Twenty two patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each case was assessed light microscopically and in select biopsies spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within one day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of dermatitis, interface dermatitis, granulomatous inflammation and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris and guttate psoriasis were seen in select cases. In two cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsies of normal skin post-vaccine and skin affected by the post vaccine eruption showed rare deep microvessels positive for spike glycoprotein without complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from severe COVID-19 patients. It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly due to a substance found in the vaccine vehicle such as polyethylene glycol. An immune response that is directed against human-manufactured spike has to be considered since some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis and subclinical hypersensitivity.

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The vulva is an under-studied area of the female genitourinary tract which is prone to maceration, overgrowth of organisms, and atypical presentations of common dermatologic conditions. In current practice, dermatologists must recognize and manage vulvar infections and infestations beyond the more commonly recognized sexually transmitted infections. Herein, this article reviews the literature on a selection of under-recognized viral, bacterial, fungal, and parasitic vulvar infections and infestations.

We present a 76-year old woman with a five-year history of asymptomatic, white papules that were grouped on the lateral and posterior aspects of the neck, inferior axillae, and central mid-back. The histopathologic findings showed thickened collagen bundles. A diagnosis of white fibrous papulosis of the neck was made, which is believed to be a manifestation of intrinsic aging. There are no treatments for white fibrous papulosis of the neck. One hypothesized approach is the application of a topical antioxidant to reduce free-radical induced aging.