4 Patients known or suspected to have COVID-19

4 Patients known or suspected to have COVID-19

4.1 Be aware that patients taking drugs that affect the immune system may have atypical presentations of COVID‑19. For example, patients taking prednisolone may not develop a fever.

4.2 If patients with known or suspected COVID‑19 need to attend the dermatology department, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on patient transfers and options for outpatient settings.

4.3 If COVID‑19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance for health professionals.

Topical treatment

4.4 In patients known or suspected to have COVID‑19:

  • continue topical treatments

  • think about treating new-onset dermatological conditions with topical treatments rather than new systemic treatments that affect the immune system.

Systemic treatment

4.5 In patients known or suspected to have COVID‑19:

  • do not suddenly stop oral corticosteroids

  • continue hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine

  • consider temporarily stopping all other oral immunosuppressive therapies, novel small-molecule immunosuppressants, biological therapies and monoclonal antibodies, and contact the dermatology department for advice on when to restart treatment.

    The half-life of some drugs means that immunosuppression will continue for some time after stopping treatment. See the BNF and the summaries of product characteristics (SPCs) for specific information about individual drugs. [amended 30 April 2020]

4.6 When deciding whether to stop treatment, discuss the risks and benefits with the patient, or their parent or carer, and take into account:

  • whether COVID‑19 is confirmed

  • the severity of the COVID‑19

  • the risks and benefits of stopping or continuing treatment

  • the severity of the dermatological condition

  • the effect of stopping treatment on other conditions, for example the effect on asthma of stopping dupilumab

  • other risk factors such as age and comorbidities, for example respiratory or cardiovascular conditions.