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Wu PC, Huang IH, Wang CY, Chi CC. New Onset and Exacerbation of Autoimmune Bullous Dermatosis Following COVID-19 Vaccination: A Systematic Review. Vaccines (Basel) 2024; 12:465. [PMID: 38793716 PMCID: PMC11125893 DOI: 10.3390/vaccines12050465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Cases of autoimmune bullous dermatosis (AIBD) have been reported following COVID-19 vaccination. OBJECTIVE We aimed to provide an overview of clinical characteristics, treatments, and outcomes of AIBDs following COVID-19 vaccination. METHODS We conducted a systematic review and searched the Embase, Cochrane Library, and Medline databases from their inception to 27 March 2024. We included all studies reporting ≥ 1 patient who developed new-onset AIBD or experienced flare of AIBD following at least one dose of any COVID-19 vaccine. RESULTS We included 98 studies with 229 patients in the new-onset group and 216 in the flare group. Among the new-onset cases, bullous pemphigoid (BP) was the most frequently reported subtype. Notably, mRNA vaccines were commonly associated with the development of AIBD. Regarding the flare group, pemphigus was the most frequently reported subtype, with the mRNA vaccines being the predominant vaccine type. The onset of AIBD ranged from 1 to 123 days post-vaccination, with most patients displaying favorable outcomes and showing improvement or resolution from 1 week to 8 months after treatment initiation. CONCLUSIONS Both new-onset AIBD and exacerbation of pre-existing AIBD may occur following COVID-19 vaccination. Healthcare practitioners should be alert, and post-vaccination monitoring may be essential.
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Affiliation(s)
- Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
| | - Ching-Ya Wang
- Department of Dermatology, Heping Fuyou Branches, Taipei City Hospital Renai, Taipei 10629, Taiwan;
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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2
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Burmann SN, Oellig F, Wehry UP, Matull J, Kreuter A. [Blisters in a "cluster of jewels"-like pattern in a child with chronic hepatitis B infection]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:176-178. [PMID: 38092978 DOI: 10.1007/s00105-023-05270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Affiliation(s)
- Sven-Niklas Burmann
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Frank Oellig
- Pathologie Rhein-Ruhr, Mülheim an der Ruhr, Deutschland
| | - Ulrich Peter Wehry
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Johanna Matull
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland.
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Johannes Klinik Duisburg, Universität Witten/Herdecke, Duisburg, Deutschland.
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3
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Murished GM, Dandachi I, Aljabr W. Side effects of COVID-19 vaccines in the middle eastern population. Front Immunol 2023; 14:1270187. [PMID: 38022593 PMCID: PMC10654979 DOI: 10.3389/fimmu.2023.1270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The COVID-19 pandemic has caused severe worldwide health concerns since its first description as the SARS-COV-2 virus in December 2019. The wide dissemination of this virus, together with the lack of treatment, prompted vaccine development within a short period of time to elicit a protective immunity against COVID-19. Due to their rapid development, potential subsequent side effects of COVID-19 vaccines were overlooked, which might lead to many health concerns. This is especially true for patients at a greater risk of harm from COVID-19, such as pregnant women, children, and patients with pre-existing chronic diseases. In this review, we provide a summary of common to rare side effects of administrated COVID-19 vaccines in a Middle Eastern population. We have found that the distinction between side effects from COVID-19 vaccines in terms of frequency and severity is attributed to the differences in study populations, gender, and age. Pain at the injection site, fever, headache, fatigue, and muscle pain were the most common reported side effects. Vaccinated subjects with previous COVID-19 infection exhibited an equivalent neutralizing response after just one dose compared to two doses of vaccine. Consequently, individuals who experienced more side effects had significantly higher antibody levels. This indicates that having better immunity correlates with higher antibody levels, leading to a higher frequency of vaccine side effects. Individuals with underlying comorbidities, particularly having known allergies and with illnesses such as diabetes and cancer, might be more prone to post-vaccination side effects. Studies of a high-risk population in Middle Eastern countries are limited. Future studies should be considered to determine long-term side effects, side effects after booster doses, and side effect differences in cases of heterologous and homologous vaccination for better understanding and proper handling of high-risk populations and patients who experience these side effects.
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Affiliation(s)
| | | | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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4
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Zou H, Daveluy S. Linear IgA bullous dermatosis after COVID-19 vaccination. Int J Dermatol 2023; 62:e56-e58. [PMID: 36468781 PMCID: PMC9877671 DOI: 10.1111/ijd.16541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Henry Zou
- Michigan State University College of Human MedicineGrand RapidsMIUSA
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5
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Pira A, Sinagra JLM, Moro F, Mariotti F, Di Zenzo G. Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine. Front Med (Lausanne) 2023; 10:1112823. [PMID: 36744126 PMCID: PMC9893122 DOI: 10.3389/fmed.2023.1112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Autoimmune bullous diseases (AIBDs) are a heterogeneous group of life-threatening disorders associated with subepidermal or intraepidermal blistering. Skin barrier alterations and prolonged immunosuppressive treatments increase the risk of infections in patients with AIBDs, who are considered fragile. COVID-19 pandemic had a heavy impact on these patients. Although advances have been made in terms of prevention and treatment of COVID-19, this topic remains significant as the pandemic and its waves could last several years and, so far, a relevant proportion of the population worldwide is not vaccinated. This review is a 2022 update that summarizes and discusses the pandemic's burden on AIBD patients mainly considering relevant studies in terms of: (i) sample dimension; (ii) quality of control populations; (iii) possible standardization by age, gender and country. The findings show that: (i) the risk of COVID-19 infection and its severe course were comparable in AIBD patients and in the general population, except for rituximab-treated patients that presented a higher risk of infection and severe disease; (ii) the mortality rate in COVID-19-infected bullous pemphigoid patients was higher than in the general population, (iii) 121 cases of AIBD onset and 185 cases of relapse or exacerbation occurred after COVID-19 vaccination and a causal relationship has not been demonstrated so far. Altogether, acquired knowledge on COVID-19 pandemic could also be important in possible, albeit undesirable, future pandemic scenarios.
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Affiliation(s)
- Anna Pira
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Jo Linda Maria Sinagra
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
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6
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Nahm WJ, Juarez M, Wu J, Kim RH. Eosinophil-rich linear IgA bullous dermatosis induced by mRNA COVID-19 booster vaccine. J Cutan Pathol 2023; 50:24-28. [PMID: 35922892 PMCID: PMC9538274 DOI: 10.1111/cup.14305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/09/2022] [Accepted: 08/01/2022] [Indexed: 01/03/2023]
Abstract
We present a case of eosinophil-rich linear IgA bullous disease (LABD) following the administration of a messenger RNA COVID-19 booster vaccine. A 66-year-old man presented to the emergency department with a 3-week history of a pruritic blistering rash characterized by fluid-filled bullae and multiple annular and polycyclic plaques. He was initially diagnosed with bullous pemphigoid based on a biopsy showing a subepidermal blister with numerous eosinophils. However, direct immunofluorescence studies showed linear IgA and IgM deposition along the basement membrane zone with no immunoreactivity for C3 or IgG. Additionally, indirect immunofluorescence was positive for IgA basement membrane zone antibody. The patient was subsequently diagnosed with LABD and initiated on dapsone therapy with resolution of his lesions at 3-month follow-up. This case illustrates the growing number of autoimmune blistering adverse cutaneous reactions from vaccination. Dermatopathologists should be aware that features of autoimmune blistering diseases can overlap and may not be distinguishable based on these histopathological findings alone. Confirmation with direct immunofluorescence and/or serological studies may be necessary for accurate diagnosis.
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Affiliation(s)
- William J. Nahm
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Michelle Juarez
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Julie Wu
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Randie H. Kim
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
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7
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Washrawirul C, Triwatcharikorn J, Phannajit J, Ullman M, Susantitaphong P, Rerknimitr P. Global prevalence and clinical manifestations of cutaneous adverse reactions following COVID-19 vaccination: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2022; 36:1947-1968. [PMID: 35666609 PMCID: PMC9348179 DOI: 10.1111/jdv.18294] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023]
Abstract
Although vaccination is widely accepted as an effective method of preventing and controlling the COVID-19 pandemic, many people are concerned about possible cutaneous side-effects, which can delay or prevent them from being vaccinated. The objectives of this systematic review were to assess the global prevalence and clinical manifestations of cutaneous adverse reactions following COVID-19 vaccination. PubMed and Scopus databases were searched for articles published from 1 January 2019 to 31 December 2021, and reference lists for each selected article were screened. Case reports, case series, observational studies and randomized controlled trials that provided information on cutaneous adverse reactions following COVID-19 vaccines were included. A total of 300 studies were included in a systematic review of which 32 studies with 946 366 participants were included in the meta-analysis. The pooled prevalence of cutaneous manifestations following COVID-19 vaccination was 3.8% (95% CI, 2.7%-5.3%). COVID-19 vaccines based on the mRNA platform had a higher prevalence than other platforms at 6.9% (95% CI, 3.8%-12.3%). Various cutaneous manifestations have been reported from injection site reactions, which were the most common (72.16%) to uncommon adverse reactions such as delayed inflammatory reactions to tissue filler (0.07%) and flares of pre-existing dermatoses (0.07%). Severe cutaneous reactions such as anaphylaxis have also been reported, but in rare cases (0.05%). In conclusion, cutaneous adverse reactions are common, especially in those receiving mRNA vaccines. Most reactions are mild and are not contraindications to subsequent vaccination except for anaphylaxis, which rarely occurs. COVID-19 vaccination may also be associated with flares of pre-existing dermatoses and delayed inflammatory reactions to tissue filler. Patients with a history of allergies, pre-existing skin conditions or scheduled for filler injections should receive additional precounselling and monitoring. A better understanding of potential side-effects may strengthen public confidence in those wary of new vaccine technologies.
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Affiliation(s)
- C. Washrawirul
- Division of Dermatology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - J. Triwatcharikorn
- Division of Dermatology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - J. Phannajit
- Division of Nephrology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Division of Clinical Epidemiology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
- Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - M. Ullman
- Department of Research AffairsChulalongkorn UniversityBangkokThailand
| | - P. Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
- Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - P. Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Skin and Allergy Research UnitChulalongkorn UniversityBangkokThailand
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8
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Himed S, Gray A, Awethe Z, Libson K, Kaffenberger BH, Korman AM, Trinidad JCL. SARS-CoV-2 Infection and Vaccination Cutaneous Manifestations for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2022; 11:252-262. [PMID: 36274753 PMCID: PMC9579541 DOI: 10.1007/s13671-022-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review The overall purpose of this review was to characterize and summarize cutaneous eruptions associated with coronavirus disease 2019 (COVID-19) as well as COVID-19 vaccination. Recent Findings Cutaneous eruptions associated with COVID-19 infection have a reported frequency of 1-20%. Increased COVID-19 disease severity has been associated with morbilliform exanthems, urticaria, retiform purpura, and livedo racemosa. Papulovesicular eruptions were associated with a milder COVID-19 disease course. A range of dermatoses have also been reported with COVID-19 vaccination but have rarely prevented subsequent vaccination. Summary Dermatologists should be aware of the associations between COVID-19 disease severity and cutaneous eruptions. Livedo racemosa and retiform purpura are particularly associated with increased disease severity and death. In the setting of COVID-19 vaccination, cutaneous eruptions can largely be managed symptomatically and very rarely do these reactions prevent subsequent vaccination.
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Affiliation(s)
- Sonia Himed
- College of Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Ashley Gray
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - Zaynah Awethe
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - Karissa Libson
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - Benjamin H. Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - Abraham M. Korman
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - John C. L. Trinidad
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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9
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Wan V, Chen D, Shiau CJ, Jung GW. Association between COVID-19 vaccination and bullous pemphigoid - a case series and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221131868. [PMID: 36274858 PMCID: PMC9580082 DOI: 10.1177/2050313x221131868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bullous pemphigoid is an acquired autoimmune blistering dermatosis that is commonly associated with high morbidity and mortality. New-onset bullous pemphigoid following vaccinations has rarely been reported in the literature. We report two cases of new-onset bullous pemphigoid after COVID-19 vaccination followed by a brief literature review. Twenty-six cases were included in our analysis. Our cases support that new-onset bullous pemphigoid may develop following COVID-19 vaccinations. Entering a period of clinical remission before subsequent COVID-19 vaccinations in addition to close follow-up should be considered to lessen the risk of recurrences or exacerbations.
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Affiliation(s)
- Vincent Wan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dilys Chen
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Carolyn J Shiau
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Gordon W Jung
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, BC, Canada
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10
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Rodríguez Y, Rojas M, Beltrán S, Polo F, Camacho-Domínguez L, Morales SD, Gershwin ME, Anaya JM. Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review. J Autoimmun 2022; 132:102898. [PMID: 36041291 PMCID: PMC9399140 DOI: 10.1016/j.jaut.2022.102898] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022]
Abstract
Autoimmunity linked to COVID-19 immunization has been recorded throughout the pandemic. Herein we present six new patients who experienced relapses of previous autoimmune disease (AD) or developed a new autoimmune or autoinflammatory condition following vaccination. In addition, we documented additional cases through a systematic review of the literature up to August 1st, 2022, in which 464 studies (928 cases) were included. The majority of patients (53.6%) were women, with a median age of 48 years (IQR: 34 to 66). The median period between immunization and the start of symptoms was eight days (IQR: 3 to 14). New-onset conditions were observed in 81.5% (n: 756) of the cases. The most common diseases associated with new-onset events following vaccination were immune thrombocytopenia, myocarditis, and Guillain-Barré syndrome. In contrast, immune thrombocytopenia, psoriasis, IgA nephropathy, and systemic lupus erythematosus were the most common illnesses associated with relapsing episodes (18.5%, n: 172). The first dosage was linked with new-onset events (69.8% vs. 59.3%, P = 0.0100), whereas the second dose was related to relapsing disease (29.5% vs. 59.3%, P = 0.0159). New-onset conditions and relapsing diseases were more common in women (51.5% and 62.9%, respectively; P = 0.0081). The groups were evenly balanced in age. No deaths were recorded after the disease relapsed, while 4.7% of patients with new-onset conditions died (P = 0.0013). In conclusion, there may be an association between COVID-19 vaccination and autoimmune and inflammatory diseases. Some ADs seem to be more common than others. Vaccines and SARS-CoV-2 may induce autoimmunity through similar mechanisms. Large, well-controlled studies are warranted to validate this relationship and assess additional variables such as genetic and other environmental factors.
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Affiliation(s)
- Yhojan Rodríguez
- Clínica del Occidente, Bogota, Colombia; Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Santiago Beltrán
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Fernando Polo
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - Laura Camacho-Domínguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Samuel David Morales
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States
| | - Juan-Manuel Anaya
- Clínica del Occidente, Bogota, Colombia; LifeFactors, Rionegro, Colombia.
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11
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Cebeci Kahraman F, Savaş Erdoğan S, Aktaş ND, Albayrak H, Türkmen D, Borlu M, Arıca DA, Demirbaş A, Akbayrak A, Polat Ekinci A, Gökçek GE, Çelik HA, Taşolar MK, An İ, Temiz SA, Hazinedar E, Ayhan E, Hızlı P, Solak EÖ, Kılıç A, Yılmaz E. Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study. J Cosmet Dermatol 2022; 21:3692-3703. [PMID: 35780311 PMCID: PMC9349975 DOI: 10.1111/jocd.15209] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID-19 vaccination with the Sinovac/CoronaVac (inactivated SARS-CoV-2) and Pfizer/BioNTech (BNT162b2) vaccines. METHODS This prospective, cross-sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID-19 vaccines. Systemic, local injection site, and non-local cutaneous reactions after vaccination were identified, and their rates were determined. RESULTS Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non-local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non-local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. CONCLUSIONS There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non-local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self-limiting or required little therapeutic intervention.
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Affiliation(s)
- Filiz Cebeci Kahraman
- Department of Dermatologyİstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City HospitalİstanbulTurkey
| | - Sevil Savaş Erdoğan
- Department of DermatologyUniversity of Health Sciences, İstanbul Training and Research HospitalİstanbulTurkey
| | - Nurhan Döner Aktaş
- Department of Dermatologyİzmir Katip Çelebi University, Atatürk Training and Research HospitalİzmirTurkey
| | - Hülya Albayrak
- Department of Dermatology, Faculty of MedicineNamık Kemal UniversityTekirdağTurkey
| | - Dursun Türkmen
- Department of Dermatology, Faculty of Medicineİnönü UniversityMalatyaTurkey
| | - Murat Borlu
- Department of Dermatology, Faculty of MedicineErciyes UniversityKayseriTurkey
| | - Deniz Aksu Arıca
- Department of Dermatology, Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey
| | - Abdullah Demirbaş
- Department of Dermatology, Faculty of MedicineKocaeli UniversityKocaeliTurkey
| | - Atiye Akbayrak
- Department of Dermatology, Faculty of MedicineGaziosmanpaşa UniversityTokatTurkey
| | - Algün Polat Ekinci
- Department of Dermatology, İstanbul Faculty of Medicineİstanbul UniversityİstanbulTurkey
| | - Gözde Emel Gökçek
- Department of Dermatology, Faculty of MedicineYozgat Bozok UniversityYozgatTurkey
| | - Hilal Ayvaz Çelik
- Department of Dermatology, Faculty of MedicineIsparta Süleyman Demirel UniversityIspartaTurkey
| | | | - İsa An
- Department of DermatologyŞanlıurfa Training and Research HospitalŞanlıurfaTurkey
| | - Selami Aykut Temiz
- Department of DermatologyNecmettin Erbakan University Meram Faculty of MedicineKonyaTurkey
| | - Emel Hazinedar
- Department of Dermatology, Faculty of MedicineZonguldak Bülent Ecevit UniversityZonguldakTurkey
| | - Erhan Ayhan
- Department of DermatologyUniversity of Health Sciences, Gazi Yaşargil Training and Research HospitalDiyarbakırTurkey
| | - Pelin Hızlı
- Department of Dermatology, Faculty of MedicineBalıkesir UniversityBalıkesirTurkey
| | - Eda Öksüm Solak
- Department of Dermatology, Faculty of MedicineErciyes UniversityKayseriTurkey
| | - Arzu Kılıç
- Department of Dermatology, Faculty of MedicineBalıkesir UniversityBalıkesirTurkey
| | - Ertan Yılmaz
- Department of Dermatology, Faculty of MedicineAkdeniz UniversityAntayaTurkey
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Mori F, Saretta F, Liotti L, Giovannini M, Castagnoli R, Arasi S, Barni S, Mastrorilli C, Pecoraro L, Caminiti L, Marseglia GL, Barbaud A, Novembre E. Linear Immunoglobulin a Bullous Dermatosis in Children. Front Pediatr 2022; 10:937528. [PMID: 35874598 PMCID: PMC9304959 DOI: 10.3389/fped.2022.937528] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023] Open
Abstract
Linear Immunoglobulin A Bullous Disease (LABD) is a rare dermatosis whose pathomechanisms are not yet completely understood. LABD has different features characterizing adults and children in terms of potential triggers, clinical manifestations, and prognosis. The aim of the present study is to review all neonatal and pediatric cases of LABD and summarize the major characteristics. Childhood LABD is mainly idiopathic with a benign prognosis. Neonatal cases are difficult to differentiate from infectious diseases and usually have a poor prognosis. Drugs are one of the possible triggers that can activate autoimmune responses through antigen mimicry and epitope spreading as well as different stimuli (e.g., infections, inflammatory diseases, trauma). The gold standard for the diagnosis is based on direct immunofluorescence. Prognosis is generally favorable but often depends on the prompt dermatological diagnosis, treatment and follow-up guaranteed by a multidisciplinary team, including pediatricians for this group of age.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annick Barbaud
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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13
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Han J, Russo G, Stratman S, Psomadakis CE, Rigo R, Owji S, Luu Y, Mubasher A, Gonzalez BR, Ungar J, Harp J, Magro C, Ungar B, Lamb A, Gulati N. Toxic Epidermal Necrolysis-like Linear IgA Bullous Dermatosis after Third Moderna COVID-19 Vaccine in the Setting of Oral Terbinafine. JAAD Case Rep 2022; 24:101-104. [PMID: 35571457 PMCID: PMC9077902 DOI: 10.1016/j.jdcr.2022.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Calabria E, Canfora F, Mascolo M, Varricchio S, Mignogna MD, Adamo D. Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review. Pathol Res Pract 2022; 232:153834. [PMID: 35278817 PMCID: PMC8896864 DOI: 10.1016/j.prp.2022.153834] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cases of severe autoimmune blistering diseases (AIBDs) have recently been reported in association with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. AIMS To describe a report of oropharyngeal Pemphigus Vulgaris (OPV) triggered by the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/ BioNTech) and to analyze the clinical and immunological characteristics of the AIBDs cases reported following the SARS-CoV-2 vaccination. METHODS The clinical and immunological features of our case of OPV were documented. A review of the literature was conducted and only cases of AIBDs arising after the SARS-CoV-2 vaccination were included. CASE REPORT A 60-year old female patients developed oropharyngeal and nasal bullous lesions seven days after the administration of a second dose of the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/BioNtech). According to the histology and direct immunofluorescence findings showing the presence of supra-basal blister and intercellular staining of IgG antibodies and the presence of a high level of anti-Dsg-3 antibodies (80 U/ml; normal < 7 U/ml) in the serum of the patients, a diagnosis of oropharyngeal Pemphigus Vulgaris was made. REVIEW A total of 35 AIBDs cases triggered by the SARS-CoV-2 vaccination were found (including our report). 26 (74.3%) were diagnosed as Bullous Pemphigoid, 2 (5.7%) as Linear IgA Bullous Dermatosis, 6 (17.1%) as Pemphigus Vulgaris and 1 (2.9%) as Pemphigus Foliaceus. The mean age of the sample was 72.8 years and there was a predominance of males over females (F:M=1:1.7). In 22 (62.9%) cases, the disease developed after Pfizer vaccine administration, 6 (17.1%) after Moderna, 3 (8.6%) after AstraZeneca, 3 (8.6%) after CoronaVac (one was not specified). All patients were treated with topical and/or systemic corticosteroids, with or without the addition of immunosuppressive drugs, with a good clinical response in every case. CONCLUSION Clinicians should be aware of the potential, though rare, occurrence of AIBDs as a possible adverse event after the SARS-CoV-2 vaccination. However, notwithstanding, they should encourage their patients to obtain the vaccination in order to assist the public health systems to overcome the COVID-19 pandemic.
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Affiliation(s)
- Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
| | - Federica Canfora
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy.
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
| | - Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
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15
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Cutaneous Complications of mRNA and AZD1222 COVID-19 Vaccines: A Worldwide Review. Microorganisms 2022; 10:microorganisms10030624. [PMID: 35336199 PMCID: PMC8953728 DOI: 10.3390/microorganisms10030624] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/07/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
Because of the increasing emergence of cutaneous reactions from COVID-19 vaccines worldwide, we investigated the published reports of these complications. We searched the PubMed, Google Scholar, and Scopus databases and the preprint server bioRxiv for articles on cutaneous complications linked to mRNA-1273 (Moderna), BNT162b2 (Pfizer–BioNTech), and AZD1222 (AstraZeneca–Oxford University) vaccines published until 30 September 2021. Eighty studies describing a total of 1415 reactions were included. Cutaneous reactions were more prevalent in females (81.6%). Delayed large local reactions were the most common complication (40.4%), followed by local injection site reactions (16.5%), zoster (9.5%), and urticarial eruptions (9.0%). Injection site and delayed large local reactions were predominantly caused by the mRNA-1273 vaccine (79.5% and 72.0%, respectively). BNT162b2 vaccination was more closely linked to distant reactions (50.1%) than mRNA-1273 (30.0%). Zoster was the most common distant reaction. Of reactions with adequate information for both vaccine doses, 58.3% occurred after the first dose only, 26.9% after the second dose only, and 14.8% after both doses. Overall, a large spectrum of cutaneous reaction patterns occurred following the COVID-19 vaccination. Most were mild and without long-term health implications. Therefore, the occurrence of such dermatologic complications does not contraindicate subsequent vaccination.
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16
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Avallone G, Quaglino P, Cavallo F, Roccuzzo G, Ribero S, Zalaudek I, Conforti C. SARS-CoV-2 vaccine-related cutaneous manifestations: a systematic review. Int J Dermatol 2022; 61:1187-1204. [PMID: 35141881 PMCID: PMC9111829 DOI: 10.1111/ijd.16063] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Gianluca Avallone
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Francesco Cavallo
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Gabriele Roccuzzo
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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17
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Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines. J Clin Med 2021; 10:jcm10225344. [PMID: 34830627 PMCID: PMC8618511 DOI: 10.3390/jcm10225344] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022] Open
Abstract
Many patients are receiving SARS-CoV-2 vaccinations, which have been associated with a variety of adverse effects. Cutaneous adverse reactions to SARS-CoV-2 vaccinations have been progressively reported, but they have not been reviewed according to their morphological clinical patterns. The objective of this review was to summarize the existing data concerning the cutaneous adverse reactions following SARS-CoV-2 vaccines and group them according to common morphological and pathogenetic patterns. We reviewed the English language literature up to 15 August 2021, using predefined keywords to identify the relevant studies evaluating cutaneous adverse reactions associated with SARS-CoV-2 vaccines. We search for recurrent morphological patterns sharing clinical signs and symptoms and physio-pathological mechanisms. Timing to onset following the first or booster dose of the vaccine, predisposing conditions, therapeutic management, and outcome were also collected. Among the dermatological manifestations associated with SARS-CoV-2 vaccinations, we distinguished: (1) new onset reactions and (2) flares of preexisting dermatoses. The most common were injection site reactions, affecting 30–70% and generally mild or moderate. Small case series or single case reports included filler reactions, exanthemas, vascular lesions, urticaria, eczematous dermatitis, autoimmune bullous reactions, and severe cutaneous adverse reactions. In addition, the exacerbation of chronic immuno-mediated dermatoses (mainly psoriasis and atopic dermatitis) and reactivations of herpes infection were reported. The cutaneous reactions were generally mild, self-limiting, and resembled common cutaneous drug eruptions and/or COVID-19 skin manifestations.
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18
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Hali F, Kerouach A, Alatawna H, Chiheb S, Lakhdar H. Linear IgA bullous dermatosis following Oxford AstraZeneca COVID-19 vaccine. Clin Exp Dermatol 2021; 47:611-613. [PMID: 34762342 PMCID: PMC8652795 DOI: 10.1111/ced.15007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- F Hali
- Department of Dermatology and Venereology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - A Kerouach
- Department of Dermatology and Venereology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - H Alatawna
- Center of Pathology, Ibn Zohr, Casablanca, Morocco
| | - S Chiheb
- Department of Dermatology and Venereology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - H Lakhdar
- Department of Dermatology and Venereology, Ibn Rochd University Hospital, Casablanca, Morocco
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19
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Balogun M, Millette D, Yip V, Chan SA, Lee P, Gamal N, Hashim N, Phillips D, Walsh M, Trehan P, Hanna-Bashara L, Abdullah A, Wernham A, Tso S. Phenotypic spectrum of serious cutaneous-only adverse event following immunization with COVID-19 vaccines: a multicentre case series and literature review. Clin Exp Dermatol 2021; 47:614-616. [PMID: 34748655 PMCID: PMC8653198 DOI: 10.1111/ced.15003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 01/26/2023]
Affiliation(s)
- M Balogun
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Millette
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - V Yip
- Department of Dermatology, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - S A Chan
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Lee
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Gamal
- Dermatology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - N Hashim
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - D Phillips
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - M Walsh
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - P Trehan
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - L Hanna-Bashara
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - A Abdullah
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - A Wernham
- Department of Dermatology, Walsall Healthcare NHS Foundation Trust, Walsall, UK
| | - S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
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20
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Alghamdi AN, Alotaibi MI, Alqahtani AS, Al Aboud D, Abdel-Moneim AS. BNT162b2 and ChAdOx1 SARS-CoV-2 Post-vaccination Side-Effects Among Saudi Vaccinees. Front Med (Lausanne) 2021; 8:760047. [PMID: 34692740 PMCID: PMC8531069 DOI: 10.3389/fmed.2021.760047] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/13/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Vaccination against SARS-CoV-2 is important for reducing hospitalization and mortalities. Both Pfizer-BioNTech (BNT162b2) and the Oxford-AstraZeneca (ChAdOx1 nCoV-19) vaccines are used in Saudi Arabia and in many parts of the world. Post-vaccinal side effects were recorded, so we aimed to screen different complaints after vaccination among vaccinees in Saudi Arabia. Methods: An online questionnaire was designed to screen the local, systemic, and allergic post vaccination reactions for vaccinees who received either one or two doses of the BNT162b2 vaccine or one dose of the ChAdOx1 vaccine. The number and percentage were recorded for each response and analyzed using cross-tab and Chi square tests. The degree of the severity of post vaccination reactions were analyzed using Roc curve. The cofactors that may affect the severity of post-vaccinal reactions including previous COVID-19 infection, age, sex, body mass index, and comorbidities were investigated. Results: During our study, 4,170 individuals reported their responses: 2,601 received one dose of BNT162b2, of whom 456 completed the second dose, and 1,569 received a single dose of ChAdOx1. The side effects were reported in 85.6% of BNT162b2 vaccinees and 96.05% of ChAdOx1 vaccinees who voluntarily responded to a survey about post-vaccination side effects. The side effects were more severe in BNT162b2 than ChAdOx1. ChAdOx1 vaccinees reported mild, moderate, severe and critical side effects in 30.13, 28.62, 29.73, and 1.53%, respectively. In contrast, mild side effects were recorded among the majority of BNT162b2 vaccinees (63.92%) while moderate, severe, and critical side effects were 27.67, 7.68, and 0.72%, respectively. Both local and systemic side effects were recorded more frequently in ChAdOx1 in comparison to BNT162b2 vaccinees. Palpitation was among the new systemic side effects reported in the current study in high frequency. Abnormal menstrual cycle (delaying/increase hemorrhages or pain) was also reported in 0.98% (18/1846) of Pfizer-BioNTech and 0.68% (7/1028) of ChAdOx1 vaccinees, while deep vein thrombosis was only reported in a single case vaccinated with BNT162b2 vaccine. Conclusion: Both vaccines induced post-vaccinal side effects; however, ChAdOx1 induces a higher frequency of post-vaccinal systemic side effects than BNT162b2.
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