State‐of‐the‐Art Review: Vaccination in Pediatric Dermatology Patients Receiving Immunosuppressive or Immunomodulatory Therapy: A Review

Immunomodulatory agents have become a mainstay treatment for various dermatologic conditions within the pediatric population. Increased use of off-label and FDA-approved medications, especially at younger ages, decreases disease burden and mortality. The earlier usage of these immunosuppressants often parallels the pediatric vaccine schedule. Successful treatment of dermatologic conditions while enabling children to mount an adequate immunologic response to preventable diseases necessitates partnering between dermatologists and primary care physicians. Understanding the guidelines will enable dermatologists to better educate patients and engage in shared decision-making. A review of the literature for vaccination guidelines for patients on conventional immune modulating medications (CIMM), tumor necrosis factor alpha inhibitors (TNF-i), various biologic medications, and Janus kinase inhibitors (JAKi) was performed. Inactivated vaccines are generally considered safe, and routine administration, including during active treatment with immunosuppressants, is acceptable. For live attenuated vaccines, including measles-mumps-rubella (MMR) and varicella, consideration to vaccinate 4 weeks prior to initiation of immunosuppressants is generally advised.