Inflammatory skin conditions may be associated with higher risk for COVID-19, study data published in the Journal of Allergy and Clinical Immunology suggests. In a subsequent gene expression analyses, shared genetic components were also identified in certain skin conditions and the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Investigators conducted an epidemiological study of patients with COVID-19 followed by an analysis of bronchial epithelial cells infected with SARS-CoV-2. Medical records data were extracted from a health system in Michigan. COVID-19 and inflammatory skin conditions were identified using the appropriate diagnostic codes. Multiple logistic regression was used to identify the medical comorbidities were associated with COVID-19 and with severe disease outcomes. Models were adjusted for age, sex, race/ethnicity, obesity, and socioeconomic status. For the transcriptome analysis, investigators compared gene expression across 9 inflammatory skin conditions and bronchial epithelial cells infected with SARS-CoV-2.  Data were also abstracted from a prior genetic meta-analysis of COVID-19 susceptibility to identify potential shared loci between COVID-19 and inflammatory skin conditions.

Medical data were available for 1115 patients with COVID-19, of whom 105 (9.4%) had acne, 38 (3.4%) had atopic dermatitis, 36 (3.2%) had psoriasis, and 35 (3.1%) had rosacea. In logistic regression models, atopic dermatitis (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.06-2.06; P =.020) and psoriasis (OR, 1.48; 95% CI, 1.06-2.07; P =.0.22) were associated with increased odds of COVID-19. However, inflammatory skin conditions appeared to be associated with lower risk for severe COVID-19 outcomes. Specifically, having any skin condition appeared to substantially decrease the odds for ventilation (OR, 0.22; 95% CI, 0.11-0.47; P = 8.5 × 10-5).

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In the transcriptome portion of the study, substantial overlap was observed in gene expression between bronchial epithelial cells infected with SARS-CoV-2 and lesion cells with inflammatory skin disease. In addition, epidermal differentiation complex (EDC) genes were found to be upregulated in both SARS-CoV-2 infection and in inflammatory skin conditions. A shared locus in the EDC was also detected between psoriasis and COVID-19 infection (P = 3.3 × 10-7).

Findings from this multi-omics study underscore a potential association between inflammatory skin conditions and COVID-19. Interestingly, diagnosis with psoriasis or atopic dermatitis appeared to decrease the risk for ventilation with COVID-19. Preliminary genetic data also highlight a potential shared genomic component. “[Although] the epidemiological and genetic findings require additional validation and replication…this work will serve as an important study to reveal individuals that are more susceptible to infection of SARS-CoV-2, and how their pre-existing conditions may affect the course of the disease,” investigators wrote.

Disclosure: Two study authors declared affiliations with the pharmaceutical industry

Please see the original reference for a full list of authors’ disclosures.


Patrick MT, Zhang H, Wasikowski R, et al. Associations between COVID-19 and skin conditions identified through epidemiology and genomic studies Published online January 21, 2021. J Allergy Clin Immunol. doi: 10.1016/j.jaci.2021.01.006