Cutaneous reactions following COVID‐19 vaccination: The evidence says “less fear”

Abstract

Dear Editor, The outbreak of COVID-19 represented a new worldwide challenge.1 Since then, several strategies have been adopted to contain the widespread of the infection.1 Among these, vaccination was the most important measure. However, the rapid development of vaccines for COVID-19, the mechanism of action (particularly mRNA-based), and the lack of several data on the effectiveness and safety of vaccines as well as on the duration of protection raised numerous concerns in the general population.2 Fortunately, the vaccination campaign was a global success, causing the reduction of COVID-19 diffusion, disease severity, hospitalization, and mortality.2 Two types of vaccines have been licensed for COVID-19, mRN-based or viral vector-based vaccines and more than 5.3 billion people have received at least one dose of COVID-19 vaccine.2 Similar to other drugs, adverse events following vaccination have been collected. Regarding skin disease, they have been rarely assessed in clinical trials. However, several dermatological reactions were described during global mass vaccination, and most of them were not initially recognized in clinical studies.3 Thus, dermatologists were involved in knowing how to recognize and treat cutaneous reactions. Among skin disease following vaccination, injection-site reaction was the commonest. Moreover, the development or exacerbation of several dermatoses such as atopic dermatitis, psoriasis, lichen planus, alopecia areata, bullous disorders, vitiligo, and autoimmune disease has been reported.3-5 Fortunately, most of the reported diseases were mild and self-limited, not requiring medical attention. Of note, cutaneous reactions were reported also after the booster dose.6 As regard the pathogenetic mechanism underlying the development cutaneous reactions, it does not seem directly related to the vaccine mechanism of action itself (mRNA or viral vector-based vaccines) as well as the temporal association between the administration of the vaccine and the development of skin reaction may be casual in several cases. The progression of COVID-19 vaccination campaign confirmed the effectiveness and safety of vaccines. As regard cutaneous disease, vaccines showed to be effective and safe in patients affected by several dermatoses. Even if de-novo or exacerbation of skin disease were reported, most of them were mild. Certainly, further studies are needed to understand pathogenetic mechanisms linking cutaneous reaction and COVID-19 vaccination in order to identify “at-risk” subjects and to adopt preventive measures. Clinicians must keep in mind the possibility of cutaneous reaction following COVID-19 vaccination, regardless the type of vaccination. Patients should be advised to self-control their disease, if present, seeking clinical advice if a worsening is noted. Certainly, COVID-19 vaccination should not be discouraged. Potestio Luca involved in data curation, formal analysis, investigation, visualization, writing–original draft preparation, and writing–review and editing. Fabbrocini Gabriella involved in conceptualization, validation, visualization, writing–review and editing, and supervision. D'Agostino Michela involved in conceptualization, validation, visualization, writing–original draft preparation, and writing–review and editing. Piscitelli Ilaria involved in conceptualization, validation, visualization, writing–original draft preparation, and writing–review and editing. Martora Fabrizio involved in data curation, formal analysis, investigation, visualization, writing–original draft preparation, and writing–review and editing. All authors read and approved the final version of the manuscript. The patients in this manuscript have given written informed consent to publication of their case details. The authors reported no conflict of interest. Not required.

Topics & Concepts