BI19 Risk management of infectious diseases in dermatology: a comprehensive clinical framework for patients being managed with immunosuppressants and biological agents

Abstract

Immunosuppressants and biologic agents are central to the management of many dermatological conditions. However, they increase susceptibility to vaccine-preventable infections, reactivation of latent pathogens and severe viral disease. In the UK, recommendations are distributed across Immunisation Against Infectious Disease known as ‘The Green Book’, the BAD guidance and the NICE guidance, creating barriers to consistent, up-to-date information. We aimed to develop a single, UK-aligned, point-of-care framework to standardize risk management of infectious disease for dermatology patients receiving systemic immunomodulatory therapy at the Northern Care Alliance NHS Foundation Trust. Dermatology-led multidisciplinary team guidance was synthesized into an operational clinical framework. Content was organized into (i) pretreatment optimization including vaccination planning and baseline infectious risk assessment; (ii) therapy-class prompts for screening and monitoring across conventional immunosuppressants, biologics and targeted oral agents and (iii) scenario-based algorithms for higher-risk circumstances, including varicella zoster virus (VZV) nonimmunity or exposure, pregnancy and breastfeeding, infant live vaccination after in utero biologic exposure, and pathways for latent tuberculosis and viral hepatitis. Our framework consolidates immunization schedules with timing relative to treatment initiation and provides explicit contraindications for live vaccines during active immunosuppression. It provides concise, class-based prompts to support consistent baseline assessment and follow-up and incorporates decision support with escalation pathways for common dilemmas such as VZV postexposure prophylaxis and monitoring following evidence of past hepatitis B infection. An update section highlights emerging issues relevant to immunomodulated patients including mpox and coronavirus disease and directs clinicians to local escalation routes. Our framework consolidates UK guidance into a practical, point-of-care workflow and is intended to reduce unwarranted variation and strengthen patient safety by supporting timely prevention and management of infectious complications. The framework is adaptable and could be implemented across UK dermatology centres with local pathway alignment.