Derms say certain oral meds for skin conditions are 'like throwing a grenade at your immune system.'

By Kiera Carter
Mar 31, 2020 @ 12:00 pm
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You probably have about four billion things on your mind right now, but they all ladder up to the same goal: avoiding the coronavirus like the modern-day plague it is. And now that you’re basically an Olympic athlete at washing your hands (too soon? RIP Olympics), you may be considering next-level ways to prevent the coronavirus from upheaving your life any more than it already has.

That’s why some people are taking a hard look at their beauty products and skincare regimens. One place you may want to start is with spironolactone, an oral medication frequently prescribed for acne. According to one outspoken New York City-based derm who posted about her concerns with the drug on Instagram, there's a chance it could up your risk for coronavirus.

“The virus can attach to cell receptors in your upper respiratory tract, allowing it to enter the cell, reproduce, and make you sick,” says Ellen Marmur, M.D., dermatologist and founder of MMSkincare. Spironolactone, a blood pressure medication also prescribed for acne, has been shown in one 2005 study to increase the number of receptors on these cells, essentially creating more entry points for the virus.

 

 

Is the concern about spironolactone legit?

 

To be clear, not every doc is worried about this — or thinks the limited research on the topic is strong enough to warrant concern. “Spironolactone should not pose any risk in terms of coronavirus,” says Zenovia Gabriel, M.D., a dermatologist practicing in Newport Beach, CA. “There are no physiologic reasons why spironolactone would cause reason for concern at this time."

The problem is, there’s really no way to confirm the connection. As Dr. Marmur points out: “You’ll never have a study where you give some people spironolactone and others a placebo, expose them all to the coronavirus, then see who dies.”

The American Academy of Dermatology has not said to stop spironolactone, but as far as Dr. Marmur is concerned, it’s not worth the risk. Even though acne sucks, it doesn’t suck as much as the coronavirus. “I love spironolactone. I call it the magic bullet for female acne,” she says, noting that it mellows out the hormones behind lots of breakouts. “But I feel very strongly about ‘doing no harm,’ from the Hippocratic oath, so at this moment, it’s worth discussing an alternative with your doctor, via telemedicine, of course.” (Note: She’s talking about people taking the medication for acne, not other more serious conditions, like heart disease and PCOS.)

Could any other meds affect my risk of contracting coronavirus?

Sadly, yes, particularly some oral meds prescribed for immune-related skin conditions like eczema and psoriasis. “You don’t need to worry about topical steroids because they don’t get absorbed systemically,” says Dr. Gabriel. “But taking an oral steroid like prednisone [for eczema] is like throwing a grenade at your immune system.”

Other oral medications to watch out for: Methotrexate, mycophenolate, and cyclosporine are all potent immunosuppressants and used to treat psoriasis, says Craig A. Kraffert, M.D., dermatologist and president of Amarte Skin Care. “These aren’t widely prescribed because more targeted treatments are available, but they could be a potential problem.” (More on those targeted treatments in a bit.)

FYI: While these conditions can be painful in their own right, it’s worth noting that they don’t up your risk for coronavirus, since it isn’t transmitted through skin. “Cracked skin does compromise your barrier and you have a higher risk of bacterial infections, but the coronavirus is transmitted through lung tissue, not skin,” Dr. Garbriel says. At least there’s that.

So, what’s my game plan during the coronavirus pandemic?

It’s worth repeating: You need to tele-chat your doc to determine your best course of action if you’re taking any meds, skin-related or otherwise. Some will be either fine to continue or potentially dangerous to cut cold turkey (very important: you need to taper off of prednisone and other steroids, for example).

There are other options: Dr. Marmur suggests spironolactone patients consider switching to minocycline, doxycycline, or tetracycline, which are all antibiotics that can also be used to treat acne — and aren’t believed to have any significant impact on the immune system. And like Dr. Gabriel said earlier, topicals are fair game, so there’s no need to cut back on your prescription retinol or any of your other go-to creams.

If you struggle with serious eczema or psoriasis, something called biologic treatments are probably a better choice given that they’re more targeted in their approach. “Unlike a grenade that blows everything up around it, these are more like ‘stealth laser bombers’ that attack a specific signal for less overall immunosuppressive effects,” Dr. Gabriel says. Only problem is, if you’re not already on them, you need to see your doctor for an injection. So depending on your specific situation, you’ll likely need to wait out your appointment given, you know, all this. Again, give your derm a call to talk through your best options.

And BTW, there are easy ways to make your immune system stronger regardless of your RX status: a low inflammation diet, exercise, and sleep, which is “massively beneficial to the immune system,” Dr. Gabriel says. Hope you’re at least getting that in spades right now, Tiger King binges notwithstanding.

The coronavirus pandemic is unfolding in real time, and guidelines change by the minute. We promise to give you the latest information at time of publishing, but please refer to the CDC and WHO for updates.