key: cord-255583-kgph7lr8
authors: Kutlu, Ömer; Metin, Ahmet
title: A case of exacerbation of psoriasis after oseltamivir and hydroxychloroquine in a patient with COVID‐19: Will cases of psoriasis increase after COVID‐19 pandemic?
date: 2020-04-24
journal: Dermatol Ther
DOI: 10.1111/dth.13383
sha: 
doc_id: 255583
cord_uid: kgph7lr8

nan

psoriasis exacerbated with hydroxychloroquine and oseltamivir treatment in a patient with COVID-19 will be presented. A 71-year-old woman with no skin lesions was admitted to the pandemic clinic with the diagnosis of COVID-19. The patient had a history of psoriasis that has been activated occasionally since childhood. The patient was started orally oseltamivir 2 × 75 mg and hydroxychloroquine on 2 × 400 mg on the first day then 2 × 200 mg. On the fourth day of treatment, the patient had an exacerbation of silver-scaled psoriatic plaques spread quickly all over the body separated from the surrounding tissue with sharp borders. This is the first case of exacerbation of psoriasis during COVID-19 infection in a patient receiving oseltamivir versus hydroxychloroquine. The exacerbation of psoriasis in this patient can be explained by several conditions. First, it is well known that hydroxychloroquine is an inhibitor of the epidermal trans-glutaminase, cause to the collection of the epidermal cells. 5 In addition, hydroxychloroquine promotes IL-17 production through p38-dependent IL-23 release resulting in keratinocyte growth and differentiation. 6 Therefore, hydroxychloroquine treatment, which was started as a high dose on the first day, maybe the main factor that exacerbates psoriasis in this patient. To date, we did not find any 10, granulocyte-colony stimulating factor, interferon-inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and tumor necrosis factor α. 7 The increasing some cytokines in the COVID-19 that are also accused in the etiopathogenesis of psoriasis may suggest that COVID-19 may be a new entity that exacerbates psoriasis vulgaris. As a result, it can be speculated that hydroxychloroquine, a commonly used drug for COVID-19 infection, can lead to a worldwide increase number of psoriasis that is prevalence between 1% and 3%. This condition may lead clinicians to new treatments that do not have immunosuppressive properties. 8 

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