New-Onset and Exacerbation of Psoriasis Following COVID-19 Infection and Vaccination: A Comprehensive Review

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disease influenced by complex interactions of genetic, environmental, and immunological factors [1].The COVID-19 pandemic and the subsequent global rollout of vaccination programs, particularly those involving mRNA vaccines, have brought forth discussions regarding their potential impact on autoimmune skin disorders, including psoriasis [2].This review aims to comprehensively explore the current understanding of how both COVID-19 infection and vaccination influence psoriasis, focusing on disease exacerbations, the proposed underlying pathophysiological mechanisms, and the significant psychological implications for patients [3].Methods: A literature review was conducted to synthesize current evidence on psoriasis flares or new-onset psoriasis following COVID-19 infection and vaccination [4].The search encompassed case reports, observational studies, and cohort data.Primary outcomes assessed included the incidence and severity of psoriasis exacerbations post-infection or post-vaccination, and the proposed pathophysiological mechanisms involved [5].The review also considered the psychological impact of the pandemic and vaccination on psoriasis patients, as well as the overall benefits of vaccination [8,11].Results: Evidence indicates that both COVID-19 infection and mRNA-based vaccines may trigger new-onset or worsen existing psoriasis in susceptible individuals [6].Proposed mechanisms involve heightened immune responses, including the upregulation of cytokines such as .Psychological stress and altered lifestyle factors experienced during the pandemic further contributed to disease exacerbation [8].While statistical data reveal a small but notable number of autoimmune disease flare-ups, including psoriasis, following COVID-19 vaccination [9], the incidence remains low relative to the overall vaccinated population [10].The benefits of COVID-19 vaccination significantly outweigh these potential dermatological risks [11,13].Conclusion: Both COVID-19 infection and vaccination can influence psoriasis progression, with mRNA vaccines being frequently associated with exacerbations [43].However, vaccination remains a crucial strategy in controlling COVID-19, offering substantial benefits in preventing severe complications [13, 44].Pre-vaccination risk assessment and post-vaccination monitoring are critical for optimizing care in psoriasis patients, and a holistic approach incorporating mental health support and lifestyle interventions is essential to improve patient outcomes during and after the pandemic [12, 46].