Association of COVID-19 With Skin Diseases and Relevant Biologics

A Cross-sectional Study Using Nationwide Claim Data in South Korea

S.I. Cho; Y.E. Kim; S.J. Jo


The British Journal of Dermatology. 2021;184(2):296-303. 

In This Article

Abstract and Introduction


Background: As the coronavirus disease 2019 (COVID-19) pandemic has spread, information about COVID-19 and skin disease or related biologics is still lacking.

Objectives: To identify the association between COVID-19 and skin diseases or biologics.

Methods: A nationwide claim dataset relevant to COVID-19 in South Korea was analysed. This dataset included insurance claim data before and during COVID-19 treatment and clinical outcomes. Claim data related to skin diseases and relevant biologics were analysed to determine the association of COVID-19 with skin diseases and relevant biologics.

Results: The dataset contained a total of 234 427 individuals (111 947 male and 122 480 female) who underwent COVID-19 testing. Of them, 7590 (3·2%) were confirmed as having COVID-19, and 227 (3·0%) confirmed patients died. Among various skin diseases and biologics, no significant increase in the presence of specific skin diseases or exposure to biologics was observed in the COVID-19-positive group, even after adjusting for or matching covariates. The presence of skin diseases and exposure to biologics also did not seem to affect clinical outcomes including mortality.

Conclusions: Underlying skin diseases did not appear to increase susceptibility to COVID-19 or mortality from COVID-19. Considering the risks and benefits, biologics for dermatological conditions might be continuously used during the COVID-19 pandemic.


Coronavirus disease 2019 (COVID-19) was first found in Wuhan, Hubei Province, China in December 2019 and has now become a global pandemic.[1] COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is an enveloped, nonsegmented, positive-sense, single-stranded RNA virus.[2] SARS-CoV-2 infection causes immune responses including a T-cell response.[2] Previous studies reported that COVID-19 can cause immune dysregulation in the form of cytokine storms, including an elevation of inflammatory cytokines such as tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-4, IL-12p70 or IL-17A.[3,4]

Many skin diseases, such as alopecia areata, atopic dermatitis, psoriasis, rosacea and vitiligo, are known to be caused by abnormal immunological pathways.[5–9] Classic immunosuppressants are broadly used for various dermatological conditions, and recently, biologics targeting specific cytokines have been widely used in dermatology.[10] Studies of patients with severe COVID-19 reported elevated serum levels of TNF-α and IL-17, which are major targets of biologics in dermatology.[11] In addition, recent articles have reported cases of COVID-19 in dermatological patients under biologic treatments,[12–18] and thus there is a concern regarding maintenance of biologics for skin diseases during the COVID-19 pandemic.[10,19]

South Korea borders China and experienced an early outbreak of COVID-19 in February 2020.[20] Recently, the Ministry of Health and Welfare and the Health Insurance Review & Assessment Service (HIRA) in South Korea opened a dataset of emerging confirmed cases of COVID-19 from the Korea Centers for Disease Control and Prevention (KCDC) and insurance claims relevant to cases of COVID-19 (OpenData4Covid19). In this study, we aimed to identify the association of COVID-19 with the presence of skin diseases and the use of biologics.