An old entity, a new trigger: Post COVID-19 vaccine pityriasis rubra pilaris

Abstract

BACKGROUND: Pityriasis rubra pilaris (PRP) is a rare, acquired, chronic papulosquamous dermatosis which can occur in all ages. PRP can be associated with infection, autoimmunity, drugs and malignancies, and can be idiopathic. OBJECTIVE: PRP following vaccination has been rarely described in the literature. To the best of our knowledge, we report the first case of PRP two weeks following COVID-19 vaccination (Covishield). CASE REPORT: A 72-year-old male presented to the outpatient dermatology department at All India Institute of Medical Sciences – Bhopal with minimally pruritic superficial plaques since one week. The patient was vaccinated against COVID-19 with Covishield two weeks earlier. The lesions developed as erythematous scaly follicular papules and plaques over axilla that rapidly spread to the trunk in the following weeks and involved palms and soles as well as thickening and fissuring. The clinical features suggested PRP. The histopathology showed epidermal acanthosis with hypergranulosis alternating with parakeratosis and orthokeratosis with broad rete ridges with follicular plugging. The patient had started taking topical corticosteroids and emollients, which proved effective. There was no recurrence after receiving a second dose on follow-up. CONCLUSION: In patients presenting with new onset PRP in this COVID-19 era, the possibility of vaccine as a trigger should be taken into consideration, and further dosing should be carefully monitored in view of possible recurrence.

Pityriasis rubra pilaris potentially triggered by messenger RNA–1273 COVID vaccine

“…Manufactured by different companies, Covishield and Vaxzevria are identical recombinant vaccines that utilize an adenoviral vector that expresses the SARS-CoV-2 spike proteins. 6 , 7 Compared to our case, the 72-year-old man with PRP responded to high-potency topical corticosteroids, and the PRP did not recur following the second Covishield vaccination. 6 The 63-year-old woman was treated with acitretin, without the mention of a second vaccine dose or response to therapy.…”

“… 6 , 7 Compared to our case, the 72-year-old man with PRP responded to high-potency topical corticosteroids, and the PRP did not recur following the second Covishield vaccination. 6 The 63-year-old woman was treated with acitretin, without the mention of a second vaccine dose or response to therapy. 7 Notably, our patient’s skin eruption arose days after receiving his first Moderna vaccine, worsened dramatically after his second dose, and persists, albeit improved with therapy, 1 year later.…”

Pityriasis rubra pilaris (type I) following ChAdOx1 COVID‐19 vaccine: A report of two cases with successful treatment with oral isotretinoin

“… 2 Multiple cutaneous adverse events were associated with COVID‐19 and its vaccines, to date, there are four reports of PRP related to COVID‐19 vaccination. 3 , 4 , 5 , 6 Here, we report two cases of PRP after ChAdOx1 (AstraZeneca) vaccine, compare them with other similar cases and highlight a satisfactory response with oral isotretinoin.…”

“…The causal relationship between COVID‐19 vaccines and cutaneous immunological reactions is still not understood, but they can be due to an upregulated inflammatory immunological pathway or cross‐reactivity between vital or adjuvant molecules and self‐antigens. 4 …”

Pityriasis rubra pilaris nach COVID-19-Impfung: Kausaler Zusammenhang oder Koinzidenz?

“…In der Literatur finden sich bisher nur 3 Fälle, die eine PRP-Erstmanifestation in zeitlicher Assoziation mit einer COVID-19-Impfung (in 2 Fällen nach Vaxzevria®, 1‑mal nach Comirnaty®) beschreiben [ 9 – 11 ]. In 2 Fällen traten die ersten Läsionen einige Tage, in dem dritten Fall 2 Wochen nach der ersten Impfdosis auf.…”