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Amid the introduction of immunosuppressant therapies and the ongoing pandemic, dermatologists find themselves guiding new decisions for patient treatment around vaccinations.
Though it’s never been an inherent subject in dermatology training, vaccination strategies and guidance have come to the forefront of skin disease management discussions in 2023.
From the COVID-19 pandemic to the risk of suppressed immunity associated with topline biologic therapies, dermatologists find themselves immersed in new discussions with patients regarding prophylaxes—and their line of messaging is still being shaped.
In an interview with HCPLive during the American Academy of Dermatology (AAD) 2023 Annual Meeting in New Orleans this weekend, Megan Noe, MD, MPH, assistant professor of dermatology at Harvard Medical School, discussed her session regarding vaccine controversies in dermatology—a subject that seems to be growing annually, despite the stakeholders’ limited knowledge.
“We don’t do (vaccine) training other than maybe a year in internal medicine,” Noe said. “Because of that, vaccines and preventive care issues aren’t typically part of our education in residency. However, the topics around vaccinations in dermatology patients is really relevant to our current clinical practice.”
Available, pathway-targeting biologic agents like dupilumab are known to impact patients immunologic status, and have warranted education on when treated patients may need increased immunization against an infectious disease or how to monitor a patient’s vulnerability relative to their treatment regimens. A great example of this quandary, Noe said, is with the current state of COVID-19 vaccine recommendations.
“Now that we’re outside of the original series, we’re thinking about boosters: who needs boosters, how many do they need?” Noe said. “And the answer to those questions may be related to someone’s skin disease or what medications they’re on for their disease.”
Noe also stressed the burden of knowing the role of vaccination timing among treated patients, noting that dupilumab’s recently expanded label to include children ≥6 months old with atopic dermatitis could impact the schedule of live vaccines initiated at 12 months, including the first MMR and varicella shots.
The underlying issue is that guidance in balancing vaccines against immunosuppressive therapy is limited, especially for children. Noe mentioned an ongoing longitudinal trial that hopes to “tease this out a little bit more,” but the current recommendation is informed by dupilumab’s manufacturer and advises clinicians pause treatment for 12 weeks prior to vaccination, then wait another 12 weeks after to re-initiate.
“As you can imagine, for a child with severe atopic dermatitis, that may not be feasible,” Noe said. “That’s when I think it is important to have a discussion between parents and the provider about, knowing what you know about this child, how long can we safely hold their dupilumab without risking a flare?”