Bullous pemphigoid after SARS‐CoV‐2 vaccination: spike‐protein‐directed immunofluorescence confocal microscopy and T‐cell‐receptor studies

Abstract

Dear Editor, Growing evidence suggests that SARS‐CoV‐2 vaccination is associated with a variety of cutaneous reactions, also including autoimmune‐mediated conditions such as autoimmune blistering diseases such as bullous pemphigoid (BP). 1,2 We report new‐onset BP in two patients following the first SARS‐CoV‐2 vaccination.

Bullous Pemphigoid Associated With COVID-19 Vaccines: An Italian Multicentre Study

“…A close relationship between vaccination and BP onset is difficult to prove considering the extensive vaccination of the adult population during COVID-19 pandemic. However, the recent immunopathological findings by Gambichler et al (17) as well as timing reported across our cohort and published cases support the hypothesis of a causal link between SARS-CoV-2 vaccine and BP development. Further research is warranted to better define the nature of SARS-CoV-2-vaccine-associated immune dysregulation leading to BP.…”

“…Our sample size prevents the possibility to reliably compare different treatments. However, most of the subjects were easily controlled with treatment regimens concepted for milder forms of BP (i.e., topical steroids, lowto-moderate doses of systemic corticosteroids, doxycycline), supporting the assumption that the majority of COVID-19 induced BP cases would be non-severe (17,(24)(25)(26). Systemic corticosteroids as well as immunosuppressive adjuvants required to achieve disease control in BP may affect the efficacy of anti-SARS-CoV-2 vaccines.…”

“…SARS-CoV-2-vaccine-associated cutaneous eruptions encompass a growing spectrum of clinicopathological varieties, including local injection site reactions, urticarial eruptions, morbilliform eruptions, pernio/chilblain-like lesions, cosmetic filler reactions, herpes zoster and herpes simplex flares, pityriasis rosea-like eruptions (11,20,21). Autoimmune bullous skin diseases have also been observed following SARS-CoV-2-vaccination, with approximately 34 individual cases of vaccine-associated BP currently described (12,14,17,(22)(23)(24)(25)(26)(27)(28) (Supplementary Table 1). According to the registry-based studies by McMahon et al, BP-like eruptions accounted for 20% (12/58) of biopsy-proven SARS-CoV-2-vaccine-associated cutaneous reactions and 1.5% overall (11,22).…”

“…Autoimmune mechanisms following SARS-CoV-2 infection may be associated with molecular mimicry ( 15 , 16 ). On the other hand, vaccination may activate B and T-cell immunity, triggering an autoimmune response in genetically predisposed individuals ( 17 ).…”

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

“…A total of 195 articles was retrieved and after the screening, 20 articles were finally included for the review. A total of 35 AIBDs cases (including our case) were found, as shown in Table 1 [7] , [8] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . The sub-epithelial diseases were the most frequent, accounting for 28 cases (80.0%), specifically 26 cases of BP (74.3%) and 2 case of LABD (5.7%).…”