Table I.

Considerations for commonly used immunomodulators and immunosuppressants for dermatologic conditions

Drug class	Mechanism of action	Drug name	Risk	Comments/considerations∗
Classic immunosuppressants
	Inhibits NF-κB	Corticosteroids	Likely concerning risk	Consider stopping when viral symptoms present especially with known or potential exposure
	Calcineurin inhibitor	Tacrolimus
		Cyclosporine
Antimetabolites	Inhibits DNA replication	Mycophenolate mofetil
		Azathioprine
		Methotrexate
Immunomodulators
Monoclonal antibodies	TNF-α inhibition	Infliximab	Likely moderate risk	Continue if viral symptoms are mild, consider stopping if viral symptoms worsen or high fever develops
Receptor fusion protein		Etanercept
Monoclonal antibodies		Certolizumab
Monoclonal antibodies		Adalimumab
IL receptor modulators	IL inhibition	Anakinra (IL-1)
Monoclonal antibodies		Dupilumab (IL-4)	Likely low risk	Continue unless severe symptoms present
Monoclonal antibodies		Brodalumab (IL-17)	Likely moderate risk	Continue if viral symptoms are mild, consider stopping if viral symptoms worsen or high fever develops
Monoclonal antibodies		Secukinumab (IL-17a)
Monoclonal antibodies		Ixekizumab (IL-17a)
Monoclonal antibodies		Ustekinumab (IL-12/23)
Monoclonal antibodies		Guselkumab (IL-23)
Monoclonal antibodies	Anti-CD20 antibody	Rituximab	Likely concerning risk	Consider stopping when viral symptoms present especially with known or potential exposure.
	PDE4 inhibition	Apremilast	Likely low risk	Continue unless severe symptoms present

IL, Interleukin; NF-κB, nuclear factor κB; PDE4, phosphodiesterase 4.

^∗General considerations only, medication use should be considered based on each individual patient's risk and disease profile.