New onset and exacerbation of oral lichenoid mucositis following SARS‐CoV‐2 infection or vaccination

Lichen planus after COVID-19 infection and vaccination

“…Multiple authors have hypothesized that exposure to the COVID-19 spike protein antigen via infection or vaccination may trigger immune dysregulation including altered T -cell activity and elevated cytokines that mediate LP pathogenesis [ 2 , 5 , 7 – 10 ]. SARS-CoV-2 antigens in COVID-19 vaccines induce B -cell activation and a strong CD8+ cytotoxic T -cell (CTL) response that can escalate into an autoimmune reaction against basal keratinocytes in the epidermis, triggering keratinocyte apoptosis and subsequent LP development [ 2 , 5 ].…”

“…SARS-CoV-2 antigens in COVID-19 vaccines induce B -cell activation and a strong CD8+ cytotoxic T -cell (CTL) response that can escalate into an autoimmune reaction against basal keratinocytes in the epidermis, triggering keratinocyte apoptosis and subsequent LP development [ 2 , 5 ]. Furthermore, the vaccines also activate CD4+ helper T -cells (Th1), which release proinflammatory cytokines including interleukin-2 (IL-2), tumor necrosis factor-ɑ (TNF-ɑ), and interferon-γ (IFN-γ) that maintain the CTL response, further upregulate Th1 activity, and induce tissue damage [ 2 , 7 – 10 ]. TNF-ɑ, and IFN-γ result in basal keratinocyte apoptosis, the hallmark of LP.…”

“…M [ 9 ] (Zagaria et al) Vaccination Tozinameran, 1st dose 10 days Trunk, upper and lower limbs Oral prednisolone 25 mg daily for 7 days, then tapered for up to 4 weeks Rapid resolution without side effects or recurrence 72-y.o. M [ 10 ] (Alabdulaaly et al) Vaccination Spikevax, 1st and 2nd doses ~ 30–60 days Gingiva and upper lip High potency topical steroids Improved within 3 months 61-y.o. M [ 10 ] (Alabdulaaly et al) Vaccination Spikevax, 2nd dose ~ 30–45 days (flare) Gingiva and tongue Continued topical pimecrolimus 1% cream Recovered to baseline 12 weeks after 2nd dose 65-y.o.…”

“…M [ 10 ] (Alabdulaaly et al) Vaccination Spikevax, 1st and 2nd doses ~ 30–60 days Gingiva and upper lip High potency topical steroids Improved within 3 months 61-y.o. M [ 10 ] (Alabdulaaly et al) Vaccination Spikevax, 2nd dose ~ 30–45 days (flare) Gingiva and tongue Continued topical pimecrolimus 1% cream Recovered to baseline 12 weeks after 2nd dose 65-y.o. F [ 10 ] (Alabdulaaly et al) Vaccination Tozinameran, 2nd dose 7 days (flare) Buccal mucosa and tongue Topical vitamin A 0.025% gel and clobetasol 0.05% gel four times daily Resolution after 4 weeks 65-y.o.…”

“…M [ 10 ] (Alabdulaaly et al) Vaccination Spikevax, 2nd dose ~ 30–45 days (flare) Gingiva and tongue Continued topical pimecrolimus 1% cream Recovered to baseline 12 weeks after 2nd dose 65-y.o. F [ 10 ] (Alabdulaaly et al) Vaccination Tozinameran, 2nd dose 7 days (flare) Buccal mucosa and tongue Topical vitamin A 0.025% gel and clobetasol 0.05% gel four times daily Resolution after 4 weeks 65-y.o. F [ 10 ] (Alabdulaaly et al) Vaccination Tozinameran, 2nd dose 1 day (flare) Gingiva and vestibular mucosa Topical clobetasol and bethanechol Significant reduction in erythema after 1 month 51-y.o.…”