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

Abstract

Pityriasis rubra pilaris (PRP) is a rare erythematous papulosquamous disorder, clinically and pathologically similar to psoriasis. 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. The patient also reported no personal or family history of psoriasis, PRP, or other autoimmune disease.Laboratory investigations showed a raised C-reactive-protein level and liver and kidney function altered. Serological testing for

Pityriasis following COVID-19 vaccinations: a systematic review

“… 11 , 18 Additional successful treatments included the use of methotrexate, 12 oral and topical corticosteroids such as prednisone, 12 , 15 , 17 , 45 emollients, 15 isotretinoin, 13 and ixekizumab, 16 while ustekizumab showed partial improvement in one case and none in another. 36 Two PRP cases in this systematic review did not report the patient’s final outcome after initiation of treatment, 24 , 46 while in another case, the patient was lost to follow-up. 10 …”

Clinical characteristics of patients with pityriasis rubra pilaris following SARS‐CoV‐2 vaccination

“…Including the case of Zhang et al, 1 20 COVID-19 vaccine-induced PRP cases have been published so far (Figure 1). [1][2][3][4][5] Unlike classic adult-onset PRP, which is a rare autoinflammatory keratinising disease without gender preference, COVID-19 vaccine-induced PRP appears to be more likely in males (70% of cases, Table 1). By contrast, disease onset in patients with COVID-19 vaccineinduced PRP is around the 60s matching the expected age of disease onset of classic adult PRP.…”

“…COVID-19 vaccine-induced PRP usually occurred about 10 days after vaccination, whereas there was a wide range from 3 to 60 days. [1][2][3][4][5] The vaccines applied were as follows: 8/20 (40%) cases with vector-based vaccines (Vaxzevria, Covishield/AstraZeneca), 8/20 (40%) cases with mRNA-based vaccines (Comirnaty/Pfizer-BioNTech, Spikevax/Moderna) and 4/20 (20%) cases with an inactivated vaccine (CoronaVac/ Sinovac). In most patients, systemic treatment consisted of retinoids.…”

“…I would like to briefly add some more information on the clinical characteristics of the previously published COVID-19 vaccine-induced PRP cases. [2][3][4][5][6][7] A broad spectrum of COVID-19 vaccine-induced skin conditions has been reported since the worldwide introduction of SARS-CoV-2 vaccines. 8 Apart from very frequent nonspecific injection site reactions and rare hypersensitivity reactions, chilblain-like lesions, urticarial or moribilliform exanthemas, pityriasis rosea-like, petechial and erythema multiforme-like rashes and autoimmune-mediated conditions (e.g.…”

“…In most patients, systemic treatment consisted of retinoids. [1][2][3][4][5] The latter represented first-choice therapies for PRP, even though the evidence for its use in PRP patients is relatively poor. In current and recent cases, however, interleukin 17 (IL-17), IL-23, and IL-23/12(p40) have also been administered with success in most cases.…”