department either previously diagnosed or as fresh cases of PV or BP. Results: Treating patients with BP or PV during the pandemic has been a challenge. Analyzing the risk versus benefit and making a custom-based treatment helped us minimize the risk for severe COVID-19 infection as well as the side effects due to the primary drugs that are used in BP/PV. We were successful in keeping the primary disease in control. None of our patients was infected with symptomatic COVID-19 infection. Conclusion: With rapidly changing scenario of the pandemic it is very difficult to assess the optimal management of complex diseases such as PV and BP. With contradictory data available whether suppressing the immunity will result in a milder form of COVID 19 with less complications or render the patient at higher risk of complicated COVID-19 is unknown. Thus we, as dermato-physicians, need to keep ourselves and our patients updated, educated, and choose the best possible option where in the risk for severe COVID-19 infection minimized while keeping their primary disease in control.

Keywords

• bullous pemphigoid
• coronavirus disease 2019
• pemphigus vulgaris
• vesiculobullous diseases