COVID‐19 vaccine‐related new‐onset lichen planus

Abstract

Coronavirus disease 2019 (COVID‐19) vaccines significantly impacted world health and well‐being. However, various adverse events have been observed following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. Cutaneous reactions have been prevalent following many vaccines, including COVID‐19 vaccines. Here, we present a case of new‐onset lichen planus in a patient who received the COVID‐19 vaccine at the same time as being infected with SARS‐CoV‐2. A 52‐year‐old woman presented to the clinic with extensive pruritic skin lesions. The eruptions had appeared a week after her second dose of the Sinopharm COVID‐19 vaccine. She mentioned a history of SARS‐CoV‐2 infection approximately 10 days following the first dose of her vaccine, causing a 1‐month delay in getting the second dose. Her past medical history was not significant. On examination, erythematous and squamous papules were demonstrated predominantly on the extremities, including inguinal and axillary folds. Moreover, desquamation of the lips was visible, and buccal lesions were also found. After consultation with a dermatologist, a skin biopsy was indicated for the patient, but she refused to undergo the procedure. Therefore, considering the typical appearance of the eruptions, lichen planus was suspected, for which she was treated with oral antihistamines and topical corticosteroids.

Oral lesions after COVID-19 vaccination: Immune mechanisms and clinical approach

“… 1 to 28 days - - - Riad et al [23] Cross-sectional survey 539 participants mRNA-based COVID-19 vaccines First and second dose Oral paraesthesia (1.3%) was the most common side effect, followed by oral ulcers (1.1%), taste disturbance (0.4%), skin rash (0.4%), and skin eruptions (0.4%). - - - - Sharda et al [10] Letter to the editor A 35-year-old female BNT162b2, - Oral lichen planus erythematous base lesions with white reticular streaks over them, some of them had erosions 2 weeks - Short term course of steroids - Babazadeh et al [24] Case report A 52‐year‐old woman BBIBP-CorV Second dose Oral lichen planus Buccal lesions/ Desquamation of the lips 1 week - Oral antihistamines and topical corticosteroids The Th1 response is elicited, increase in IL-2, TNF-α, and IFN-γ levels Elboraey et al [25] Case report A middle-aged female BNT162b2 Second dose SJS Large, red-colored bullae at the left retromolar area Whitish-yellow patches all over the tongue dorsal surface and upper and lower lips Multiple large ulcers at the buccal mucosa, labial mucosa, tongue, and palate 5 days - Mouthwash corticosteroids with addition of triamcinolone acetonide to 100 ml of sterile saline Specific drugs stimulate immune cells such as cytotoxic T cells and natural killer cells that secrete granulysin, which destroys cells in the skin and mucous membrane by dysregulation of specific transmembrane protein pathways Dash et al [26] Case report A 60‐year‐old male - First dose SJS Hemorrhagic crusting lesions over the lips, epidermal keratinocyte necrosis. 3 days 7 days Oral cyclosporine 300mg Virotpes of the vaccine has been believed to cause SJS.…”

“…Vaccination is one of the predisposing factors of OLP. Tetanus- diphtheria– acellular pertussis (Tdap), Hepatitis B vaccine, Measles–Mumps– Rubella (MMR), rabies, and influenza vaccines have been reported to provoke OLP [24] .…”

“…These lesions appeared 1 week to 2 weeks after the second dose administration of the BBIBP-CorV (Sinopharm) and BNT162b2. Patients were treated by a short-term course of topical steroids and oral antihistamines ([ 10 , 24 ]).…”

“…In the literature the related mechanism suggested for OLP following COVID-19 vaccination was the increased Th1 response, which sequentially leads to the increase of IL-2, Tumor Necrosis Factor (TNF)-α, and interferon (IFN)-γ levels [24] .…”

Morphea in two patients after being infected to and being vaccinated against SARS‐CoV‐2 infection

“… 1 , 2 , 3 , 4 These cutaneous adverse events have been either a new‐onset dermatologic disorder or exacerbation of the pre‐existing one. 5 , 6 The new‐onset or flare‐up of psoriasis, lichen planus, eczematous dermatitis, and many other dermatoses have been reported following COVID‐19. 7 , 8 , 9 , 10 , 11 On the contrary, dermatologic complications have also been abundantly observed after being vaccinated against SARS‐CoV‐2.…”