Cutaneous reactions following COVID‐19 vaccination assessed by dermatologists: a single‐institutional study in Germany

Abstract

Summary Background and objectives Cutaneous reactions following COVID‐19 vaccination have been frequently described, whereas larger case series by dermatologists are lacking. This study assesses SARS‐CoV‐2 vaccination‐associated skin reactions, severity, treatment, course, eliciting vaccines, allergy test results and tolerance to revaccination. Patients and methods Single‐institutional, non‐interventional study of dermatologists assessing cutaneous manifestations in 83 patients in Germany. Results 93 reactions were presented. Manifestations clustered into immediate (n = 51, 54.8%) and delayed hypersensitivity reactions (n = 10, 10.8%), chronic inflammatory skin diseases (n = 13, 14.0%), reactivation of latent herpes virus infection (pityriasis rosea/herpes zoster; n = 9; 9.7%) and others (n = 10, 10.8%). Vaccination was associated with new (76.3%) – mostly hypersensitivity reactions – or exacerbation of known skin diseases (23.7%), in this case predominantly chronic inflammatory skin diseases. Reactions occurred primarily within the first week (72.8%) and after first vaccination (62.0%). Treatment was required in 83.9% and hospitalization in 19.4%. In 48.8% revaccination led to recurrence of the same reactions. Disease was ongoing at last consultation in 22.6%, primarily in chronic inflammatory skin diseases. Allergy tests were performed in 15 patients (18.1%) and resulted negative. Conclusions It can be assumed that vaccination may trigger immune activation‐related reactions especially in those patients predisposed to develop respective skin diseases.

Relapse of inflammatory skin diseases following vaccination against monkeypox

“…Similarly, studies on the cutaneous reactions following COVID-19 vaccination found that these reactions included exacerbation of known skin diseases indicating that vaccinations may trigger immunological diseases in those patients who are already predisposed to them. 4 To the best of our knowledge, this is the first report of AD and psoriasis flare-ups after monkeypox vaccine administration.…”

“…1 During the largest outbreak of monkeypox beginning in 2022 and affecting almost exclusively men who have sex with men with multiple sexual partners, 2 the administration of the Jynneos vaccine was authorized for the high-risk population. 1 In clinical trials, common mild side effects have been described with a latency time ranging from 0 to 21 days: redness and itching at the injection site (40−60%), 3 similar to the "COVID-arm" observed after COVID-19 vaccine, 4 and several systemic reactions were frequently observed after vaccinations: fatigue, headache, and nausea. Adverse events with serious outcomes were uncommon.…”

“…New onset and flare-up of psoriasis and AD have been described in association with several vaccinations (influenza and pneumococcal polysaccharide vaccines) related to the immune response induced by the vaccines. 4,9,10 Psoriasis and AD are immune-mediated inflammatory diseases and any change in the immune system balance might cause their manifestation in genetically susceptible individuals. 45 A recent study on immune responses induced by monkeypox vaccination found that the T cell response in immunized mice was characterized by a significant increase of several cytokines such as INF-γ, TNF-α, IL-4, IL-17A, and IL-22 (all crucial molecules in the psoriasis pathophysiology), compared to the control group.…”

The Impact of COVID-19 Vaccination on Inflammatory Skin Disorders and Other Cutaneous Diseases: A Review of the Published Literature

“…In our review, 98 cases have been collected, also during treatment with omalizumab [ 95 , 96 , 101 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 ]. Of note, two types of urticaria may be distinguished: immediate and delayed, with the first as the most common, as reported by Wang et al in their monocentric real-life study investigating cutaneous manifestations following vaccination [ 207 ] ( Table 5 ).…”