Cutaneous Complications of mRNA and AZD1222 COVID-19 Vaccines: A Worldwide Review

Abstract

Because of the increasing emergence of cutaneous reactions from COVID-19 vaccines worldwide, we investigated the published reports of these complications. We searched the PubMed, Google Scholar, and Scopus databases and the preprint server bioRxiv for articles on cutaneous complications linked to mRNA-1273 (Moderna), BNT162b2 (Pfizer–BioNTech), and AZD1222 (AstraZeneca–Oxford University) vaccines published until 30 September 2021. Eighty studies describing a total of 1415 reactions were included. Cutaneous reactions were more prevalent in females (81.6%). Delayed large local reactions were the most common complication (40.4%), followed by local injection site reactions (16.5%), zoster (9.5%), and urticarial eruptions (9.0%). Injection site and delayed large local reactions were predominantly caused by the mRNA-1273 vaccine (79.5% and 72.0%, respectively). BNT162b2 vaccination was more closely linked to distant reactions (50.1%) than mRNA-1273 (30.0%). Zoster was the most common distant reaction. Of reactions with adequate information for both vaccine doses, 58.3% occurred after the first dose only, 26.9% after the second dose only, and 14.8% after both doses. Overall, a large spectrum of cutaneous reaction patterns occurred following the COVID-19 vaccination. Most were mild and without long-term health implications. Therefore, the occurrence of such dermatologic complications does not contraindicate subsequent vaccination.

Pityriasis rubra pilaris (type I) following administration of the BNT162b2 mRNA COVID ‐19 vaccine: Successful treatment with ustekinumab and acitretin

“…Since the approval of the mRNA vaccines for SARS‐CoV‐2, multiple cutaneous adverse events were associated with the administration of the vaccine. 2 , 3 …”

“…1 Since the approval of the mRNA vaccines for SARS-CoV-2, multiple cutaneous adverse events were associated with the administration of the vaccine. 2,3 We report a case of recalcitrant PRP following administration of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech).A 47-year-old Caucasian man presented us with fast development of scaly reddish plaques on scalp, back, chest, and limbs that appeared 15 days after he received the booster with the BNT162b2 vaccine in October 2021 (Figure 1A). He was vaccinated with two doses of CoronaVac (Sinovac Biotech) in March 2021, without intercurrences.He did not have any evidence of previous comorbidities or active infection and was not using other drugs.…”

“…9,10 The causal relationship between mRNA vaccines and cutaneous immunological reactions is still under debate, but triggers include an abundance of type I interferons as a direct effect of the immunogenicity of vaccines (Th1 response), activation of tissue-resident memory T cells in susceptible individuals (Th17/Th22 response), and vaccinederived damage to the extracellular matrix (imbalance of regulatory T cells). 2,3 We are just starting to understand more about the efficacy and toxicity of the novel COVID-19 vaccines.…”

“…1 Since the approval of the mRNA vaccines for SARS-CoV-2, multiple cutaneous adverse events were associated with the administration of the vaccine. 2,3 We report a case of recalcitrant PRP following administration of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech).…”

Linear lichen planus after COVID‐19 vaccination

“…Cutaneous side effects are more common in women, and the most frequent skin manifestations are delayed large local reactions, local injection site reactions, urticaria, and herpes zoster. 1 There are few reports of a lichenoid reaction. We report a case of linear lichen planus triggered by the Pfizer‐BioNTech COVID‐19 vaccine.…”