Dermatological Lesions near the Smallpox Vaccination Site after Scab Detachment

Abstract

Lesions arising after scab detachment at the smallpox vaccination site have been described in the medical literature. We investigated reports of postscab lesions among US civilian volunteers vaccinated against smallpox from January through August 2003. We conducted enhanced surveillance, using a standard questionnaire, for reports of skin lesions appearing at or near the smallpox vaccination site after scab detachment. We identified 21 reports; 19 of the case patients responded to our questionnaire. The lesions (scab and/or fluid) of 7 case patients were tested for vaccinia virus by use of polymerase chain reaction and/or immunohistochemistry; all were found to be negative. We contacted 18 case patients 11 months after the initial lesion appearance; 10 (56%) of the 18 reported having another lesion appear after the initial postscab lesion had resolved. Lesions were heterogeneous in morphology, clinical appearance, and histology. The evidence from our case series and follow-up suggests that these lesions are self-limited, without significant clinical sequelae.

Injection Site Lichenoid Dermatitis Following Pneumococcal Vaccination: Report and Review of Cutaneous Conditions Occurring at Vaccination Sites

“…Cutaneous dermatoses and malignancies have occurred at the sites of other vaccines, including Bacillus Calmette-Guerin (Table 2 ) [ 18 – 44 ], hepatitis B (Table 3 ) [ 28 , 45 – 53 ], smallpox (Table 4 ) [ 28 , 54 – 79 ], tetanus (Table 5 ) [ 14 , 80 – 86 ], and others (Table 6 ) [ 36 , 51 , 55 , 73 , 87 – 97 ]. Granuloma annulare is one of the more common skin conditions to subsequently occur at the site of an immunization [ 25 , 26 , 46 , 98 , 99 ].…”

“…Granuloma annulare is one of the more common skin conditions to subsequently occur at the site of an immunization [ 25 , 26 , 46 , 98 , 99 ]. The most frequently observed vaccination site-associated malignancy is basal cell carcinoma [ 33 , 38 , 55 – 57 , 73 ], followed by squamous cell carcinoma [ 33 , 38 , 54 , 55 , 57 , 73 ]. However, the prevalence of melanoma [ 55 , 57 , 73 ] and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) [ 55 , 57 , 60 – 62 , 72 ] in smallpox vaccination scars—as compared to the scars of other vaccines—is greater than expected and may be secondary to a unique characteristic of the vaccine (Table 7 ) [ 15 , 33 , 38 , 54 – 57 , 60 – 62 , 69 , 72 , 73 , 86 , 90 , 94 – 96 ].…”

“…However, the prevalence of melanoma [ 55 , 57 , 73 ] and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) [ 55 , 57 , 60 – 62 , 72 ] in smallpox vaccination scars—as compared to the scars of other vaccines—is greater than expected and may be secondary to a unique characteristic of the vaccine (Table 7 ) [ 15 , 33 , 38 , 54 – 57 , 60 – 62 , 69 , 72 , 73 , 86 , 90 , 94 – 96 ].…”

Squamous cell carcinoma arising in smallpox vaccination scar

“…Smallpox immunisation with vaccinia virus leaves a slightly depressed, smooth scar at the site of vaccination. Although rare, benign and malignant tumours have been reported at these vaccination sites, such as squamous cell carcinoma, basal cell carcinoma, melanoma, dermatofibrosarcoma protuberans, and malignant fibrous histiocytoma 123…”

Vaccination against Smallpox in the Posteradication Era

“…Lesions arising at the smallpox vaccination site after scab detachment, including malignancies, have been described, and the historical medical literature hypothesized that vaccinia might be a carcinogen. Kroger et al [17] investigated lesions arising at or near the site of smallpox vaccination after the Jennerian progression was completed and the scab had detached. The characterized lesions were heterogeneous in morphology, clinical appearance, and histology.…”