Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases

Abstract

Background Cutaneous reactions after mRNA-based COVID-19 vaccines have been reported but are not well characterized. Objective To evaluate morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results From December 2020-February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first dose reactions experienced second dose recurrence. Limitations Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusion We report a spectrum of cutaneous reactions after COVID-19 mRNA vaccines. Most patients with first dose reactions did not develop a second dose reaction, and no patients in the registry developed serious adverse events after the first or second dose. These data provide reassurance to patients and providers.

Erythema-chronicum-migrans-artiges Bild als Folge der COVID-Impfung

“…Unseres Wissens ist dies der erste Fall einer verzögerten Lokalreaktion nach COVID-Impfung, die in ihrem Erscheinungsbild ein Erythema chronicum migrans imitiert. In der bisher größten Fallserie mit verzögerten Hautreaktionen nach Impfung mit mRNA-Impfstoffen bei 414 amerikanischen Patienten [ 2 ] wurden vielfältige Veränderungen wie Erythromelalgie, Urtikaria, morbilliformes Erythem und sogar in Einzelfällen ein Pernionen- oder Chilblain-ähnliches Bild beobachtet, aber kein Fall, der unserem ähnelt. In dieser Fallserie traten Reaktionen vorwiegend nach Impfung mit dem Moderna-Impfstoff auf (83 %).…”

“…Verzögerte Lokalreaktionen nach COVID-19-Impfung sind v. a. bei Verwendung der m(messenger)RNA-Impfstoffe bereits wiederholt berichtet worden, zuletzt in einer kleinen Fallserie aus dem Universitätsklinikum Frankfurt [ 1 ] und in einer großen amerikanischen Fallauflistung mit 414 Fällen (hier auch Literaturübersicht [ 2 ]). Im Unterschied zu sofort auftretenden allergischen Reaktionen kommt es hierbei einige Tage nach der Impfung zu lokalen, meist juckenden Erythemen mit unterschiedlicher Konfiguration und unterschiedlicher Dauer des Auftretens.…”

Cutaneous Drug Eruption after COVID-19 Vaccination

“…Compared to the Pfizer vaccine, the Moderna vaccine demonstrated a higher incidence of cutaneous eruptions, many of which look similar to the cutaneous signs of COVID-19 infection [6]. Both the vaccines and viral infection can cause a wide array of dermatologic manifestations such as morbilliform exanthem, urticaria, exaggerated herpes zoster, pernios, and pityriasis-rosea like exanthems [6,7]. This overlap in dermatologic signs of vaccination reaction and COVID-19 infection presents a new challenge for dermatologists to distinguish the cause.…”

“…Another study reviewed cutaneous manifestations after COVID-19 vaccination with either the Moderna vaccine or the Pfizer vaccine. Compared to the Pfizer vaccine, the Moderna vaccine demonstrated a higher incidence of cutaneous eruptions, many of which look similar to the cutaneous signs of COVID-19 infection [6]. Both the vaccines and viral infection can cause a wide array of dermatologic manifestations such as morbilliform exanthem, urticaria, exaggerated herpes zoster, pernios, and pityriasis-rosea like exanthems [6,7].…”

COVID-19 and Dermatology: One Year in Review

“… 1 Dermatologists have played an important role in all aspects of the COVID-19 pandemic, from identification of cutaneous manifestations of the virus, to restructuring clinical practice to accommodate lockdown and social distancing measures, and now to vaccine roll out and management of cutaneous vaccine side effects. 2 , 3 , 4 , 5 , 6 …”