Cutaneous manifestations following COVID‐19 vaccination: A report of 25 cases

Abstract

Various adverse effects particularly cutaneous manifestations associated with different COVID‐19 vaccines have been observed in practice. The aim of our study was to evaluate all patients who presented to our tertiary center with skin manifestations following COVID‐19 vaccines injection from September to December 2021. All patients with skin manifestation within 30 days or less following COVID‐19 vaccination were enrolled in our case‐series. All cases included in our study were diagnosed based on clinical and/or histopathological evaluation and all other possible differential diagnoses were ruled out. Twenty‐five individuals including 16 (64%) males and 9 (36%) females with the mean age of 47 ± 17.62 years (range 18–91) were enrolled in our study. Twenty‐two (88%) patients developed lesions after Sinopharm vaccine injection and 3 (12%) cases manifested lesions after the AstraZeneca vaccine. Six (24%) patients developed new‐onset lichen planus (LP) and 1 (4%) patient manifested LP flare‐up. Two (8%) individuals developed psoriasis and 1 (4%) case showed psoriasis exacerbation. One (4%) patient developed new‐onset pemphigus vulgaris (PV) and 1 (4%) case experienced a flare of PV lesions. One (4%) patient manifested pityriasis lichenoides et varioliformis acuta (PLEVA) flare‐up. Other new‐onset cases were as follows: toxic epidermal necrolysis (TEN) (n = 1, 4%), bullous pemphigoid (BP) (n = 2, 8%), alopecia areata (AA) (n = 2, 8%), pytriasis rosea (n = 1, 4%), herpes zoster (n = 1, 4%), cutaneous small vessel vasculitis (n = 1, 4%), erythema multiform (EM) and urticaria (n = 3, 12%), and morphea (n = 1, 4%). Physicians should be aware of the possible side effects especially cutaneous manifestations associated with COVID‐19 vaccines.

Comment on ‘Morphoea following COVID-19 vaccination’

“…Moreover, we disagree with the authors that there is a need to routinely evaluate vaccination history in patients with recent-onset morphoea, 3 as there is a lack of strong evidence. Even though morphoea following COVID-19 vaccination has been reported in the literature, 5,6 the cases described to date verge more toward generalized morphoea, confirming our hypothesis of a coincidence.…”

Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature

“…61 To date, 13 cases of new-onset cutaneous lichen planus and 3 cases of cutaneous lichen planus exacerbation have been reported. [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] Like psoriasis, also cases of new onset and flare of atopic dermatitis or eczema have been reported (7 and 14, respectively). [77][78][79][80][81][82][83] However, there is not a clear correlation with clinical phenotypes.…”

“… BNT162b2: 10 mRNA-1273: 3 AZD1222: 3 Ad26.COV2: 1 Flare of psoriasis 81 Huang et al 29 (15), Sotiriou et al 30 (14), Koumaki et al 31 (12), Megna et al 32 (11), Wei et al 53 (6), Ruggiero et al 26 (4), Durmaz et al 33 (2), Tran et al 34 (2), Piccolo et al 36 (2), Bostan et al 37 (1), Nagrani et al 35 (1), Pavia et al 38 (1), Durmus et al 39 (1), Fang et al 40 (1), Krajewski et al 41 (1), Trepanowski et al 42 (1), Mieczkowska et al 43 (1), Lopez et al 44 (1), Perna et al 45 (1), Tsunoda et al 47 (1), Nia et al 48 (1), Pesqué et al 28 (1). BNT162b2: 43 mRNA-1273: 17 AZD1222: 21 Ad26.COV2: 0 Cutaneous lichen planus 16 New-onset: Merhy et al 62 (1), Camela et al 63 (1), Kato et al 69 (1), Diab et al 70 (1), Zagaria et al 71 (1), Awada et al 72 (1), Picone et al 73 (1), Hlaca et al 74 (1), Zengarini et al 75 (1), Masseran et al 76 (1), Gamonal et al 64 (1), Alrawashdeh et al 65 (1), Shakoei et al 66 (1). Flare: Hiltun et al 67 (1), Herzum et al 68 (1), Hlaca et al 74 (1).…”

“…(1). Merhy et al62 (1), Camela et al63 (1), Kato et al69 (1), Diab et al70 (1), Zagaria et al71 (1), Awada et al72 (1), Picone et al73 (1), Hlaca et al74 (1), Zengarini et al75 (1), Masseran et al76 (1), Gamonal et al64 (1), Alrawashdeh et al65 (1), Shakoei et al66 (1). Zou et al122 (3), Gui et al123 (2), Rouatbi et al124 (2), Aryanian et al125 (1), Koutlas et al126 (1), Knechtl et al127 (1), Ong et al128 (1), Yıldırıcı et al129 (1), Singh et al130 (1), Norimatsu et al131 (1), Agharbi et al132 (1), Almasi-Nasrabadi et al133 (1),…”

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

“…Oxford-AstraZeneca adenoviral vaccine (ChAdOx1 nCoV-19 AZD1222) ( 69 – 79 ). Johnson & Johnson adenoviral vaccine (Ad26.COV2.S) ( 80 – 82 ), and inactivated vaccines [Sinovac CoronaVac ( 83 ), Bharat Biotech Covaxin ( 84 ), Sinopharm BBiBP-CorV] ( 85 , 86 ) ( Supplementary Table 2 ).…”