SARS‐CoV‐2 vaccine‐related cutaneous manifestations: a systematic review

Abstract

To date, over 250 million people have been reportedly infected by COVID‐19 disease, which has spread across the globe and led to approximately 5.1 million fatalities. To prevent both COVID‐19 and viral transmission, DNA‐based/RNA‐based vaccines, non‐replicating viral vector vaccines, and inactivated vaccines have been recently developed. However, a precise clinical and histological characterization of SARS‐CoV‐2 vaccine‐related dermatological manifestations is still lacking. A systematic review of 229 articles was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, in order to provide an extensive overview of SARS‐CoV‐2 vaccine‐related skin manifestations. Data on demographics, number of reported cases with cutaneous involvement, vaccine, and rash type (morphology) were extracted from articles and summarized. A total of 5941 SARS‐CoV‐2 vaccine‐related dermatological manifestations were gathered. Local injection‐site reactions were the most frequently observed, followed by rash/unspecified cutaneous eruption, urticarial rashes, angioedema, herpes zoster, morbilliform/maculopapular/erythematous macular eruption, pityriasis rosea and pityriasis rosea‐like eruptions, and other less common dermatological manifestations. Flares of pre‐existing dermatological conditions were also reported. Cutaneous adverse reactions following SARS‐CoV‐2 vaccine administration seem to be heterogeneous, rather infrequent, and not life‐threatening. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.

Fixed drug eruption after the Sinopharm COVID‐19 vaccine

“… 3 Dermatological reactions were found to be more common after the Pfizer and Moderna vaccines. 1 Sinopharm, an inactivated virus SARS‐CoV‐2 vaccine, was developed in China. This vaccine induced mild, self‐limiting adverse reactions, most commonly pain at the injection site and fever.…”

“…A wide spectrum of skin manifestations has occurred among coronavirus vaccine recipients, which appear to be more common with the Moderna vaccine. 1 Injection site reactions are the most common cutaneous reaction to COVID‐19 vaccines. Fixed drug reaction (FDE) is a rare skin side effect previously reported in eight cases after COVID‐19 vaccines, but none of them after the Sinopharm vaccine.…”

Maternal SARS‐CoV‐2 infection and aplasia cutis congenita in a newborn

“… 9 Moreover, vaccine studies reported that cutaneous lesion occurred after COVID‐19 vaccine inoculation, especially among children. 10 It is biologically plausible that the identified ACC in this newborn resulted from his immunological responses to the maternal SARS‐CoV‐2 infection, which impacts the fetus in utero and cause damage to the fetal skin development.…”

Facial Angioedema after the first dose of Covishield (adenovirus-vectored severe acute respiratory syndrome coronavirus 2 vaccine): follow-up after the second and third booster doses

“…Covishield and other SARS-Cov-2 vaccines may also lead to cutaneous reactions, mainly at local sites, and delayed large local reactions. Urticaria, vasculopathic manifestations, pityriasis rosea-like eruptions, and herpes zoster have also been associated with Covishield and other SARS-Cov-2 vaccines 4 )-( 5 . We report a case of facial angioedema that followed the first dose of Covishield.…”