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Associations between COVID-19 and inflammatory skin conditions

Published: January 20, 2021

While the skin manifestations of COVID-19 have been clearly described (occurring in up to 20% of affected individuals), it is less well known how pre-existing inflammatory skin conditions (such as psoriasis and atopic dermatitis) impact patients’ risk of COVID-19. Skin diseases have previously been found to increase susceptibility to different infections (for example, psoriasis and pneumonia) and case reports indicate COVID-19 can exacerbate existing psoriasis.

Patrick et al. applied an integrative approach to evaluate COVID-19 susceptibility in patients with different skin conditions. First, they investigated the epidemiological relationship, controlling for race, age, sex, obesity and social disadvantage, then they performed genomics analysis using gene expression from SARS-CoV-2 infected bronchial epithelial cell lines and case/control studies from nine different inflammatory skin conditions. Finally, they performed a GWAS trans-disease meta-analysis between COVID-19 susceptibility and psoriasis. Their findings, published in The Journal of Allergy and Clinical Immunology (JACI), help to unravel the potential shared immunological components between COVID-19 and skin conditions.

The researchers found that inflammatory skin conditions increase the risk of COVID-19, yet surprisingly reduce the risk of mechanical ventilation, an indicator of COVID-19 severity. This contrasts with other established risk factors, including type 2 diabetes, hypertension and coronary artery disease, which were found to increase both the risk of infection and severity of disease. Significant overlap was observed in gene expression between SARS-CoV-2 infection and the skin conditions, including four S100 family members in the epidermal differentiation complex (EDC). Furthermore, a shared genome-wide significant locus was identified in this region between psoriasis and SARS-CoV-2 infection, with the lead marker being a significant eQTL for S100A12. Applying an advanced subset-based approach to the gene expression data revealed IL-17 signaling as one of the most significantly enriched pathways.

Together, these findings highlight the distinct relationships between COVID-19 and pre-existing skin conditions, and suggest potential roles of lesional skin to increase susceptibility to SARS-CoV-2 through the disrupted epidermal barrier.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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