If you have an autoimmune disorder like psoriasis, it can be a constant balancing act. One of many triggers can cause your immune system to act up and start a flare. You need to be careful about anything that could either make you more susceptible to illness or make your existing condition worse. People with immune conditions may wonder how vaccines, like the COVID-19 vaccine, could affect them because vaccines work with the immune system.

With the introduction of the COVID-19 vaccine, which can protect you from getting COVID-19, and monoclonal antibody treatments for the virus, it’s important to understand the difference between how they work and how they may affect you.

Read on to learn more about COVID-19 vaccines, monoclonal antibody treatments for COVID-19, and what you need to know about them if you’re living with psoriasis.

How COVID-19 Vaccines Work

Vaccines rely on using your body’s immune system memory to fight off potential infectious diseases. They work by “showing” your body either a weakened or an inactive part of a pathogen — an infectious agent such as a virus, bacteria, or fungus or other toxins. This part of the pathogen, called an antigen, triggers an immune response: Your body will recognize the antigen as a foreign invader, and cells in your immune system called B cells will produce antibodies — disease-fighting cells — to attack the associated pathogen.

Antibodies are proteins that flow in your bloodstream and recognize and attach to specific foreign substances called antigens that enter your body. They can bind to an antigen, blocking its ability to cause disease, or they can tag the antigen to be destroyed by T cells with the help of other circulating immune cells.

Your immune system has a memory system, so once you’ve received a vaccine and your body has fought off the infection, your immune system will remember it. If your body encounters that same infectious agent again, your immune system will recognize it more quickly and fight it off much more effectively than if it had never seen it before.

There are four COVID-19 vaccines approved for use in the U.S., and they’re made of different ingredients:

• Pfizer — A messenger RNA (mRNA) vaccine
• Moderna — An mRNA vaccine
• Novavax — A protein subunit vaccine
• Johnson & Johnson — A viral vector vaccine

Boosters are also available for COVID-19 vaccines. Booster shots are extra doses of a vaccine that can increase the amount of antibodies already in your body from the first vaccine or from a previous infection.

Side effects of the COVID-19 vaccine tend to be mild and include fevers, chills, headaches, and lack of energy. Severe side effects can happen, including allergic reactions, heart conditions known as myocarditis and pericarditis, and blood clots.

COVID-19 Vaccines and Psoriasis

If you have psoriasis and are taking an immunosuppressant medication (medicine that reduces the activity of the immune system), you may be at higher risk of illness and death from COVID-19. Because recommendations can vary by age, type of immunosuppressant medication, and more, it is best to speak to your doctor before getting any particular type of vaccine.

The timeline for receiving booster shots after the primary vaccine series varies depending on which COVID-19 vaccine you received. The same is true for boosters — the timelines after the primary vaccine series vary depending on which COVID-19 primary vaccine you received. Research has found that people sometimes experience psoriasis flare-ups after receiving a COVID-19 vaccine.

Members of MyPsoriarisTeam have also described their thoughts after receiving the COVID-19 vaccine. “I got Pfizer for all three shots and felt tired but overall happy with my outcome. So, no COVID for me,” one member wrote.

Another member said, “With every COVID shot and booster, I seem to get my psoriasis and psoriatic arthritis symptoms more in check.”

Monoclonal Antibody Treatments for COVID-19

Monoclonal antibody treatments for COVID-19 made headlines in 2020 and 2021 after several received emergency use authorization from the U.S. Food and Drug Administration (FDA) for treating COVID-19 infection. You may already be familiar with these types of treatments, as there are several on the market that treat psoriasis, as well as multiple sclerosis, rheumatoid arthritis, and many other conditions.

The general theory behind monoclonal antibody treatments is that they enhance the body’s natural immunity to fight off disease. Unlike vaccines, these treatments contain synthetic antibodies –– meaning they’re created in a laboratory. They function very similarly to regular antibodies in your immune system, with the goal of destroying an invading antigen.

A vaccine is meant to help prevent infection, and monoclonal antibody treatments are used to help treat an infection after you’ve contracted it.

Initially, COVID-19 monoclonal antibodies were shown to reduce the severity of the disease by decreasing hospitalizations and risk of death. Their effectiveness in treating COVID-19, however, can vary significantly depending on which variant or subvariant of the coronavirus is most dominant. The FDA determined that these treatments aren’t effective in treating the current dominant variant of the virus that causes COVID-19, Omicron. As such, these treatments — which include tocilizumab, bamlanivimab, bebtelovimab, sotrovimab, and others — currently aren’t authorized for use in the U.S.

Importantly, even if the FDA does approve monoclonal antibody therapy in the future for an active COVID-19 infection, they’re still no substitutes for a COVID-19 vaccine. Although these therapies may help a person fight COVID-19 once they’ve been infected, they don’t prevent the condition like a vaccine does.

Monoclonal Antibody Treatments for Psoriasis

Monoclonal antibody treatments for COVID-19 are different from those used to treat psoriasis. Monoclonal antibody treatments for COVID-19 aren’t authorized for use in the U.S., while those for psoriasis remain effective FDA-approved treatments.

Monoclonal antibody treatments fall into a medication category known as biologics. Biologics act differently than other types of psoriasis medications, such as methotrexate or cyclosporine, which suppress the immune system. Biologics target specific proteins that are responsible for causing the immune system to go into overdrive, which then causes disease.

In general, biologics are used to treat psoriasis when the disease is moderate or severe and when topical (applied directly to the skin) medications, phototherapy, or other first-line treatments are not effective.

Some common monoclonal antibody treatments used to treat psoriasis include ixekizumab (Taltz), infliximab (Remicade), and adalimumab (Humira). Side effects of such medications are often similar to what you would experience fighting off an infection. These symptoms can include fevers and chills, rash, muscle pain, or diarrhea.

Members of MyPsoriasisTeam have discussed using biologic medications. One member wrote, “Over 80 percent of my body was covered with psoriasis. Three years ago, I started using biologics. Since then, I have been over 95 percent clear of the psoriasis.”

Getting COVID-19 Vaccines While Taking Biologics for Psoriasis

If you’re using a monoclonal antibody treatment for psoriasis, you may be wondering whether getting a COVID-19 vaccine or booster is safe. A study published in 2022 investigated the effectiveness of three doses of the BNT162b2 (Pfizer) mRNA COVID-19 vaccine in 45 people living with psoriasis who were taking biologic medications — including monoclonal antibody medications. This study found that vaccine uptake was the same as compared to healthy controls (those who do not have the condition being studied) and that the participants didn’t experience flares after vaccination.

In summary, you can be actively taking a monoclonal antibody medication for your psoriasis treatment and receive a COVID-19 vaccine or booster, but you should speak to your doctor first. They’ll also consider other medications you’re taking, such as methotrexate or another medication that interferes with your immune system. Getting a vaccination while using one of these immunosuppressive drugs could put you at a higher risk for a flare.

Generally speaking, though, health experts recommend that most people with psoriasis receive the COVID-19 vaccine, as the benefits of preventing infection outweigh the risk of a flare. However, you and your doctor should give careful consideration to starting on a new biologic medication for psoriasis soon after you’ve received a COVID-19 vaccine. It’s similarly important to take necessary care in timing a COVID-19 vaccination after a monoclonal antibody infusion for psoriasis. Additionally, if you’re experiencing a severe flare or if your psoriasis is active, it’s recommended to delay getting vaccinated until your condition is stable.

Always speak to your doctor if you have questions or concerns about your medication, the COVID-19 vaccine, and how they might interact with each other. Each person is different, and you’ll need to be fully informed about how your medications, immune system, and a vaccine could interact with one another.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis and have questions about COVID-19? Share your experience in the comments below, or start a conversation by posting on your Activities page.