Oral Lichen Planus arising after BNT162b2 mRNA COVID-19 Vaccine: report of two cases

Lichen planus following COVID-19 vaccination: a narrative review

Lichen planus (LP) is an inflammatory disease that afflicts the skin, mucous membranes and cutaneous appendages. Moreover, LP represents a prototype of lichenoid dermatosis, being characterized by the presence of a dense dermal cell infiltrate. Although most cases of LP are idiopathic, infectious and drug-related factors must also be considered in the aetiology. In this context, the occurrence of LP and lichenoid drug eruptions following different types of vaccination is a possible event. Therefore, the aim of our review is to provide a broad perspective to clinicians by analysing the current literature of cases of LP and lichenoid eruptions following COVID-19 vaccination, and also investigating the possible pathogenetic mechanisms underlying this phenomenon. In total, 61 cases of LP and lichenoid eruption following COVID-19 vaccination have been collected. However, the number of cases of LP and lichenoid drug eruption is extremely low compared with the number of vaccines administered overall, suggesting that the risk of LP and lichenoid eruption following COVID-19 vaccination is extremely low. Certainly, further studies are desirable to identify the population most at risk and the possibility of taking preventive measures.

Pathophysiology of oral lesions subsequent to SARS-CoV-2 vaccination: A systematic review

Amidst worldwide reports of adverse oral lesions subsequent to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, the current systematic review planned to determine the prevalence of adverse oral events in adult individuals (≥18 years) after SARS-CoV-2 vaccination, emphasizing upon the type and dose of vaccine, time of onset, and underlying pathophysiology. The registered protocol (PROSPERO CRD42023421307), conforming with PRISMA guidelines, included an all-inclusive literature search through online databases, consisting of Scopus, PubMed/MEDLINE, Web of Science, Lilacs, Livivo, and PROSPERO, completed on 2 May 2023, followed by assessment of risk of bias by Joana Briggs Institute Evaluation Checklist. Due to the paucity of literature, case reports and case series were included. Self-reported lesions were excluded. Qualitative synthesis employing Microsoft Excel software 2019 revealed low prevalence (43 subjects) from 26 case reports and two case series. There were multiple erosive oral ulcers on gingiva, palate, burning pain in the mouth, xerostomia, tongue fissuring and glossitis, palatal petechiae, diffuse erythematous lesions and loss of smell (16.2%), primary herpetic gingivostomatitis (21%), oral lichen planus (16.2%), Stevens-Johnson syndrome (6.9%), Bell's palsy in four cases where two cases were Guillain-Barré syndrome (9.3%), erythema multiforme (11.6%), pemphigus (4.6%), idiopathic thrombocytopenic purpura (6.9%), unilateral hypoglossal nerve palsy (4.6%), and trigeminal neuralgia (2.3%). Maximum cases (22 subjects) presented oral lesions after Pfizer (BNT162b2) SARS-CoV-2 vaccine. No association was found between the vaccine type and dose with oral side effects. Dentists must be aware of the oral adverse effects after coronavirus disease 2019 vaccination to better understand the pathogenesis and the risk factors associated with such reactions.

Neurological complications following mRNA COVID-19 vaccination: Oral and lower limb paresthesia. A case discussion and literature review

Vaccines used in the coronavirus pandemic have reported some minor side effects such as pain at the injection site, headache, myalgia and fever. Also major neurological side effects have been experienced by some patients. We present the clinical case of a healthy woman who two weeks after being vaccinated with the third dose of Moderna COVID-19 Vaccine, began to feel numbness in mouth, both feet, legs, interscapular space, and hands. She was diagnosed with distal sensory polyneuropathy caused by the vaccine. Progressive improvement was seen. The patient did not require corticosteroid medication. We reviewed the literature to assess the frequency of this type of complication. Key words:COVID-19, SARS-CoV-2, vaccine, vaccination, peripheral axonal neuropathy, transverse myelitis, oral manifestations.

Systematic review of the oral manifestations produced by the SARS-CoV-2 vaccine

Background

To combat the coronavirus pandemic different vaccines have been developed. However, diverse adverse effects have been reported due to their use, including oral manifestations. Our objective is to review the existing bibliography to analyze what complications these vaccines have caused in the oral cavity.

Material and Methods

A bibliographic search was conducted by two independent reviewers (TS and CL), in parallel in 6 electronic databases (PubMed, Scopus, Cochrane, Google Scholar, LILACS, BioMed Central). A total of 22 articles were analyzed.

Results

The most frequent adverse effect was oral lichen planus, with a higher prevalence in women and after the Pfizer mRNA BNT162b2 vaccine.

Conclusions

These complications are minor and resolve with treatment, so the benefit of the use of vaccines outweigh the potential risks associated with these. Key words:Covid-19 vaccine, oral lesions, oral manifestations, SARS-CoV-2 vaccine, oral symptoms.

Lichen planus pigmentosus post COVID-19-vaccination: A case report with literature review

Lichen planus (LP) is a T cell‐mediated chronic inflammatory disorder. Several clinical variants based on lesion morphology and localization are reported. LPP remains uncommon with an unknown etiology. Besides, some precipitating factors have been suggested in the literature including hepatitis C infection; restrictive underwear, localized friction, and sun exposure.^{(1, 2)} Herein, we present a case of new‐onset of LPP following the ChAdOx1 nCoV‐19 (Oxford‐AstraZeneca) vaccine. A literature review was also conducted to summarize the various cases of LP induced and/or trigged by Covid‐19 vaccine.

Oral Adverse Events Following COVID-19 Vaccination: Analysis of VAERS Reports

Background

Oral adverse events (AEs) following COVID-19 vaccination have been sporadically reported during the previous months, warranting further investigation for their prevalence and suspected relationship with vaccine-elicited immune response.

Methods

A retrospective analysis using the Vaccine Adverse Event Reporting System (VAERS) data was conducted to evaluate AEs within the oral cavity (mucosa, tongue, lips, palate, dentition, salivary glands) and AEs involving taste and other sensations. Oral AEs reported after receiving COVID-19 vaccination (test group) and seasonal influenza vaccination (control group) were extracted and cross-tabulated to assess their relative prevalence.

Results

Among the 128 solicited (suspected) oral AEs, oral paresthesia (0.872%) was most reported after receiving COVID-19 vaccines, followed by the swelling of lips (0.844%), ageusia (0.722%), oral hypoesthesia (0.648%), swollen tongue (0.628%), and dysgeusia (0.617%). The reported prevalence of oral AEs was higher in the COVID-19 vaccine group than in the seasonal influenza group. The distribution pattern of the most reported oral AEs was similar for both COVID-19 and seasonal influenza vaccines. Female sex, older age (>39 years old), primer doses, and mRNA-based COVID-19 vaccines exhibited a higher reported prevalence of oral AEs.

Conclusion

Within the limitations of this study, COVID-19 vaccines were found to be associated with rare oral AEs that are predominantly similar to those emerging following seasonal influenza vaccines. The most commonly reported oral AEs were oral paraesthesia (mouth-tingling), lip swelling, and ageusia, representing various pathophysiologic pathways that remain unclear. Taste-related AEs should be acknowledged in the context of the COVID-19 pandemic and the public should be adequately informed about a potential taste dysfunction after receiving the COVID-19 vaccination. Dentists and dental teams need to be aware of the prevalence, severity, and prognosis of oral AEs to inform their patients and increase public confidence in vaccines.