Cutaneous Adverse Reactions Following Influenza Vaccination in Adults.

OBJECTIVE: To review the literature on cutaneous reactions to the influenza vaccine in adults. DATA SOURCES: Authors systematically searched three databases: PubMed, MEDLINE, and EMBASE. STUDY SELECTION: Case reports published between January 1, 1995 and December 31, 2020 that described a cutaneous reaction to any brand of the influenza vaccine in adults were included. Exclusion criteria included having the wrong study design, pediatric cases, publication prior to 1995, and lack of cutaneous reaction to the vaccine. DATA EXTRACTION: A total of 232 articles were identified. After duplicate removal, title and abstract screening, and full-text screening, 29 studies were included in the final review. Data extracted included patient sex, age, type of influenza vaccine received, time from vaccine administration to cutaneous reaction, duration of cutaneous reaction, description of cutaneous reactions, treatments used, and the outcome (eg, resolution, reoccurrence, complications). DATA SYNTHESIS: The mean age of participants was 43.7 years (range, 19-82 years), and 60% were women (n = 18). The most frequent cutaneous reaction that occurred following influenza vaccination included erythematous macules/papules/plaques (n = 17 [56.7%]), vasculitic and purpuric rashes (n = 5 [16.7%]), and maculopapular (morbilliform) rashes (n = 3 [10.0%]). All patients received treatment, and 96.7% (n = 29) of the cutaneous manifestations were resolved. Most studies did not report any further complications upon follow-up. CONCLUSIONS: Understanding and identifying the relationship between the influenza vaccine and possible cutaneous manifestations can help providers predict and anticipate these adverse effects.

Characteristics and Outcomes of Squamous Cell Carcinoma and Other Cutaneous Malignancies in Epidermolysis Bullosa: A Systematic Review.

OBJECTIVE: To identify cases and summarize outcomes of cutaneous malignancies in patients with epidermolysis bullosa (EB). DATA SOURCES: MEDLINE and EMBASE databases were searched on February 8, 2022. STUDY SELECTION: Original observational or experimental studies with cases of cutaneous malignancy in patients with inherited EB were included. DATA EXTRACTION: Data were extracted by two reviewers in duplicate. DATA SYNTHESIS: A total of 87 articles with 367 patients were included in this systematic review. Squamous cell carcinomas were the most common malignancy (94.3%) with a median survival of 60 months. The presence of metastasis was investigated at diagnosis in 77 patients; 18.8% of patients had detectable metastasis. Patients with squamous cell carcinoma with metastasis at diagnosis had significantly shorter median survival (16.8 months) than those without (72 months; P = .027). The remission rate was 47.6%. At the end of follow-up, 15.1% were alive with disease, and 41.6% were deceased. Other malignancies included malignant melanoma and basal cell carcinoma. The most common initial modes of management were excisions (71.9%) and amputations (17.6%). Other modes included chemotherapy (4.6%), radiation (3.9%), and no treatment (2.6%). The overall rate of recurrence or new lesions was 38.8%, with a median time of 16 months to recurrence or new lesions. Immediate recurrence was lowest following amputation (4.3%). There were no statistically significant differences in median survival among initial excision, amputation, and all other modes combined ( P = .30). CONCLUSIONS: Squamous cell carcinomas in patients with EB have a high likelihood of metastasis and mortality. Surgical excision is the most common intervention. There are no significant differences in survival among different initial management options. There is a need for research that documents and monitors outcomes of the treatment options.