TY - JOUR
T1 - Systemic immunosuppressive therapy for inflammatory skin diseases in children
T2 - Expert consensus-based guidance for clinical decision-making during the COVID-19 pandemic
AU - Reynolds, Sean D.
AU - Mathur, Anubhav N.
AU - Chiu, Yvonne E.
AU - Brandling-Bennett, Heather A.
AU - Pope, Elena
AU - Siegel, Michael P.
AU - Holland, Kristen E.
AU - Paller, Amy S.
AU - Siegfried, Elaine C.
AU - Tom, Wynnis L.
AU - Lara-Corrales, Irene
AU - Tollefson, Megha M.
AU - Maguiness, Sheilagh
AU - Eichenfield, Lawrence F.
AU - Sugarman, Jeffrey
AU - Frieden, Ilona J.
AU - Oza, Vikash S.
AU - Cipriano, Sarah D.
AU - Huang, Jennifer T.
AU - Shah, Sonal D.
AU - Lauren, Christine T.
AU - Castelo-Soccio, Leslie
AU - McMahon, Patrick
AU - Cordoro, Kelly M.
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - infection - viral
KW - inflammatory disorders
KW - therapy - systemic
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U2 - 10.1111/pde.14202
DO - 10.1111/pde.14202
M3 - Review article
C2 - 32320494
AN - SCOPUS:85084616464
SN - 0736-8046
VL - 37
SP - 424
EP - 434
JO - Pediatric Dermatology
JF - Pediatric Dermatology
IS - 3
ER -