Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines

Abstract

Many patients are receiving SARS-CoV-2 vaccinations, which have been associated with a variety of adverse effects. Cutaneous adverse reactions to SARS-CoV-2 vaccinations have been progressively reported, but they have not been reviewed according to their morphological clinical patterns. The objective of this review was to summarize the existing data concerning the cutaneous adverse reactions following SARS-CoV-2 vaccines and group them according to common morphological and pathogenetic patterns. We reviewed the English language literature up to 15 August 2021, using predefined keywords to identify the relevant studies evaluating cutaneous adverse reactions associated with SARS-CoV-2 vaccines. We search for recurrent morphological patterns sharing clinical signs and symptoms and physio-pathological mechanisms. Timing to onset following the first or booster dose of the vaccine, predisposing conditions, therapeutic management, and outcome were also collected. Among the dermatological manifestations associated with SARS-CoV-2 vaccinations, we distinguished: (1) new onset reactions and (2) flares of preexisting dermatoses. The most common were injection site reactions, affecting 30–70% and generally mild or moderate. Small case series or single case reports included filler reactions, exanthemas, vascular lesions, urticaria, eczematous dermatitis, autoimmune bullous reactions, and severe cutaneous adverse reactions. In addition, the exacerbation of chronic immuno-mediated dermatoses (mainly psoriasis and atopic dermatitis) and reactivations of herpes infection were reported. The cutaneous reactions were generally mild, self-limiting, and resembled common cutaneous drug eruptions and/or COVID-19 skin manifestations.

Symmetric drug–related intertriginous and flexural exanthema–like eruption related to coronavirus disease 2019 vaccine

“…Reports of COVID‐19 vaccination‐related SDRIFE are rare. 2 , 3 , 4 , 5 To date, five cases induced by an inactivated whole‐virus vaccine (CoronaVac [Sinovac Life Sciences]), messenger RNA (mRNA) vaccine (BNT162b2), and adenoviral vaccine (ChAdOx1 nCoV‐19) have been published (Table 1 ). Although it is not possible to discern the immunological mechanism of vaccine‐associated SDRIFE, it is considered a type IVc and IVd delayed‐type systemic allergic dermatitis.…”

COVID-19 and the Unraveling of Experimental Medicine - Part II

“…Within months of the rollout reports began to appear detailing a wide range of adverse effects occurring days to weeks after vaccination: arterial and venous thrombosis [143-146], heart attack [147,148], yocarditis/pericarditis [149][150][151][152], stroke [153,154], pulmonary embolism [155][156][157][158], seizures [159,160], encephalomyelitis [161-170], Guillain-Barré syndrome [171][172][173][174][175][176][177], Bell's palsy [178][179][180], reactivation of viral infections [181][182][183], induction of autoimmune states or exacerbation of preexisting autoimmune conditions [184-192], pregnancy complications [193], anaphylaxis, allergic reactions and lymphadenopathy [194][195][196][197][198][199][200], appendicitis [201] and sudden death [202]. In our search of the literature, we identified over 1,000 reports in peer-reviewed journals of various vaccine-associated adverse events.…”

Skin adverse reactions to Sars‐CoV‐2 vaccination: a relevant responsibility issue for dermatologists

“…In selected cases, the administration of a different type of vaccine and/or a prophylactic premedication with antihistamines and oral or topical glucocorticoids may be reasonable. 4 For patients with immune-mediated inflammatory diseases, such as psoriasis and atopic dermatitis receiving conventional or biologic disease modifying anti-rheumatic drugs, the vaccination against Sars-CoV-2 is recommended. Although patients receiving methotrexate (likely also cyclosporine) could have a reduced response to mRNA Sars-CoV-2 vaccines, it may still provide some degree of protection against the infection.…”

“…In conclusion, skin adverse reactions to Sars‐CoV‐2 vaccination could rarely occur, and they are generally mild and self‐limiting. Dermatologists will play an important role in establishing the real association between skin reaction and vaccination, addressing their pathogenetic mechanisms and the open issues still present 2,4 . The responsibility of making the casual association is trading off with the need of each individual to receive repeated doses of the vaccine.…”

“…Dermatologists will play an important role in establishing the real association between skin reaction and vaccination, addressing their pathogenetic mechanisms and the open issues still present. 2,4 The responsibility of making the casual association is trading off with the need of each individual to receive repeated doses of the vaccine. There is, thus, an urgent need to internationally establish recommendations on how to advice at best doctor and patients.…”