Cutaneous reactions associated with vaccination against SARS-CoV-2.

BACKGROUND: Since the first reports in November 2019, coronavirus 2 has represented a priority health problem causing severe acute respiratory syndrome and other extrapulmonary manifestations, originating a pandemic with millions of deaths. Therefore, vaccines represent the most effective means of controlling the COVID-19 pandemic. Skin reactions to COVID-19 mRNA vaccines have been observed. The objective of this paper is to evaluate the morphology of the cutaneous manifestations and to carry out a review on the current recommendations for their management. CLINICAL CASE: Case 1: A 25-year-old male patient who presented a morbilliform rash after the first dose of the Pfizer vaccine against SARS-CoV-2, which remitted without sequelae at 24 hours. Case 2: A 65-year-old female patient with erythema at the puncture site 10 days after the first dose of the Modern vaccine against SARS-CoV-2 with complete remission on the 4th day after its onset. CONCLUSION(S): Some of the dermatological manifestations to the mRNA COVID-19 vaccines were identified as mimicking the SARS-CoV-2 infection itself. As the administration of vaccines increases, it is essential to recognize and understand their adverse effects.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Waking Up to Monkeypox in the Midst of COVID-19.

The first incidence of the monkeypox virus (MPXV) was reported in a Danish research facility. Even though first discovered in monkeys, rodents account for the largest reservoir of the disease. It is an encapsulated, brick-shaped double-stranded DNA virus strongly related to the smallpox virus. The risk of acquiring MPXV has been found to be inversely related to smallpox vaccination. Although the cases were initially restricted to African countries, they were first reported outside Africa in the early 2000s. MPXV is transmitted through close personal contact, most commonly through direct skin-skin contact. The fatality rates associated with the MPXV tend to vary in different regions, with Congo clad basin having the highest mortality rate. The majority of the cases of MPXV have been reported in men who have sex with men. Although optimal infection control and treatment strategies are under investigation, the current management focus is on immunization and the isolation of patients. Effective control strategies are based on implementing a method of contact tracing, quarantining exposed and infected individuals, and using vaccines. There is no proven cure for MPXV, and most infected patients recover without medical intervention. Extensive studies are being conducted to determine the efficacy of antivirals in managing MPXV, with tecovirimat being the first antiviral medication approved by the Food and Drug Administration (FDA) to manage MPXV. The smallpox vaccine has traditionally been thought of as the most effective method of controlling the infection, possibly due to the similarities between the two viruses. However, numerous obstacles prevent the effective control of MPXV, including social isolation and stigma, poor understanding of the disease dynamics, lack of adequate patient education, and public health strategies.

Dermatological presentations in COVID-19 patients: perspectives on the present and the future

The Coronavirus 19 (COVID19) disease is a global pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV2). Extrapulmonary symptoms related with COVID-19 have grown more prominent in recent months, particularly within dermatological manifestations. As a result, dermatologists should be familiar with the different ways in which the COVID-19 disease can present itself, and what to look out for if a COVID-19 patient appears to have skin lesions. When coming in touch with a suspected or confirmed case of COVID-19, personal protective equipment must be used. However, its use has been linked to dermatological adverse effects, which dermatologists practicing during the COVID-19 era should be aware of. Tele dermatology can help to avoid these problems, and should be made more widely available, especially in rural locations. By examining PubMed and a few review articles on dermatological presentations in current and future views for covid19, a systematic review was done. As a result of the variable nature of COVID-19-related cutaneous symptoms, our group identified six basic clinical patterns: Papulovesicular exanthem, a chilblain-like acral pattern, a livedo-reticularis-racemose-like pattern, purpuric "vasculitic” papulovesicular exanthem, and a confluent erythematous/maculopapular/morbilliform rash. With an emphasis on the clinical characteristics and therapeutic treatment options for each subcategory, this review presents an overview of the COVID-19-associated cutaneous symptoms. © Salus Internazionale ECM srl-Provider ECM no 763.

Localized Delayed T-cell Mediated Hypersensitivity After mRNA SARS-CoV-2 Vaccination.

Since the emergency authorization of SARS-CoV-2 vaccines, the medical literature has been investigating the management of allergic reactions to the vaccines. Anaphylaxis has been reported among a minority of vaccinated individuals, and many trials monitoring the safety profile of the vaccines have identified cases of benign cutaneous reactions. Typical features of delayed benign cutaneous hypersensitivity reactions include localized erythema, pruritus, and rash. However, reports have described rare cases of rash and atopy at sites apart from the injection site following vaccine delivery. We will discuss a unique case of delayed benign cutaneous hypersensitivity presenting in the lower extremity after an upper-extremity administration of an mRNA SARS-CoV-2. Additionally, we describe management strategies to guide clinicians who encounter similar vaccine-induced hypersensitivity reactions.

Generalized fixed drug eruption following Pfizer-BioNtech COVID-19 vaccination.

Fixed drug eruption is a cutaneous drug reaction which recurs at the same site when the individual is exposed to the causative drug, characterized by single or multiple round sharply demarcated erythematous-to-violaceous patches. Here, we report a patient with generalized non-bullous fixed drug eruption following mRNA-based Pfizer-BioNTech COVID-19 vaccine.

Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue?

It has been reported that the novel coronavirus disease (COVID-19) may be associated with a papulovesicular skin eruption predominantly involving the trunk. We hereby present a case of COVID-19-associated varicella-like exanthem in an 8-year-old girl with mild systemic symptoms.

COVID-19 Skin Manifestations in Skin of Colour.

Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.

The Cutaneous Manifestations Associated with COVID-19: A review.

IMPORTANCE: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic spreads, increasing cases of dermatologic manifestations of the disease continue to be reported. OBSERVATIONS: In this general review of the case reports, case series, and other systematic reviews on this subject, several patterns of cutaneous lesions have been compiled. These include viral exanthems, papulovesicular, pernio-like, vasculopathy-related, and other miscellaneous rashes. CONCLUSIONS AND RELEVANCE: While clinical observations and subjective cases of rashes associated with SARS-CoV-2 are important to furthering our research and study of this viral disease, we as clinicians must be cautious in attributing causation with correlation. Continued research and study are needed before we can attribute a source for these dermatologic manifestations.

Cutaneous Manifestations of COVID-19: Early Diagnosis and Prognostic Information.

Coronavirus disease 2019 (COVID-19) is a multiple organ disease caused by SARS-CoV-2 virus infection. Among the organs and tissues affected by the disease, the skin has received less attention. Skin is the largest tissue in the body and is responsible for temperature maintenance, protection against external dangers and dehydration, and other roles. Although the skin manifestations of COVID-19 are common, the lack of standardization in the description of its signs makes it difficult to group them together. Considering the literature available so far, the skin manifestations can be divided into 4 patterns: exanthem, urticarial lesions, vascular and acro-papular eruptions. The localization, age, onset, symptoms and severity vary among them. The treatment, when necessary, is usually focused on the inflammatory response control. The pathophysiological mechanisms seem to involve the apoptosis of keratinocytes as well as endothelial cell dysfunction, favouring the establishment of skin inflammation. The better characterization of the skin manifestations is essential to understand the possible effects of COVID-19 on skin as well as for the development of appropriate treatments.

Cutaneous Manifestations of COVID-19 in the Inpatient Setting.

Cutaneous findings have increasingly been reported in patients with coronavirus disease 2019 (COVID-19). This review discusses associated skin findings in patients with COVID-19 in the inpatient setting, ranging from vasculopathy-related lesions associated with high hospitalization rate and poor prognosis to inflammatory vesicular and urticarial eruptions that are rarely associated with prolonged hospitalization. We also discuss other reported COVID-19 cutaneous manifestations such as Sweet's syndrome, purpuric eruptions, and Multisystem Inflammatory Syndrome in Children. Although the relationship between dermatologic changes and COVID-19 disease progression is not fully elucidated, familiarity with cutaneous manifestations is valuable for physicians caring for patients hospitalized with COVID-19 and may help improve disease recognition and care.

Pleomorphicskin eruptions in a COVID-19 affected patient: Case report and review of the literature.

The coronavirus disease (COVID-19), during its course, may involve several organs, including the skin with a petechial skin rash, urticaria and erythematous rash, or varicella-like eruption, representing an additional effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as commonly observed in other viral diseases. Considering that symptomatic patients with COVID-19 generally undergo multidrug treatments, the occurrence of a possible adverse drug reaction presenting with cutaneous manifestations should be contemplated. Pleomorphic skin eruptions occurred in a 59-year-old Caucasian woman, affected by a stable form of chronic lymphocytic leukemia, and symptomatic SARS-CoV-2 infection, treated with a combination of hydroxychloroquine sulfate, darunavir, ritonavir, sarilumb, omeprazole, ceftriaxone, high-flow oxygen therapy devices, filgrastim (Zarzio®) as a single injection, and enoxaparin. The patient stopped all treatment but oxygen and enoxaparin were continued and the patient received a high-dose Desametasone with complete remission of dermatological impairment in 10 days. It is very important to differentially diagnose COVID-19 disease-related cutaneous manifestations, where is justified to continue the multidrug antiviral treatment, from those caused by an adverse drug reaction, where it would be necessary to identify the possible culprit drug and to start appropriate antiallergic treatment.

Systemic lupus erythematosus and varicella-like rash following COVID-19 in a previously healthy patient.

Emerging reports show that coronavirus disease 2019 (COVID-19) may lead to autoimmune and autoinflammatory diseases. However, COVID-19 triggered systemic lupus erythematosus (SLE) has never been reported to our knowledge. COVID-19 also has associated cutaneous manifestations. Here we present a case of SLE with antiphospholipid antibody syndrome in a previously healthy patient with COVID-19, who subsequently developped a varicella-like exanthem on the trunk. The disease resulted in death of the patient. The pathophysiological mechanisms resulting in overlapping disorders in our patient remain unknown, adding to the growing mystery of this virus and raising questions about the nature of its link with cutaneous, autoimmune, and autoinflammatory manifestations. Sharing the images of this case may benefit physicians dealing with similar patients during this pandemic.

Cutaneous manifestations and dermatological sequelae of Covid-19 infection compared to those from other viruses.

In the last few months, there have been numerous reports describing a variety of cutaneous signs associated with COVID-19. Clinicians from Italy were the first to describe the cutaneous manifestations of COVID-19, which were later observed in other parts of the globe. In some cases, cutaneous signs were the only manifestation of COVID-19 rather than the typical syndrome of fever and upper respiratory tract symptoms. However, there is considerable heterogeneity amongst the cutaneous signs described so far, which has been published extensively. Our aim is to summarise the latest studies that have reported the early and late cutaneous signs of COVID-19 and compare them to the most common established viral exanthems.

Suspected COVID-19-related reticulated purpura of the soles in an infant.

A growing number of skin lesions during the COVID-19 pandemic are being recognized. Acral ischemic lesions identical to chilblains are most typical in children and young adults. We report an infant girl, aged 1 month and 29 days, with a peculiar reticulated purpuric eruption on her soles, with positive immunohistochemistry for SARS-CoV-2 in the endothelia of dermal blood vessels. The patient had an excellent outcome without specific therapy.

Erythema multiforme-like lesions in children and COVID-19.

During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.