Dermatological manifestations associated with COVID‐19 and COVID‐19 vaccination: results from the Lebanese COVID registry

Abstract

BackgroundA number of cutaneous manifestations and adverse cutaneous reactions have been associated with COVID‐19 infection and vaccine.ObjectivesA Lebanese national registry was established to characterize the dermatologic manifestations and adverse cutaneous reactions associated with COVID‐19 infection and vaccination in a sample of the Lebanese population.MethodsAn observational cross‐sectional study was conducted via a web‐based clinical form distributed to physicians wishing to report their cases from May 2021 till May 2022.ResultsIn total, 142 patients were entered in the registry, of which 133 were adults and nine were pediatric patients. The main dermatological manifestations reported with COVID‐19 infection in the adult group were urticaria (32.9%), telogen effluvium (21.4%), morbilliform (10%), and papulosquamous (8.6%) eruptions. Urticaria was the most common adverse cutaneous reaction to the vaccine (33%). Interestingly, herpes zoster was triggered in 12 patients post vaccination in our series with this finding more frequently seen in patients above the age of 41 (P = 0.013). In the pediatric group, the most reported dermatological findings associated with COVID‐19 infection were malar erythema (25%) and telogen effluvium (25%). One 16‐year‐old patient developed lichen planus after one dose of a COVID‐19 vaccine. No deaths were reported in both age groups.ConclusionThis Lebanese registry adds more robust evidence that clinical manifestations of the COVID‐19 virus and vaccine are diverse. More studies are necessary to establish the pathophysiology of these dermatological findings in the context of COVID‐19 infection and vaccination.

Erythema nodosum after COVID‐19 vaccine associated with varicella‐zoster virus reactivation

“…3 Herpes zoster (HZ) has been identified as a more prevalent skin manifestation post-COVID-19 vaccination. 4 The incidence of HZ following COVID-19 vaccination was notably higher after the initial dose (68.2%) than after the second dose (31.2%). The median interval between vaccination and HZ onset was 6 days (interquartile range: 3-10).…”

“…Several cases of CV have resulted after chemical exposure, such as, monobenzone (MBEH) in the gloves of factory workers, 4 mercaptobenzothiazole (MBT) after developing CD, 1 in Japan associated with a skin-lightening product containing rhododendrol. 4 Current evidence supports that vitiligo is a product of preexistent melanocyte dysfunction targeted and amplified by autoreactive CD8 + T cells that cause a loss of melanocytes through innate inflammation through the interferong-CXCL10 pathway. Vitiligo inheritance is polygenic and increases based on the closeness of the individuals (i.e., 2% in the general population and 23% with an identical twin).…”

“…Vitiligo inheritance is polygenic and increases based on the closeness of the individuals (i.e., 2% in the general population and 23% with an identical twin). 2,4 Chemicals that are tyrosine analogs, such as phenols, disrupt melanin synthesis, which increases stress and contributes to inflammation. 4 Melanin and energy production may already be hindered in vitiligo patients, thus creating a system that cannot keep up with the demands of the cell.…”

“…2,4 Chemicals that are tyrosine analogs, such as phenols, disrupt melanin synthesis, which increases stress and contributes to inflammation. 4 Melanin and energy production may already be hindered in vitiligo patients, thus creating a system that cannot keep up with the demands of the cell. A lack of CD4 + T regulatory cells also significantly impacts the disease state and prognosis.…”

“…A lack of CD4 + T regulatory cells also significantly impacts the disease state and prognosis. 2,4 The prevalence of CL is increasing in industrially developing countries where many household products may not meet rigorous regulatory standards. 4,5 CL in higher-income countries is from occupational exposures.…”