Global prevalence and clinical manifestations of cutaneous adverse reactions following COVID‐19 vaccination: A systematic review and meta‐analysis

Abstract

Although vaccination is widely accepted as an effective method of preventing and controlling the COVID‐19 pandemic, many people are concerned about possible cutaneous side‐effects, which can delay or prevent them from being vaccinated. The objectives of this systematic review were to assess the global prevalence and clinical manifestations of cutaneous adverse reactions following COVID‐19 vaccination. PubMed and Scopus databases were searched for articles published from 1 January 2019 to 31 December 2021, and reference lists for each selected article were screened. Case reports, case series, observational studies and randomized controlled trials that provided information on cutaneous adverse reactions following COVID‐19 vaccines were included. A total of 300 studies were included in a systematic review of which 32 studies with 946 366 participants were included in the meta‐analysis. The pooled prevalence of cutaneous manifestations following COVID‐19 vaccination was 3.8% (95% CI, 2.7%–5.3%). COVID‐19 vaccines based on the mRNA platform had a higher prevalence than other platforms at 6.9% (95% CI, 3.8%–12.3%). Various cutaneous manifestations have been reported from injection site reactions, which were the most common (72.16%) to uncommon adverse reactions such as delayed inflammatory reactions to tissue filler (0.07%) and flares of pre‐existing dermatoses (0.07%). Severe cutaneous reactions such as anaphylaxis have also been reported, but in rare cases (0.05%). In conclusion, cutaneous adverse reactions are common, especially in those receiving mRNA vaccines. Most reactions are mild and are not contraindications to subsequent vaccination except for anaphylaxis, which rarely occurs. COVID‐19 vaccination may also be associated with flares of pre‐existing dermatoses and delayed inflammatory reactions to tissue filler. Patients with a history of allergies, pre‐existing skin conditions or scheduled for filler injections should receive additional precounselling and monitoring. A better understanding of potential side‐effects may strengthen public confidence in those wary of new vaccine technologies.

Global incidence pattern and factors associated with common cutaneous reactions related to COVID-19 vaccination of 2.55 million participants in real-world settings: A systematic review and meta-analysis

“…Risk of the second dose of vaccines is another issue of concern. We found similar levels of multiple cutaneous reactions for the first and the second dose, in line with the findings regarding systemic skin reactions reported by Washrawirul et al [ 60 ]. Likewise, another study [ 61 ] focusing on a population experiencing an allergic reaction to the first dose found that the rates of a second reaction with severe immediate and non-severe symptoms were 4.94% (95% CI = 0.93%-22.28%) and 9.54% (95% CI = 2.18%-33.34%), respectively.…”

COVID‐19 vaccines and filler reactions: Should it be considered as a concern?

“…22 Nevertheless, facial filler reactions are being increasingly reported in this setting. [23][24][25] Previously, dermal filler reactions had been reported after influenza and zoster vaccines. 26,27 As has previously been mentioned, vaccines can precipitate tardive adverse events in the filler injected tissues due to their immunostimulant effects.…”

Manifestation of pityriasis rosea and pityriasis rosea‐like eruptions after Covid‐19 vaccine: A systematic review

“… 7 A study also reported cutaneous reactions to be secondary to COVID‐19 vaccination, with a 3.8% pooled prevalence (95% confidence interval [CI]: 2.7%−5.3%). 8 These reactions range from exanthema to inflammation, including lichen planus, chilblain‐like lesions, maculopapular or morbilliform rash, erythema multiforme, nonspecific hypersensitivity eruptions, facial dermal filler reactions, reactivation of the varicella‐zoster virus, urticaria, and pityriasis rosea (PR) pityriasis rosea‐like rash (PR‐LE). 9 Inflammatory skin manifestations have been divided, according to their reaction pattern, into five main categories; vascular, red diffuse eruptions; vesicobullous, related with blisters; dermal, affecting deep component in the skin with little or no epidermal change; eczematous; and papulosquamous, scaly, and red conditions.…”