Dermatology and COVID-19

Dermatology and COVID-19

Last updated 27 April 2020

Author: Dr Pam Collins, Independent Consultant Occupational Physician


Dermatology condition








Age 70 or above



Renal impairment

Elevate to next level
Immuno-suppressants;- any two agents within the following classes:

Class 1

methotrexate, azathioprine, mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, fumaric acid esters (or dimethyl fumarate), hydroxycarbamide, 6-mercaptourine, leflunomide, cyclophosphamide, tacrolimus, sirolimus and thalidomide.

Class 2

Biologic/monocolonal medications include –all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab pegol and biosimilar variants of all of these, where applicable); IL17/IL17Ra agents (secukinumab; ixekizumab; brodalumab); P40/P19 (ustekinumab; guselkumab, tildrakizumab, risankizumab) anti B cell (rituximab in last 12 months, belimumab); IL6 agents (sarilumab, tocilzumab); abatacept; IL1 (canakinumab, anakinra);

Dupilumab possibly lower infection risk than other drugs)

Class 3

novel small molecule immunosuppressants

apremilast; all JAK inhibitors (e.g.) baracitinib, tofacitinib


• dose of ≥ 20 mg (or 0.5 mg/kg) prednisolone (or equivalent) per day for more than 4 weeks

• dose of ≥ 5 mg prednisolone (or equivalent) per day for more than 4 weeks plus at least one other immunosuppressive medication, from class 1, 2 or 3 drugs as listed above

Cyclophosphamide at any dose orally or if received IV dose within last 6 months

Rituximab or infliximab when prescribed primarily for skin conditions (e.g. psoriasis or pemphigus)

Very high
Well-controlled patients with minimal disease activity and no co-morbidities

single agent, standard oral immunosuppressants, class 1, 2 or 3

single biologic (e.g. anti-TNF, IL17 agent)class 2 plus methotrexate at a standard dose

single agent standard oral immunosuppressant class 1 plus hydroxychloroquine / sulfasalazine.

Medications on the following list alone or in combination:

• Topical skin treatments (creams, gels, etc).

• Hydroxychloroquine

• Acitretin

• Alitretinoin

• Isotretinoin

• Dapsone

• Chloroquine

• 5-ASA medications (e.g. mesalazine)

• Sulfasalazine

• Only inhaled or rectally administered immunosuppressant medication, e.g. steroid inhalers

• Omalizumab



Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.