Cutaneous reactions after COVID‐19 vaccination in Turkey: A multicenter study

Abstract

Objectives In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID‐19 vaccination with the Sinovac/CoronaVac (inactivated SARS‐CoV‐2) and Pfizer/BioNTech (BNT162b2) vaccines. Methods This prospective, cross‐sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID‐19 vaccines. Systemic, local injection site, and non‐local cutaneous reactions after vaccination were identified, and their rates were determined. Results Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non‐local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non‐local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. Conclusions There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non‐local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self‐limiting or required little therapeutic intervention.

Delayed nonlocal cutaneous reactions after inactive COVID‐19 vaccinations

“…In this study, 1 the most common non‐local cutaneous reactions of mRNA vaccine were reported as herpes zoster after the first dose and pityriasis rosea after the second dose. Thirdly, herpes zoster and pityriasis rosea are disorders are supposed to be related to the human herpes virus family as mentioned in the article.…”

“…The rate of serious reactions, for example, urticaria/angioedema developing within the first 24 h is higher in BioNTech than in CoronaVac, which was found to be a very important finding in this study. 1 Fourthly, IgE‐mediated type I hypersensitivity reactions usually happen in 4–6 h. Would the cutaneous reactions observed in this study up to 24 h be delayed cutaneous reactions?…”

“…To the editor, I have read the article titled "Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study" by Cebeci Kahraman et al 1 with great interest. After thanking their nice contribution to the literature, I want to raise a couple of questions on their possible working hypothesis and their experience with these patients.…”

“…Delayed cutaneous reactions have previously been reported by many groups as rather large local reactions such as in this study. 1 True/systemic delayed urticaria-angioedema reactions…”

“…They also suggested a possible hypothetical mechanism for this reactivation indicating a strong specific immune response induced by the inactivated virus, which might overwhelm cellular immune response against a latent virus. 1 Firstly, why such specific herpetic virus reactivations (zoster, pityriasis) rather than latent other herpes viruses (e.g., EBV and CMV) reactivations occur after vaccinations? Secondly, why such herpetic reactivations occur after mRNA vaccines rather than other inactive virus vaccines?…”