Psoriasis triggered by tetanus-diphtheria vaccination

Abstract

Psoriasis is a common inflammatory disease with multiple known triggers. We report the case of a patient whose psoriasis was triggered by tetanus and diphtheria immunization (Td vaccine). To the best of our knowledge, this is the first reported case of psoriasis triggered by the Td vaccine. Authors speculate about the involved mechanisms.

Possible Triggering Effect of Influenza Vaccination on Psoriasis

“…Although staphylococcal, streptococcal, measles, and varicella vaccines have also been applied previously in the treatment of psoriasis, an early report described two cases of psoriasis induced by BCG vaccination and influenza vaccination under the name of “psoriasis vaccinalis” [ 10 , 20 ]. Subsequently, extremely rare cases of psoriasis, psoriasis-like guttate eruptions, and psoriatic arthropathy have been reported following BCG vaccination and a case of psoriasis was reported, as triggered by the tetanus-diphtheria vaccination [ 11 – 14 ]. Additionally, a case-control study reported rubella vaccination as a risk factor for psoriatic arthropathy [ 15 ].…”

“…It was claimed that the vaccination may trigger an exacerbation of psoriatic skin lesions itself; however, these views also concur with the well-known Koebner phenomenon that occurs in psoriasis, that is, the development of new plaques at the locations of skin injury [ 1 ]. Researchers also indicated that the BCG and tetanus-diphtheria vaccines, due to the mycobacterial heat shock proteins in the case of the BCG and diphtheria toxoid in the case of the tetanus-diphtheria vaccines, induce IL-6 production, which, in turn, promotes the development of Th17 cells [ 12 – 14 ]. Previous studies had also demonstrated a significant increase in IL-6 values after the administration of the influenza vaccination [ 25 , 26 ].…”

A Review of Possible Triggering or Therapeutic Effects of Antimicrobial Vaccines on Psoriasis

“…Td vaccine has shown to induce IL-6 production, which stimulates Th17 cells, having a key role in psoriasis pathogenesis [37,38]. It was suggested that this mechanism was the triggering cause in this case [37].…”

“…A case of 50-year-old psoriasis patient in remission was described as guttate psoriasis 1 week after the Td vaccination [37]. Td vaccine has shown to induce IL-6 production, which stimulates Th17 cells, having a key role in psoriasis pathogenesis [37,38].…”

“…Td vaccine has shown to induce IL-6 production, which stimulates Th17 cells, having a key role in psoriasis pathogenesis [37,38]. It was suggested that this mechanism was the triggering cause in this case [37]. In a case-control study evaluating the potential risk factors for the onset of psoriatic arthritis, exposure to rubella (OR = 12.4, 95% CI = 1.2-122.14) and tetanus (OR = 1.9, 95% CI = 1.0-3.7) vaccines was reported at a higher frequency in psoriatic arthritis group as compared to the psoriasis group without arthritis [39].…”