Pityriasis rosea–like rash after messenger RNA COVID-19 vaccination: A case report and review of the literature

Abstract

A spectrum of cutaneous reactions to SARs-CoV-2 (COVID-19) vaccines have been reported in the literature. We present a case of a pityriasis rosea-like rash occurring after Pfizer COVID-19 vaccination and review cases of pityriasis rosea (PR)/PR-like eruption (PR-LE) after mRNA COVID-19 vaccine published in the medical literature. Of the 30 cases found, none experienced severe adverse effects and the rash resolved in an average of 5.6 weeks. It is important for physicians to be aware of this self-limited reaction so they can reassure and appropriately counsel patients that it is safe to receive subsequent vaccine doses despite the cutaneous eruption. Additionally, differences in incidence of this reaction after Pfizer and Moderna vaccination may suggest a differing host immune response incited by these vaccines which warrants further investigation. A spectrum of cutaneous reactions to SARs-CoV-2 (COVID-19) vaccines have been reported in the literature. We present a case of a pityriasis rosea-like rash occurring after Pfizer COVID-19 vaccination and review cases of pityriasis rosea (PR)/PR-like eruption (PR-LE) after mRNA COVID-19 vaccine published in the medical literature. Of the 30 cases found, none experienced severe adverse effects and the rash resolved in an average of 5.6 weeks. It is important for physicians to be aware of this self-limited reaction so they can reassure and appropriately counsel patients that it is safe to receive subsequent vaccine doses despite the cutaneous eruption. Additionally, differences in incidence of this reaction after Pfizer and Moderna vaccination may suggest a differing host immune response incited by these vaccines which warrants further investigation. Capsule Summary•Many cutaneous eruptions have been reported to COVID-19 vaccinations. There have been cases and case series reported of pityriasis rosea-like eruptions.•Physicians should recognize that pityriasis rosea-like eruptions following COVID-19 vaccinations are benign and self-limited, so they may counsel patients that it is safe to receive subsequent doses.In response to the COVID-19 pandemic, vaccines were developed at record speed, and as of January 2022, 9.2 billion vaccine doses have been administered worldwide.1Ritchie H. Mathieu E. Rodes-Guirao L. et al.Coronavirus pandemic (COVID-19).https://ourworldindata.org/coronavirusDate accessed: January 2, 2022Google Scholar The Pfizer/BioNTech (BNT162b2) and Moderna (messenger RNA [mRNA]-1273) vaccines have been widely administered in the United States, accounting for 58% and 38% of vaccinations, respectively.1Ritchie H. Mathieu E. Rodes-Guirao L. et al.Coronavirus pandemic (COVID-19).https://ourworldindata.org/coronavirusDate accessed: January 2, 2022Google Scholar These vaccines use a novel mRNA technology. Although their initial trials showed only local site reactions, as these vaccines have been distributed, numerous cutaneous side effects have been reported. In contrast, the Johnson and Johnson (Ad26.COV2.S) vaccine, using a nonreplicating viral vector, has fewer dermatologic side effects reported to date. Among reported cutaneous reactions to mRNA vaccination, delayed large local reaction (a wheal at the injection site after 4 or more days) occurred most commonly.2McMahon D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.20.2103.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar Other reported reactions include injection site, urticarial, and morbilliform eruptions. Less commonly reported are pernio, herpes simplex flares, pityriasis rubra pilaris, and pityriasis rosea (PR)–like reactions.Pityriasis rosea–like eruptions (PR-LEs) have been reported to both SARS-CoV-2 infection and COVID-19 vaccination. Classically, PR is a cutaneous eruption that begins with a single erythematous scaly plaque (herald patch) that progresses to multiple plaques or patches that develop diffusely over the trunk and extremities oriented along skin cleavage lines. The pathologic mechanism is unknown but believed to be the systemic reactivation of the human herpes virus (HHV)-6 or HHV-7.3Broccolo F. Drago F. Careddu A.M. et al.Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7.J Invest Dermatol. 2005; 124: 1234-1240https://doi.org/10.1111/j.0022-202X.2005.23719.xAbstract Full Text Full Text PDF PubMed Scopus (150) Google ScholarWe describe a case of PR-LE after the first dose of the Pfizer mRNA COVID-19 vaccine and review all other published cases of PR or PR-LEs after mRNA COVID-19 vaccines. Interestingly, of the 30 reported cases of PR secondary to the mRNA vaccine, which we review, 29 (96.7%) were in relation to the Pfizer vaccination.A healthy 23-year-old woman presented to the dermatology clinic for evaluation of a diffuse scaly eruption of 1 week’s duration. The rash initially began as an isolated scaly plaque under the right breast and quickly became more diffuse. The patient described the rash as mildly pruritic and had not received any treatments. She denied recent viral illness, new medication, or similarly affected contacts. She denied a history of a similar rash. She noted that she received the first dose of the Pfizer COVID-19 vaccination 7 days prior to the onset of the eruption. Other than mild fatigue, the patient had no other reactions at the time of vaccination. Physical examination revealed numerous oval to annular salmon-colored plaques with a collarette of scale diffusely involving the trunk and extremities. On the trunk, the plaques were oriented along skin cleavage lines in a Christmas tree distribution (Fig 1). On the inferior portion of the right breast, there was a 3-cm oval scaly plaque, larger than the other lesions, consistent with a herald patch (Fig 2). Triamcinolone cream was prescribed for pruritus, and the patient was reassured of the self-limited nature of the reaction and that it may take up to 6 weeks to resolve. We recommended her to still receive the second dose of the vaccine.Fig 2Herald patch of pityriasis rosea. A 3-cm oval plaque with peripheral scale, larger than the other lesions, was present on the inferior portion of the right breast.View Large Image Figure ViewerDownload Hi-res image Download (PPT)To better characterize PR or PR-like reactions after COVID-19 vaccination, we conducted a review of the medical literature. We searched the PubMed database for articles, including case reports and case series, using the following search terms: COVID-19 vaccine, coronavirus 2019 vaccine, SARS-CoV-2 vaccine, pityriasis rosea, and pityriasis rosea–like reaction. Cases were included if the patient was clinically diagnosed with PR or PR-LE and the rash had a temporal relationship to an mRNA COVID-19 vaccine. The search revealed 9 publications with 29 cases (30 including the current case) of PR or PR-LE after any mRNA COVID-19 vaccination (Table I).4Busto-Leis J.M. Servera-Negre G. Mayor-Ibarguren A. et al.Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance.J Eur Acad Dermatol Venereol. 2021; 35: e489-e491https://doi.org/10.1111/jdv.17301Crossref PubMed Scopus (16) Google Scholar, 5Carballido Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google Scholar, 6Cohen O.G. Clark A.K. Milbar H. Tarlow M. Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine.Hum Vaccin Immunother. 2021; 17: 4097-4098https://doi.org/10.1080/21645515.2021.1963173Crossref PubMed Scopus (5) Google Scholar, 7Cyrenne B.M. Al-Mohammedi F. DeKoven J.G. Alhusayen R. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 vaccine.J Eur Acad Dermatol Venereol. 2021; 35: e546-e548https://doi.org/10.1111/jdv.17342Crossref PubMed Scopus (25) Google Scholar, 8Marcantonio-Santa Cruz O.Y. Vidal-Navarro A. Pesqué D. Giménez-Arnau A.M. Pujol R.M. Martin-Ezquerra G. Pityriasis rosea developing after COVID-19 vaccination.J Eur Acad Dermatol Venereol. 2021; 35: e721-e722https://doi.org/10.1111/jdv.17498Crossref PubMed Scopus (11) Google Scholar, 9Temiz S.A. Abdelmaksoud A. Dursun R. Durmaz K. Sadoughifar R. Hasan A. Pityriasis rosea following SARS-CoV-2 vaccination: a case series.J Cosmet Dermatol. 2021; 20: 3080-3084https://doi.org/10.1111/jocd.14372Crossref PubMed Scopus (9) Google Scholar, 10Abdullah L. Hasbani D. Kurban M. Abbas O. Pityriasis rosea after mRNA COVID-19 vaccination.Int J Dermatol. 2021; 60: 1150-1151https://doi.org/10.1111/ijd.15700Crossref PubMed Scopus (14) Google Scholar, 11Farinazzo E. Ponis G. Zelin E. et al.Cutaneous adverse reactions after m-RNA COVID-19 vaccine: early reports from Northeast Italy.J Eur Acad Dermatol Venereol. 2021; 35: e548-e551https://doi.org/10.1111/jdv.17343Crossref PubMed Scopus (36) Google ScholarTable ICases of pityriasis rosea and pityriasis rosea–like eruption after messenger RNA COVID-19 vaccinationReferenceMessenger RNA vaccine typeDosePatient age, yTime from vaccination to onset of PR, d (range)Herald patchExanthem duration, wkClinical typeCurrent casePfizerFirst237Yes-PR-LE1ModernaFirst-14 (1-19)-1.4PR-LE1PfizerFirst-14 (1-19)-1.4PR-LE1PfizerFirst-14 (1-19)-1.4PR-LE1PfizerSecond-4-0.7PR-LE4PfizerSecond267Yes-PR4PfizerSecond291Yes-PR5PfizerFirst; Second35-Yes2PR-LE6PfizerFirst667Yes4PR7PfizerFirst; Second20s2Yes-PR-LE7PfizerSecond40s21Yes3PR-LE8PfizerSecond227No6PR8PfizerFirst; Pityriasis pityriasis rosea–like eruption. in a new Of the 30 29 (96.7%) occurred after the Pfizer vaccine and 1 after the Moderna vaccine. The average time of onset after vaccination was The average of the patients was patients had a reaction to the first to the second and to both first and second In the patients had reactions to both the began after the first dose and were by the second is diagnosed on the of history and examination F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar a patient for PR, it is important to other similar as secondary or F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar The history of a herald patch and of the rash are the is or can be In the cases we was and as in most cases of PR, the was on the of history and examination of these patients had a herald which not be consistent with other in the The average of the rash was 5.6 weeks. for was in only 1 which was Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google Scholar cases of PR after COVID-19 vaccination and none were associated with adverse cases were reported as PR or cases were or S.A. Abdelmaksoud A. Dursun R. Durmaz K. Sadoughifar R. Hasan A. Pityriasis rosea following SARS-CoV-2 vaccination: a case series.J Cosmet Dermatol. 2021; 20: 3080-3084https://doi.org/10.1111/jocd.14372Crossref PubMed Scopus (9) Google Scholar In the PR has been from PR-LE is as a reaction to a or vaccine, PR is there are other as the of herald evidence of of lesions, and systemic F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar In most there are of PR and the is not is important in cases of in which there is a of to a more severe and should be to the F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar In cases of COVID-19 PR, no further reactions or adverse were reported. we the as the that the PR and PR-LE may be and is for of this is associated with reactivation of other vaccinations, and have been to this Cases of PR-LE have been reported secondary to the SARS-CoV-2 infection J.M. Servera-Negre G. Mayor-Ibarguren A. et al.Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance.J Eur Acad Dermatol Venereol. 2021; 35: e489-e491https://doi.org/10.1111/jdv.17301Crossref PubMed Scopus (16) Google M. Pityriasis rosea as a cutaneous of COVID-19 Eur Acad Dermatol Venereol. PubMed Scopus Google F. G. A. A. and virus reactivation in pityriasis rosea 2021; PubMed Scopus Google Scholar In of these there was reactivation of and virus with an associated PR-like rash in a healthy F. G. A. pityriasis rosea and pityriasis rosea-like a review of the Eur Acad Dermatol Venereol. PubMed Scopus Google the COVID-19 pandemic, PR had been reported as a reaction to other vaccines. A review 29 reported cases of PR or PR-LE after et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google Scholar cases have been reported to the and vaccines. Other include and vaccines. The reported was and the average time to onset from vaccination was et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google mechanism of PR after vaccination is PR is believed to be to reactivation of by of viral In the of vaccination or the systemic may immune on the Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google B. et and of the SARS-CoV-2 J 2021; PubMed Scopus Google Scholar In the of COVID-19 PR, this is by reports of herpes simplex and in to PR following COVID-19 D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.20.2103.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar The case of PR with and virus reactivation SARS-CoV-2 infection similarly a to PR by SARS-CoV-2 infection or COVID-19 F. G. A. pityriasis rosea and pityriasis rosea-like a review of the Eur Acad Dermatol Venereol. PubMed Scopus Google Scholar The of cases of PR after both SARS-CoV-2 infection and COVID-19 vaccination that the host immune response to the virus is by the vaccine. that cutaneous of PR after viral infection are to the immune response than SARS-CoV-2 viral it is that herpes virus reactivation PR be by and in review, we that the of cases of PR or PR-LE occurred after the than mRNA vaccine. Although these vaccines use similar mRNA further is to characterize the mechanism of differing cutaneous reactions to the Pfizer and Moderna a cutaneous reaction after a vaccine dose may from It is important for physicians to counsel patients appropriately on the of the self-limited of resolved in all reported and there were no severe adverse to the first or second dose of the vaccine in patients with we these patients that the of the subsequent doses of the is a cutaneous reaction after mRNA vaccination The average time vaccination and rash onset is and most patients reaction is self-limited and in an average of 5.6 weeks. Of the reported were secondary to the Pfizer vaccine, with only 1 reported case to the Moderna vaccine. There have not been any severe adverse in any reported cases of It is important for physicians to be aware of the self-limited and benign nature of this rash and to appropriately counsel patients that it is safe for to receive doses of the mRNA COVID-19 vaccine. Capsule Summary•Many cutaneous eruptions have been reported to COVID-19 vaccinations. There have been cases and case series reported of pityriasis rosea-like eruptions.•Physicians should recognize that pityriasis rosea-like eruptions following COVID-19 vaccinations are benign and self-limited, so they may counsel patients that it is safe to receive subsequent cutaneous eruptions have been reported to COVID-19 vaccinations. There have been cases and case series reported of pityriasis rosea-like eruptions.•Physicians should recognize that pityriasis rosea-like eruptions following COVID-19 vaccinations are benign and self-limited, so they may counsel patients that it is safe to receive subsequent cutaneous eruptions have been reported to COVID-19 vaccinations. There have been cases and case series reported of pityriasis rosea-like eruptions.•Physicians should recognize that pityriasis rosea-like eruptions following COVID-19 vaccinations are benign and self-limited, so they may counsel patients that it is safe to receive subsequent In response to the COVID-19 pandemic, vaccines were developed at record speed, and as of January 2022, 9.2 billion vaccine doses have been administered worldwide.1Ritchie H. Mathieu E. Rodes-Guirao L. et al.Coronavirus pandemic (COVID-19).https://ourworldindata.org/coronavirusDate accessed: January 2, 2022Google Scholar The Pfizer/BioNTech (BNT162b2) and Moderna (messenger RNA [mRNA]-1273) vaccines have been widely administered in the United States, accounting for 58% and 38% of vaccinations, respectively.1Ritchie H. Mathieu E. Rodes-Guirao L. et al.Coronavirus pandemic (COVID-19).https://ourworldindata.org/coronavirusDate accessed: January 2, 2022Google Scholar These vaccines use a novel mRNA technology. Although their initial trials showed only local site reactions, as these vaccines have been distributed, numerous cutaneous side effects have been reported. In contrast, the Johnson and Johnson (Ad26.COV2.S) vaccine, using a nonreplicating viral vector, has fewer dermatologic side effects reported to date. Among reported cutaneous reactions to mRNA vaccination, delayed large local reaction (a wheal at the injection site after 4 or more days) occurred most commonly.2McMahon D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.20.2103.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar Other reported reactions include injection site, urticarial, and morbilliform eruptions. Less commonly reported are pernio, herpes simplex flares, pityriasis rubra pilaris, and pityriasis rosea (PR)–like Pityriasis rosea–like eruptions (PR-LEs) have been reported to both SARS-CoV-2 infection and COVID-19 vaccination. Classically, PR is a cutaneous eruption that begins with a single erythematous scaly plaque (herald patch) that progresses to multiple plaques or patches that develop diffusely over the trunk and extremities oriented along skin cleavage lines. The pathologic mechanism is unknown but believed to be the systemic reactivation of the human herpes virus (HHV)-6 or HHV-7.3Broccolo F. Drago F. Careddu A.M. et al.Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7.J Invest Dermatol. 2005; 124: 1234-1240https://doi.org/10.1111/j.0022-202X.2005.23719.xAbstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar We describe a case of PR-LE after the first dose of the Pfizer mRNA COVID-19 vaccine and review all other published cases of PR or PR-LEs after mRNA COVID-19 vaccines. Interestingly, of the 30 reported cases of PR secondary to the mRNA vaccine, which we review, 29 (96.7%) were in relation to the Pfizer vaccination. A healthy 23-year-old woman presented to the dermatology clinic for evaluation of a diffuse scaly eruption of 1 week’s duration. The rash initially began as an isolated scaly plaque under the right breast and quickly became more diffuse. The patient described the rash as mildly pruritic and had not received any treatments. She denied recent viral illness, new medication, or similarly affected contacts. She denied a history of a similar rash. She noted that she received the first dose of the Pfizer COVID-19 vaccination 7 days prior to the onset of the eruption. Other than mild fatigue, the patient had no other reactions at the time of vaccination. Physical examination revealed numerous oval to annular salmon-colored plaques with a collarette of scale diffusely involving the trunk and extremities. On the trunk, the plaques were oriented along skin cleavage lines in a Christmas tree distribution (Fig 1). On the inferior portion of the right breast, there was a 3-cm oval scaly plaque, larger than the other lesions, consistent with a herald patch (Fig 2). Triamcinolone cream was prescribed for pruritus, and the patient was reassured of the self-limited nature of the reaction and that it may take up to 6 weeks to resolve. We recommended her to still receive the second dose of the vaccine. better characterize PR or PR-like reactions after COVID-19 vaccination, we conducted a review of the medical literature. We searched the PubMed database for articles, including case reports and case series, using the following search terms: COVID-19 vaccine, coronavirus 2019 vaccine, SARS-CoV-2 vaccine, pityriasis rosea, and pityriasis rosea–like reaction. Cases were included if the patient was clinically diagnosed with PR or PR-LE and the rash had a temporal relationship to an mRNA COVID-19 vaccine. The search revealed 9 publications with 29 cases (30 including the current case) of PR or PR-LE after any mRNA COVID-19 vaccination (Table I).4Busto-Leis J.M. Servera-Negre G. Mayor-Ibarguren A. et al.Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance.J Eur Acad Dermatol Venereol. 2021; 35: e489-e491https://doi.org/10.1111/jdv.17301Crossref PubMed Scopus (16) Google Scholar, 5Carballido Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google Scholar, 6Cohen O.G. Clark A.K. Milbar H. Tarlow M. Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine.Hum Vaccin Immunother. 2021; 17: 4097-4098https://doi.org/10.1080/21645515.2021.1963173Crossref PubMed Scopus (5) Google Scholar, 7Cyrenne B.M. Al-Mohammedi F. DeKoven J.G. Alhusayen R. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 vaccine.J Eur Acad Dermatol Venereol. 2021; 35: e546-e548https://doi.org/10.1111/jdv.17342Crossref PubMed Scopus (25) Google Scholar, 8Marcantonio-Santa Cruz O.Y. Vidal-Navarro A. Pesqué D. Giménez-Arnau A.M. Pujol R.M. Martin-Ezquerra G. Pityriasis rosea developing after COVID-19 vaccination.J Eur Acad Dermatol Venereol. 2021; 35: e721-e722https://doi.org/10.1111/jdv.17498Crossref PubMed Scopus (11) Google Scholar, 9Temiz S.A. Abdelmaksoud A. Dursun R. Durmaz K. Sadoughifar R. Hasan A. Pityriasis rosea following SARS-CoV-2 vaccination: a case series.J Cosmet Dermatol. 2021; 20: 3080-3084https://doi.org/10.1111/jocd.14372Crossref PubMed Scopus (9) Google Scholar, 10Abdullah L. Hasbani D. Kurban M. Abbas O. Pityriasis rosea after mRNA COVID-19 vaccination.Int J Dermatol. 2021; 60: 1150-1151https://doi.org/10.1111/ijd.15700Crossref PubMed Scopus (14) Google Scholar, 11Farinazzo E. Ponis G. Zelin E. et al.Cutaneous adverse reactions after m-RNA COVID-19 vaccine: early reports from Northeast Italy.J Eur Acad Dermatol Venereol. 2021; 35: e548-e551https://doi.org/10.1111/jdv.17343Crossref PubMed Scopus (36) Google Scholar PR, Pityriasis pityriasis rosea–like eruption. Of the 30 29 (96.7%) occurred after the Pfizer vaccine and 1 after the Moderna vaccine. The average time of onset after vaccination was The average of the patients was patients had a reaction to the first to the second and to both first and second In the patients had reactions to both the began after the first dose and were by the second PR is diagnosed on the of history and examination F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar a patient for PR, it is important to other similar as secondary or F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar The history of a herald patch and of the rash are the is or can be In the cases we was and as in most cases of PR, the was on the of history and examination of these patients had a herald which not be consistent with other in the The average of the rash was 5.6 weeks. for was in only 1 which was Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google Scholar cases of PR after COVID-19 vaccination and none were associated with adverse cases were reported as PR or cases were or S.A. Abdelmaksoud A. Dursun R. Durmaz K. Sadoughifar R. Hasan A. Pityriasis rosea following SARS-CoV-2 vaccination: a case series.J Cosmet Dermatol. 2021; 20: 3080-3084https://doi.org/10.1111/jocd.14372Crossref PubMed Scopus (9) Google Scholar In the PR has been from PR-LE is as a reaction to a or vaccine, PR is there are other as the of herald evidence of of lesions, and systemic F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar In most there are of PR and the is not is important in cases of in which there is a of to a more severe and should be to the F. G. A. F. A. Pityriasis a PubMed Scopus Google Scholar In cases of COVID-19 PR, no further reactions or adverse were reported. we the as the that the PR and PR-LE may be and is for of this PR is associated with reactivation of other vaccinations, and have been to this Cases of PR-LE have been reported secondary to the SARS-CoV-2 infection J.M. Servera-Negre G. Mayor-Ibarguren A. et al.Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance.J Eur Acad Dermatol Venereol. 2021; 35: e489-e491https://doi.org/10.1111/jdv.17301Crossref PubMed Scopus (16) Google M. Pityriasis rosea as a cutaneous of COVID-19 Eur Acad Dermatol Venereol. PubMed Scopus Google F. G. A. A. and virus reactivation in pityriasis rosea 2021; PubMed Scopus Google Scholar In of these there was reactivation of and virus with an associated PR-like rash in a healthy F. G. A. pityriasis rosea and pityriasis rosea-like a review of the Eur Acad Dermatol Venereol. PubMed Scopus Google Scholar the COVID-19 pandemic, PR had been reported as a reaction to other vaccines. A review 29 reported cases of PR or PR-LE after et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google Scholar cases have been reported to the and vaccines. Other include and vaccines. The reported was and the average time to onset from vaccination was et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google Scholar The mechanism of PR after vaccination is PR is believed to be to reactivation of by of viral In the of vaccination or the systemic may immune on the Vázquez A.M. Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination.Br J Dermatol. 2021; 185: e34https://doi.org/10.1111/bjd.20143Crossref PubMed Scopus (14) Google et and of the BNT162b2 mRNA COVID-19 J PubMed Scopus Google B. et and of the SARS-CoV-2 J 2021; PubMed Scopus Google Scholar In the of COVID-19 PR, this is by reports of herpes simplex and in to PR following COVID-19 D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.20.2103.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar The case of PR with and virus reactivation SARS-CoV-2 infection similarly a to PR by SARS-CoV-2 infection or COVID-19 F. G. A. pityriasis rosea and pityriasis rosea-like a review of the Eur Acad Dermatol Venereol. PubMed Scopus Google Scholar The of cases of PR after both SARS-CoV-2 infection and COVID-19 vaccination that the host immune response to the virus is by the vaccine. that cutaneous of PR after viral infection are to the immune response than SARS-CoV-2 viral it is that herpes virus reactivation PR be by and vaccines. Interestingly, in review, we that the of cases of PR or PR-LE occurred after the than mRNA vaccine. Although these vaccines use similar mRNA further is to characterize the mechanism of differing cutaneous reactions to the Pfizer and Moderna vaccines. a cutaneous reaction after a vaccine dose may from It is important for physicians to counsel patients appropriately on the of the self-limited of resolved in all reported and there were no severe adverse to the first or second dose of the vaccine in patients with we these patients that the of the subsequent doses of the vaccine. PR is a cutaneous reaction after mRNA vaccination The average time vaccination and rash onset is and most patients reaction is self-limited and in an average of 5.6 weeks. Of the reported were secondary to the Pfizer vaccine, with only 1 reported case to the Moderna vaccine. There have not been any severe adverse in any reported cases of It is important for physicians to be aware of the self-limited and benign nature of this rash and to appropriately counsel patients that it is safe for to receive doses of the mRNA COVID-19 vaccine.

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