Coronavirus disease (COVID-19) represents a threat for people with immune-mediated diseases. It seems that patients with psoriasis appear to have a similar SARS-CoV-2 infection rate as the general population. Our study aimed to identify factors associated with contracting COVID-19 and determining the severity of COVID-19 among psoriatic patients in a real practice setting. We conducted a cross-sectional study with 379 respondents. About one-quarter (n = 78; 25.8%) of the respondents who provided information on their COVID-19 (n = 302) status had contracted COVID-19. Most variables tested for their effect on getting COVID-19 proved to be statistically insignificant, except education, age and gender. Our study proved the protective effect of vaccination, especially the third dose, against the COVID-19 outcome. From all the potential variables, we found that non-Roma ethnicity increased the chance of being vaccinated at least once by 2.6-fold. Patients with a longer psoriasis duration had a higher chance of being vaccinated. We consider biological treatment of psoriasis safe during COVID-19. Vaccination of patients was a statistically significant protector against COVID-19. It is important to point out that only three doses of vaccine decreased with statistical significance the chance of getting the illness. Our findings should be confirmed on larger samples in further studies.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that may be complicated by irreversible lymphatic damage in long-standing, severe cases. Secondary genital lymphedema represents a rare but debilitating complication, significantly impairing physical function and quality of life. Although biologic therapies targeting key inflammatory pathways have improved disease control, paradoxical inflammatory reactions may occur and pose therapeutic challenges. Case report: We report a patient with severe HS complicated by progressive secondary genital lymphedema culminating in scrotal elephantiasis. After secondary failure of previous systemic treatment, therapy was switched to an IL-17 inhibitor brodalumab, which was complicated by the development of a paradoxical neutrophilic dermatosis with clinical features resembling pyoderma gangrenosum. Following treatment discontinuation, the patient was transitioned to infliximab, resulting in stabilization of both HS activity and inflammatory skin manifestations. Lymphoscintigraphy demonstrated impaired lymphatic drainage, and a comprehensive conservative lymphological approach, including rehabilitation therapy and manual lymphatic drainage, was initiated. The combination of targeted anti-TNF therapy and lymphatic rehabilitation led to a partial clinical improvement of genital edema and functional status. Nevertheless, persistent scrotal lymphedema reflected irreversible lymphatic damage. From a curative perspective, radical surgical treatment would likely represent the only definitive therapeutic option; however, the patient declined this approach. Conclusion: This case highlights the complexity of managing advanced HS with secondary lymphatic complications and paradoxical reactions to biologic therapy. A multidisciplinary approach may improve symptoms, but its effectiveness is limited in advanced disease, where surgery is often necessary.