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Guidance on the use of immunosuppressive agents

The Academy strongly recommends that patients should not stop their ongoing systemic immunosuppressive therapy without consulting their physicians.

To better serve patients and their physicians, the Academy has created interim recommendations on the use of immunosuppressive agents and spironolactone during COVID-19, available below.

See the full guidance

See the Academy’s full guidance on use of immunosuppressive agents during COVID-19.

Access guidance

A brief summary follows, but see the PDF for full guidance and references.

1. Patients on systemic immunosuppressive agents who have not tested positive for COVID-19

There is insufficient evidence to recommend discontinuation of systemic immunosuppressive agents at this time. Physicians should use their clinical judgment to stop or continue the patients on these drugs.

2. Patients on systemic immunosuppressive agents who have tested positive for COVID-19

We recommend physicians discontinue or postpone the systemic immunosuppressive agents until the patient recovers from COVID-19, consistent with guidelines on the management of patients with active infections on systemic non-biologic and biologics therapy.

3. Patients who have halted systemic immunosuppressive therapy after testing positive for COVID-19

We recommend physicians can re-initiate the systemic immunosuppressive therapy after ensuring the patients have completely recovered from COVID-19.

4. Patients being considered for systemic immunosuppressive agents

We recommend physicians assess the risk vs. benefits in lower-risk patients before initiating immunosuppressive agents on a case-by-case basis, recognizing that anyone may develop serious complications from COVID-19 infection.

Guidance on the use of spironolactone

There are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients on spironolactone. For patients currently on spironolactone, we recommend continuation of spironolactone for those patients who are currently prescribed such agents for indications for which these agents are known to be beneficial. In the event patients with dermatologic disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient’s status and clinical presentation. Therefore, be advised not to add or remove spironolactone, beyond actions based on standard clinical practice.

All content solely developed by the American Academy of Dermatology