Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study

Abstract

Background: Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. Methods:We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns.Results: Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym ''V-REPP'' (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5).Limitations: Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence.

Antibody response to COVID-19 vaccine: A point of view that can help to optimize dose distribution

“…The European Medicines Agency (EMA) has authorized four vaccines in Europe: Pfizer-BioNTech/Cominarty, Moderna/Spikevax, AstraZeneca/Vaxzevria and Johnson&Johnson /COVID-19 vaccine Janssen. The first three are given in two doses some weeks apart, whereas Janseen vaccine is administered as single dose [3] , [4] , [5] .…”

Bullous Pemphigoid Associated With COVID-19 Vaccines: An Italian Multicentre Study

“…SARS-CoV-2-vaccine-associated cutaneous eruptions encompass a growing spectrum of clinicopathological varieties, including local injection site reactions, urticarial eruptions, morbilliform eruptions, pernio/chilblain-like lesions, cosmetic filler reactions, herpes zoster and herpes simplex flares, pityriasis rosea-like eruptions (11,20,21). Autoimmune bullous skin diseases have also been observed following SARS-CoV-2-vaccination, with approximately 34 individual cases of vaccine-associated BP currently described (12,14,17,(22)(23)(24)(25)(26)(27)(28) (Supplementary Table 1). According to the registry-based studies by McMahon et al, BP-like eruptions accounted for 20% (12/58) of biopsy-proven SARS-CoV-2-vaccine-associated cutaneous reactions and 1.5% overall (11,22).…”

A Case of New-Onset Lichen Planus after COVID-19 Vaccination

“…This is one of the first cases associated with the Moderna vaccine. McMahon et al [9] performed a registry-based study where they discussed the occurrence of vaccine-related eruption of papules and plaques (V-REPP) after COVID-19 vaccination. Among these skin manifestations, lichen planus was reported in four cases, three of which were related to the Pfizer vaccine and one to the Moderna vaccine.…”

“…The physiopathological mechanisms underlying the relationship between LP and vaccination for COVID-19 are still poorly understood, however, it has been shown that after such vaccines there can be a stimulation of the immune response of T helper lymphocytes type 1 (Th1) [10], leading to the stimulation of the production of interleukin (IL)-12, tumor necrosis factor (TNF)a, and interferon (IFN)c, cytokines involved in the pathogenesis of LP [11]. What emerges from the literature at present, is that COVID-19 vaccines can cause strong T-cell responses [9][10][11]. The mechanism by which they might elicit immunostimulatory effects, including triggering T-cell-dependent disorders, requires further study.…”