Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases

Català, Alba; Muñoz‐Santos, Carlos; Galván-Casas, Cristina; Riesco, Mónica Roncero; Nebreda, David Revilla; Truyols, Amador Solá; Giavedoni, Priscila; Llamas‐Velasco, Mar; González‐Cruz, Carlos; Cubiró, Xavier; Ruiz‐Villaverde, Ricardo; Gómez-Armayones, S.; Mateo, M P Gil; Pesqué, David; Marcantonio, Orianna; Fernández‐Nieto, Diego; Romaní, Jorge; Iglesias-Pena, N.; González, Lucía Carnero; Tercedor-Sánchez, J.; Carretero, G.; Masat-Ticó, T; Rodríguez‐Jiménez, Pedro; Giménez‐Arnau, Ana; Utrera-Busquets, M.; Laguna, Elena Vargas; Menendez, Alvaro G.; Lasser, E San Juan; Iglesias‐Sancho, Maribel; Naranjo, L Alonso; Hiltun, Ingrid; Marco, E. Cutillas; Olabarrieta, Isabel Polimón; Escobedo, Silvia Marinero; García-Navarro, Xavier; Gutierrez, Manuel; Baeza‐Hernández, Gloria; Camps, L Bou; Toledo-Pastrana, T.; Guilabert, Antonio

doi:10.1111/bjd.20639

Cited by 202 publications

(429 citation statements)

References 41 publications

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“…Curiously, the second dose of the same vaccine was well tolerated, and only scaly skin and slight hyperpigmentation remained over the weeks after the disseminated cutaneous eruption. Some cutaneous ADR seem to resemble the facultative skin lesions found in some COVID-19 patients [2]. We noted two cases of vesicular reactions (case #7 and 15), but both were mild and resolved quickly with topical anti-inflammatory and antibiotic ointments, respectively.…”

Section: Discussionmentioning

confidence: 56%

“…To enable the return to everyday life without drastic restrictions, the world strives for mass vaccinations to reach immunity on a population-wide scale. Even though the available vaccines display a good tolerability, a few patients experience unusual cutaneous adverse drug reactions (ADR) [2], some of them similar to findings associated with the natural infection [3]. Very early on, there were notable reports of localized erythematous plaques arising late at the site of injection of messenger ribonucleic acid (mRNA) vaccines, which has been labeled "COVID arm" [4].…”

Section: Introductionmentioning

confidence: 99%

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Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

et al. 2021

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(1) Background: Coronavirus disease 2019 (COVID-19) vaccines are currently employed on a population-wide scale in most countries worldwide. Data about unusual cutaneous adverse drug reactions (ADR) are scant, though. (2) Methods: We retrospectively analyzed moderate to severe vaccine-related ADR in the Department of Dermatology and Allergy of the University Hospital Bonn between May to June 2021 and analyzed related skin biopsies. (3) Results: As a specialized dermatological academic center, we encountered a total of n = 19 clinically and pathologically heterogeneous cutaneous ADR with a female predominance. Delayed cutaneous ADR occurred as late as 30 days after vaccination. The majority of ADR were mild, though a few patients required systemic treatment (antihistamines, glucocorticosteroids). (4) Conclusions: The clinico-pathological spectrum of cutaneous side effects with COVID-19 vaccines is wide; however, the benefits outweigh the risks by far. More dermatopathological studies on cutaneous ADR not limited to COVID-19 vaccines are desirable to enable a better understanding of underlying pathophysiological mechanisms.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

et al. 2021

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“…This is not surprising, as even the accepted incidence numbers of dermatoses in general are quite vague and depend largely on historic numbers. A recently published cross-sectional study from Spain precisely characterized the most commonly seen reactions from a dermatological point of view; however, the study design did not enable conclusions regarding the frequency in the respective population [33]. We compiled the available reports in another publication to estimate the incidence of generalized or more severe cutaneous ADRs to be below 0.3% [34].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective

et al. 2021

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(1) Background: Numerous vaccines are under preclinical and clinical development for prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19). In light of high efficacy rates and satisfactory safety profiles, some agents have already reached approval and are now distributed worldwide, with varying availability. Real-world data on cutaneous adverse drug reactions (ADRs) remain limited. (2) Methods: We performed a literature research concerning cutaneous ADRs to different COVID-19 vaccines, and incorporated our own experiences. (3) Results: Injection site reactions are the most frequent side effects arising from all vaccine types. Moreover, delayed cutaneous ADRs may occur after several days, either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis. Cutaneous ADRs may be divided according to their cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs). Specific cutaneous ADRs mimic immunogenic reactions to the natural infection with SARS-CoV-2, which is associated with an abundance of type I interferons. (4) Conclusions: Further studies are required in order to determine the best suitable vaccine type for individual groups of patients, including patients suffering from chronic inflammatory dermatoses.

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“…Particularly, a cellular response with increased CD8+ T cell and T helper type 1 CD4+ T cells has been clearly documented shortly after booster doses for Pfizer and Moderna [ 38 ]. A compelling hypothesis for this phenomenological paradox has emerged and suggests that VZV-specific CD8+ cells are not, temporarily, capable of controlling VZV after the massive shift of naïve CD8+ cells in the setting of SARS-COV-2 vaccination [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Varicella Zoster Virus Reactivation Following COVID-19 Vaccination: A Systematic Review of Case Reports

et al. 2021

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The newly developed COVID-19 vaccines have established a safe profile, yet some individuals experience a wide range of adverse events. Recently, reactivation of varicella zoster virus (VZV) has been observed after administration of different COVID-19 vaccines, although causality remains a matter of debate. The aim of this systematic review was to examine the available literature and provide an overview of reported cases of VZV reactivation following COVID-19 vaccination. We identified 12 eligible articles which included 91 patients with herpes zoster (HZ) following COVID-19 vaccination. Hypertension was the main comorbidity present in 18% of patients (16/91). Additionally, 13% of patients (12/91) had an autoimmune condition with rheumatoid arthritis being the most common (4/12). Moreover, 10% of patients (9/91) were receiving immunosuppressants. The dermatomal distribution of skin lesions varied among patients, with the mammary region being most affected. On average, symptoms developed 5.8 days post-vaccination irrespective of dose and treatment with oral valacyclovir as a monotherapy was employed in most patients (23/91). HZ is possibly a condition clinicians may expect to encounter in patients receiving COVID-19 vaccines. While causality has not yet been established increased awareness and early recognition of the disorder would be crucial for the optimal management of these patients.

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Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases

Cited by 202 publications

References 41 publications

Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective

Varicella Zoster Virus Reactivation Following COVID-19 Vaccination: A Systematic Review of Case Reports

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