A case of new‐onset acute generalized pustular psoriasis following Pfizer‐BioNTech COVID ‐19 vaccine

Abstract

Dear EditorCoronavirus disease 2019 vaccination has significantly improved protection from infection and serious illness. However, as more people are getting vaccinated, adverse effects are increasing.

New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review

“…The eruptions gradually spread to the trunk and inguinal region, and some pustules formed over 1 wk Leukocytosis and neutrophilia, elevated CRP (5.60 mg/dL) on admin day. Elevated CRP (13.23 mg/dL), hypoalbuminemia (2.6 g/dL), elevated Cr (1.65 mg/dL) on the day after admin IV INX 5 mg/kg Q8W for 9 y SEC 300 mg QW until wk 4 Improved (3 wk) None Durmaz et al 2022 [ 39 ] Turkey 25 F Pustular psoriasis for 11 y (in remission for the last 6 mo) Pfizer (1st) 3 d No previous history of infection, medication, or stress Non-follicular pustules and local desquamation on erythematous plaques on the anterior-posterior aspect of the trunk, both arms, and proximal thighs NR Without tx NR NR NR Frioui et al 2022 [ 54 ] Tunisia 20 M Mild plaque psoriasis Pfizer (1st) 4 d No history of new meds or recent illness Coalescing pustules overlying painful, erythematous skin with yellow crusts on the limbs and desquamation on the trunk. No mucosal membrane or palmoplantar involvement (Naranjo 6) Neutrophilic leukocytosis, normal serum calcium, and elevated CRP levels, bacterial skin swab(−), COVID-19 PCR(−) TCS OAC 25 mg QD, TCS Resolved (2 wk) NR Pavia et al 2022 [ 56 ] Italy 47 F Plaque psoriasis since 2001 Pfizer (2nd) 10 d Skipped the scheduled administration of UST during the month of vaccine injection Wide erythematous plaques confluent to both the trunk and the four limbs, covered by large scales (PASI 29.8, BSA > 30%) Leukocytosis, elevated CRP (14.56 mg/dL), blood culture(−), tumor marker(-) UST 90 mg since 2016, INF SC RZB 75 mg/fl (at day 0, wk 2), daptomycin 850 mg QD Resolved (4 mo) None …”

“…In the flare group, most patients received mRNA vaccines (28%) [ 8 , 10 – 12 , 28 , 38 – 58 ], with the BioNTech/Pfizer vaccine (20%) reported more often than the Moderna vaccine (7%), followed by the AstraZeneca vaccine (7%) [ 5 , 10 , 12 , 26 , 38 , 50 , 59 ] and the Sinovac vaccine (1%) [ 41 , 60 ]. Flares were most commonly reported following the second vaccine dose (23%) [ 5 , 10 , 12 , 38 – 44 , 49 – 51 , 55 , 56 , 58 ], followed by the first vaccine dose (7%) [ 10 – 12 , 26 , 28 , 38 , 39 , 48 , 50 , 53 , 54 , 59 ], both the first and second doses (2%) [ 38 , 52 ], and the third dose (1%) [ 8 , 39 ]. The onset time in the flare group ranged from 1 day to 90 days.…”

“…A slightly elevated CRP level was reported for a 51-year-old man who experienced a plaque psoriasis flare after receiving the second dose of the BioNTech/Pfizer vaccine [ 41 ]. Leukocytosis and elevated levels of acute-phase reactants were individually reported in six cases with GPP [ 11 , 42 , 54 , 56 , 57 , 60 ]. A 65-year-old man who developed severe GPP following the second dose of the BioNTech/Pfizer vaccine, reported by Yatsuzuka et al, presented with a high CRP level, hypoalbuminemia, and an elevated creatinine level on the day after admission [ 42 ].…”

“…In the flare group, various treatments were used to control underlying psoriasis, including topical treatments, such as topical corticosteroids, topical calcipotriol, and emollients; systemic immunomodulatory agents, such as acitretin, cyclosporine, methotrexate, and apremilast; narrow-band UVB phototherapy; and biologics, such as tumor necrosis factor-α (TNF-α) inhibitors (adalimumab, etanercept, infliximab), IL-17 inhibitors (brodalumab, ixekizumab, secukinumab), IL-23 inhibitors (guselkumab, risankizumab), IL-12/23 inhibitors (ustekinumab), and tyrosine kinase 2 (TYK2) inhibitor (deucravacitinib). Treatments resulted in stable psoriasis control or remission in nine cases (3%) [ 5 , 8 , 39 , 40 , 54 – 57 , 59 ]. However, treatment resulted in only partial control of chronic and relapsing psoriasis in six cases (1%) [ 26 , 41 , 47 , 53 , 58 ].…”

“…Six cases (2%) were maintained at the dosage used for prior treatments [ 26 , 28 , 38 , 43 ], and 19 patients (7%) were treated with add-on medications, such as topical agents, phototherapy, or systemic therapies, including topical emollients, betamethasone, clobetasol propionate, calcipotriol/betamethasone combination, isoconazole and diflucortolone valerate, systemic methylprednisolone, methotrexate, cyclosporine, apremilast, infliximab, tildrakizumab, and brodalumab [ 5 , 12 , 26 , 38 , 46 , 52 , 53 , 59 ]. Eighteen cases (6%) changed their treatment regimens completely to achieve disease control [ 11 , 12 , 38 , 43 , 45 , 54 – 58 , 60 , 61 ]. Among patients with psoriasis flares who were receiving prior treatment with biological agents, most (43%) were using IL-17 inhibitors [ 12 , 26 , 38 , 49 , 50 , 58 , 61 , 62 ], followed by TNF-α inhibitors (42%) [ 12 , 26 , 38 , 43 , 47 , 49 , 50 , 62 , 63 ], IL-23 inhibitors (10%) [ 12 , 43 , 49 , 50 , 62 ], IL-12/23 inhibitors (4%) [ 38 , 56 , 59 ], and TYK2 inhibitor (1%) [ 40 ].…”