Do you take medication that suppresses your immune system, for example for rheumatism, Crohn's disease, ulcerative colitis, psoriasis or after an organ transplant? This medication is important to report before an eyelid surgery, because of its possible effect on wound healing and the risk of infection.
Which medication does this concern?
- Methotrexate, widely used for rheumatoid arthritis and psoriasis
- Azathioprine, mycophenolate, among others for auto-immune conditions and after transplants
- Ciclosporin, tacrolimus
- Biologicals such as: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), and comparable ‘monoclonal antibodies’
- JAK inhibitors: tofacitinib, upadacitinib (Rinvoq)
Why is this relevant?
Immunosuppressants and biologicals suppress (part of) the immune system. This can increase the risk of infections after a surgical procedure and affect wound healing [1].
For some of these products, it is advised in practice to temporarily skip the administration around an elective procedure, depending on the type of medication and the underlying condition. This is always an individual consideration between the risk of a flare-up of the condition (if the medication is stopped) and the risk of infection or delayed healing (if the medication is continued).
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Points of attention
- Always report the use of immunosuppressants or biologicals, including the name and the dosage schedule
- The decision to (temporarily) skip medication around the procedure is always in consultation with the prescribing specialist (rheumatologist, gastroenterologist, dermatologist or transplant doctor)
- Increased risk of infections and possibly delayed wound healing [1]
Our protocol at Kliniek het Bolwerk
1. Extensive medical history
We ask about the specific medication, the dosage schedule and the underlying condition.
2. Consultation with the treating specialist
We consult, if necessary, with your rheumatologist, gastroenterologist, dermatologist or other treating specialist about the best timing of the procedure in relation to your medication schedule.
3. Planning at a favourable moment
Where possible, we plan the procedure at a moment that fits within your medication schedule and in a calm phase of your condition.
4. Extra attention to wound healing
At the follow-up check, we pay extra attention to signs of infection or delayed healing [1].
Important: never stop immunosuppressants or biologicals (such as Humira, methotrexate or Rinvoq) on your own initiative. The timing around the procedure is always determined in consultation with your treating specialist.
When do we advise against the procedure (for the time being)?
- In the case of an active flare-up of the underlying condition
- In the case of use of high doses of immunosuppressants without consultation with the treating specialist
- If the treating specialist advises against the procedure at this time
Our advice
Are you using immunosuppressants or biologicals? Bring the name and the dosage schedule to the intake consultation at Kliniek het Bolwerk. If necessary, we contact your treating specialist before we plan the procedure.
Literature references
The publications below form the medical-scientific basis of this article:
- Risk of infection, immunosuppression as a risk factor. Wikipedia (medical overview). https://en.wikipedia.org/wiki/Risk_of_infection
