'Shielding' involves self-isolation for a period of 12 weeks and is intended to protect the most vulnerable from COVID-19.
Last updated on Tuesday 24th March.
You may have seen the government’s recent guidance on ‘shielding’ up to 1.5 million people in England who are deemed to be 'extremely vulnerable' to severe illness and hospitalisation from COVID-19 (coronavirus). If you fall into this ‘extremely vulnerable' category, you will be contacted directly by the NHS, advised to stay at home for a period of at least 12 weeks and avoid any face-to-face contact.
If you are only taking a single medication that affects your immune system and have no other medical issues, it is unlikely that you will fall into the ‘extremely vulnerable’ category requiring shielding, but you must continue to follow the latest NHS advice and stay at home nonetheless.
In the meantime, we have put together the following information to help make it clearer for people who are living with psoriasis or psoriatic arthritis whether or not they fall into this ‘extremely vulnerable’ category.
In psoriasis and psoriatic arthritis, people who will be advised to self-isolate for 12 weeks are:
- Those who have the comorbidities listed by NHS England in addition to their psoriasis or psoriatic arthritis (including being aged 70+, Diabetes Mellitus, pregnancy, any pre-existing lung disease (e.g. asthma on medication), chronic kidney disease, any history of Ischaemic Heart Disease or hypertension or other factor deemed to be risk factors by the supervising doctor, OR;
- People who are taking TWO immunomodulatory drugs (please see the list below) for their psoriasis and psoriatic arthritis (except a single biologic in combination with methotrexate).
Definite high risk – to be advised to definitely self-isolate:
You will be asked to self-isolate if you are taking any TWO drugs from the following classes:
- Immunosuppressive medications: Ciclosporin, Fumaric Acid Esters (FAE, Fumaderm and Skilarence – Dimethyl Fumarate), Leflunomide, Methotrexate. This does NOT include Acitretin or Sulphasalazine.
- Biologics: Any Adalimumab biosimilar (e.g. Amgevita, Hulio, Hyrimoz, Imraldi) or Adalimumab originator (Humira), Anakinra (Kineret), Cimzia (Certolizumab pegol), Cosentyx (Secukinumab), Etanercept originator (Enbrel) or Etanercept biosimilars (e.g. Benepali), Ilumetri (Tildrakizumab), Kyntheum (Brodalumab), Infliximab originator (Remicade) or Infliximab biosimilar (e.g. Inflectra, Remsima), Simponi (Golimumab), Skyrizi (Risankizumab), Stelara (Ustekinumab), Taltz (Ixekizumab), Tremfya (Guselkumab)
- Small molecule immunosuppressants: Otezla (Apremilast), JAK inhibitors e.g. Xeljanz (Tofacitinib)
Advised to self-isolate only if there are other concerns, high-risk circumstances or comorbidities (to be decided by your clinician):
You will be asked to self-isolate if you meet any of the following criteria AND you are recommended to do so by your clinician:
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking only ONE of the following: an immunosuppressive medication, a biologic, or a small molecule immunosuppressant (please see the list above for specific examples).
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking ONE biologic (see list above) in combination with methotrexate.
- If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed above, and you are taking ONE immunosuppressive medication (see list above) plus Hydroxychloroquine or Sulphasalazine.
No need to self-isolate:
There is no need to self-isolate, but you must continue to follow the latest NHS advice as per the rest of the UK population, if you are taking any of the following medications, either alone or in combination:
- Topical skin treatments (creams, gels etc.)
Please note that the full Public Health England ‘guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19’ can be found here
The British Association of Dermatologists have put together a useful FAQ section here that includes the following examples:
Examples of the type of patient who would NOT be advised to self-isolate are:
- A person with hidradenitis on Humira (adalimumab) who is 45 and has none of the described comorbidities.
- A person who is 50, on methotrexate up to 25 mg per week, and Humira (adalimumab).
- A person who is 57, on hydroxychloroquine and mycophenolate mofetil and has no other comorbidities.
Examples of the type of patient who WOULD be advised to self-isolate
- A person on any single agent biologic - e.g. you are only using one biologic such as Humira (Adalimumab) or Cosentyx (Secukinumab) at a standard dose, who is more than 70 years old.
- A person on any single agent biologic at a standard dose, who is on medication for hypertension or diabetes or asthma or Ischaemic Heart Disease, or who is pregnant.
- A person on a single agent biologic at a standard dose, with renal (kidney) impairment.
- A person on a single agent biologic at a standard dose, and up to 25mg weekly of methotrexate, who develops any medical problems described in the above three points.
Guy's and St Thomas' NHS Foundation Trust have also put together some Dermatology and coronavirus frequently asked questions. These include a number of FAQs specifically about immunosuppressant medications, social distancing, shielding, and a handy self-assessment risk calculator. Please note, while this resource contains really useful information for everyone, please only contact Guy's and St Thomas' if you are already one of their patients.
The full Public Health England ‘guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19’ can be found here.
For the latest information on COVID-19, please visit the NHS website here.