ABSTRACT
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.
ABSTRACT
Background: Although hypersensitivity reactions to corticosteroids are rare in the general population, they are not uncommon in high-risk patients who receive repeated doses of them. It is known that delayed reactions are more common than immediate ones. Atopic dermatitis is a risk factor for the development of allergic contact dermatitis from topical corticosteroids. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral and parenteral corticosteroids. Method(s): We reported one case of a 72-year- old man with history of chronic obstructive pulmonary disease (GOLD 4) and atopic dermatitis, who experienced a morbilliform rash after intravenous hydrocortisone administration during his hospital admission for SARS-COV- 2 infection. Since 1995 he had experienced several late skin reactions with corticosteroids and after performing an allergy study he was diagnosed of delayed hypersensitivity to corticosteroids with good tolerance for intravenous hydrocortisone and inhaled mometasone. Closed patch tests were performed with hydrocortisone with immediate and late lectures of 48-96 hours. We also performed a controlled intravenous challenge with hydrocortisone (200 mg) as well as an oral challenge with deflazacort (30 mg) under surveillance in the intensive care unit. Result(s): Patch tests were negative and intravenous hydrocortisone challenge went positive after 48 hours with the same previous skin reaction. Our patient showed a good tolerance to deflazacort. Conclusion(s): Choosing an alternative corticosteroid is pivotal to the patient's safety and also decreases the worry of developing an allergic reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. Baeck et al. classified corticosteroids according to their chemical structure, improving treatment options and recommendations that can be prescribed. Nevertheless, discordance continues to be observed between the results of patch tests and the patient's tolerance to various commercial preparations. In order to provide alternative treatments, it is advisable to perform exposure tests with corticosteroids from a group other than the one the patient is sensitized to. Deflazacort could be an alternative in emergency cases. (Figure Presented).
ABSTRACT
The 2022 mpox outbreak affected 84,318 individuals in 110 countries. Mpox is transmitted by multiple modalities, including direct contact, respiratory droplets, and fomites among others. Identifying skin lesions aids prompt diagnosis. Variation in initial skin lesion location is not well understood;it is hypothesized that mode of transmission may determine primary inoculation site and subsequent clinical presentation. This study sourced healthcare provider-reported data from the AAD/ILDS Dermatology COVID-19, Mpox, and Emerging Infections Registry to explore factors related to the location of the first skin lesion in mpox cases. Out 119 mpox cases,115 had primary lesion location data. 97% were male with a median age of 37. Most (83/115, 72%) patients had first skin lesions in the genito-anal area, and 32/115 (27%) had lesions elsewhere or had morbilliform rash. 74% of males had the first lesion in the genito-anal region compared to females (25%, p=0.03). Males in same-sex relationships had ano-genital lesions more often than men in other relationships (77% vs. 44%, p=0.03). The type of mpox exposure was also associated with first lesion location: 83% of patients who contracted mpox from a spouse or other sexual contact had ano-genital lesions as compared to a non-sexual contact (0%, p=<0.01). This analysis characterized factors associated with the first mpox skin lesion location, which can aid healthcare providers in diagnosis and shed light on transmission. This data suggests that type of exposure and mode of transmission may be associated with primary lesion location;patients who contracted mpox from sexual contact were more likely to have ano-genital lesions.Copyright © 2023
ABSTRACT
COVID - 19 can be accompanied by a variety of cutaneous abnormalities, which mainly include vascular lesions chilblain - like lesions, livedo reticularis, purpura, ecchymosis, acral cyanosis, gangrene, etcand inflammatory lesionsdiffuse erythema, morbilliform exanthem, acute urticaria, varicella- like exanthem, etc. Some types of skin lesions may be the first symptom or the only clinical manifestation of COVID-19.Copyright © 2022 Chinese Journal of Dermatology. All rights reserved.
ABSTRACT
A 59-year-old man presented with a widespread morbilliform rash after receiving the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. He had no significant medical history and no known allergies. He did not take any regular medication. He developed pruritus without rash 4 h after his first vaccine. This resolved after 10 days without intervention. One day after his second dose, he developed an extensive pruritic morbilliform eruption on his trunk and limbs, affecting 35% of his body surface area. with no mucous membrane involvement. The rash persisted for 4 weeks after his second vaccination and he was referred to dermatology. Eosinophils were raised at 0.54 and liver function tests were normal. Antinuclear antibodies and extractable nuclear antigen were negative. Complement levels were normal. Histology showed mild epidermal acanthosis, spongiosis and subcorneal vesicles. Within the superficial to mid-dermis, there was a mixed chronic inflammatory infiltrate comprising lymphocytes, plasma cells, neutrophils and numerous eosinophils. Direct immunofluorescence was negative. He received a tapering dose of oral prednisolone with mometasone topically. Despite substantial improvement with this regimen, his rash began to worsen 2 days following discontinuation of oral prednisolone. He was still using daily mometasone on cessation of oral steroids. He was trialled on oral doxycycline for 1 month, which led to a marked improvement in the morbilliform rash. Despite improvement in the rash, the patient reported ongoing intense daily pruritus which was having a marked impact on his quality of life. He has commenced on narrowband ultraviolet B (UVB) phototherapy to treat his persistent pruritis, with good effect to date. Morbilliform eruptions have been reported as a cutaneous manifestation of COVID-19 and as a side-effect of mRNA vaccines. Proposed mechanisms for the development of skin rashes post-mRNA vaccines include viral protein expression following vaccination, prior infection with COVID-19 causing cross-reaction with the mRNA vaccine encoded antigen and vaccine components acting as haptens inducing a T helper 2 inflammatory reaction characterized by interleukin (IL)-4 and IL-13 expression. Drug-induced maculopapular eruptions typically resolve within 7-14 days on withdrawal of the culprit medication. The persistent nature in our patient may imply a complex immune response. The use of phototherapy to treat inflammatory dermatoses and pruritic conditions such as nodular prurigo is well described. The antipruritic effect of phototherapy is thought to work via modulation of both the neural pathways involved in itch and local immune cells in the skin. Our case highlights that phototherapy can be used in the treatment of cutaneous side-effects that arise after COVID-19 vaccines. To the best of our knowledge, this case is one of the first to use narrowband UVB phototherapy to treat a cutaneous side-effect of an mRNA vaccine.
ABSTRACT
Background Since the advent of the novel coronavirus, vaccines have been the most important tool of combat against the raging pandemic. However, several reports of adverse effects following vaccinations including dermatological reactions have emerged. Methods A descriptive observational study was carried out from June to August 2021 with all patients who presented with a new onset cutaneous reaction within 14 days of vaccination excluding patients with other possible causes of cutaneous reaction, particularly exposure to any drugs. Results A series of 13 cutaneous reactions post vaccination with the two major vaccines available in India, Covishiled and Covaxin have been reported in this series. Most of the reactions were mild and included urticaria, pityriasis rosea, morbilliform rash, whereas some uncommon reactions such as lichen planus and vitiligo were found. Severe reactions were rare, only one case of erythema multiforme major was seen. Conclusion The pathophysiology of post vaccination cutaneous reaction is still elusive and warrants further research. It is important for the dermatologist to be aware of such adverse events in order to address the common misconceptions and apprehension of people regarding vaccination. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.
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Objectives: A 36-year-old Caucasian woman developed acute hepatitis and morbilliform eruption arising ten days after the first dose of the mRNA BNT162b2 SARS-CoV-2 vaccine. Materials and Methods: The patient was asymptomatic apart from the skin rash. Liver function tests showed predmoninantly severe transaminitis (AST 523 U/L, ALT 1550 U/L, GGT 151 U/L, ALP 128 U/L, bilirubin 12 umol/L). Only the ANA 1:160 was abnormal. Other serology for autoimmune and infectious diseases were negative. Multiphase computed tomography of the abdomen was unremarkable. The SARS-CoV-2 anti-spike IgG titre was 67.5 AU/mL (cut-off[15 AU/mL). The skin histology revealed spongiotic reaction pattern with focal interface lymphocytic inflammation. Multiple eosinophils and a few plasma cells were present. The epidermal lymphocytes were composed of CD2, CD3, C4, CD5, CD7 and CD8-positive T cells, with a CD4:CD8 ratio of 1:5. A small number stained positive with TIA1, PD1 and granzyme B. CD56 staining was negative. A liver biopsy was performed after 2 days of steroids. Liver histology showed mild steatosis and mild inflammatory portal infiltrate comprising mainly of small lymphocytes that were CD3 positive with retained staining for CD7 and CD8. Lobular architecture was preserved with inconspicuous interface hepatitis or piecemeal necrosis. Results: The patient was treated with intravenous hydrocortisone (400 mg/day) followed by prednisone (50 mg/day). There was rapid improvement in her liver function tests and cutaneous manifestations (Fig. 1). Conclusion: mRNA COVID-19 vaccine induced hepatitis is a rare phenomenon that is steroid-responsive and has associations with cutaneous eruptions. Our patient's lack of hepatic histological abnormalties is most likely due to early immunosuppression. She had epidermal lymphocytosis with predominance of CD8-positive T cells that were not of cytotoxic phenotype and we are uncertain as to their significance. There is limited guidance on the safety of SARS-CoV-2 vaccination in those who have had developed significant hepatic and cutaenous reactions. Further work is needed.
ABSTRACT
Since coronavirus disease 2019 (COVID-19) vaccines were approved without long-term monitoring, tracking their adverse effects appears to be necessary. Mucocutaneous adverse events are of great importance due to their visibility and the potential effect on inducing fear in patients leading to vaccine hesitancy. We searched PubMed, Google Scholar, and Scopus in this regard, and all of the relevant papers published until June 28, 2021, were included if we could access their full texts. Moreover, we included some of our cases from Iran. We found various mucocutaneous manifestations after COVID-19 vaccination, including local injection site reactions (acute or delayed), urticarial lesions, pityriasis rosea-like rashes, angioedema, morbilliform rashes, pernio-like lesions, acrocyanosis, petechial/ purpuric/ecchymotic lesions, herpes flare-up, herpetiform rashes, oral erosive lesions, acral pustular rashes, erythema multiform, dermographism, herpes zoster, generalized pruritus, contact dermatitis, reaction to dermal fillers and non-specific rashes. We categorized them by their time of initiation (acute or delayed) and site of involvement (local injection site, remote area, or generalized). Delayed local reactions, local injection site reactions, urticarial lesions, and pityriasis rosea-like and morbilliform rashes were among the most common cutaneous adverse events. Dermatologists should be aware of these potential reactions to manage them properly, reassure patients, and encourage them to continue their vaccination.