Abstract
Aim: Live and live-attenuated vaccines are traditionally avoided in patients receiving biologic or small-molecule therapies due to concerns about vaccine-related infection. However, evidence supporting this precaution in dermatology is limited. This systematic review aimed to evaluate the safety of live and live-attenuated vaccines in patients receiving biologic or small-molecule therapies used in dermatology. Method(s): A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase and the Cochrane Library were searched from January 2010 to February 2025. Eligible studies included clinical trials, cohort studies, case series and case reports involving patients receiving dermatology-relevant biologic or small-molecule therapies who were administered a live or live-attenuated vaccine, with reported clinical safety outcomes. Data on study design, biologic or small-molecule therapy, vaccine type and clinical safety outcomes were systematically extracted and summarised across studies. Result(s): Of 424 records identified, eight studies met inclusion criteria: one randomised controlled trial, three cohort studies, three retrospective case series and one case report. Vaccines evaluated included measles-mumps-rubella, varicella, measles-mumps-rubella-varicella, live zoster vaccine and yellow fever vaccine. Biologic and small-molecule therapies included dupilumab, tumour necrosis factor inhibitors and Janus kinase inhibitors. Across all included studies, no cases of vaccine-strain infection or disseminated vaccine-related disease were reported. Adverse events were mild, self-limiting and consistent with expected post-vaccination reactions. Evidence was largely derived from observational studies and selected patient populations. Conclusion(s): Although the evidence base is limited and heterogeneous, available data suggest that live and live-attenuated vaccines can be administered safely in selected patients receiving biologic or small-molecule therapies used in dermatology. These findings support a more individualised approach to live vaccination in dermatology, rather than routine universal avoidance, while highlighting the need for larger prospective studies.
