Reply to: "Biologics for psoriasis during COVID-19 outbreak".

To the Editor: We thank Dr Di Lernia for his commentary on the stratification planning of dermatology patients on biologics that has been adopted in Italy. Because there are many patients on biologics and on immunosuppressants for psoriasis, hidradenitis, atopic dermatitis, pemphigoid, pemphigus, and other conditions in Italy and other countries hit by the COVID-19 pandemic, hopefully, we will soon have more information about whether the rate of respiratory decompensation in this population is greater or less than expected. Until then, all we can do is to make educated recommendations. Those advocated by Dr Di Lernia are logical. Suggestions that biologic therapies may abrogate the severe pneumonitis that kills many are hopeful but are as speculative as suggestions made by others that biologics might worsen the course of COVID-19 infection.

Because many biologics have long half-lives, it is neither practical nor logical to cease these over a few weeks while this pandemic is upon us, because it is likely to last months. Furthermore, recent studies have shown that a significant portion of individuals affected by COVID-19 will be asymptomatic carriers and that even those who eventually develop symptoms can transmit the virus to others before developing symptoms. , In light of this, the Centers for Disease Control and Prevention announced the voluntary wearing of nose and mouth coverings, and we recommend that all patients taking biologics wear such coverings or masks when outside the home and practice social distancing.

Currently, there is evidence that supports the accuracy and cost-effectiveness of teledermatology. Telehealth is now accepted in many countries by insurers to mitigate exposures for these patients.