Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases
A. Català, C. Muñoz‐Santos, Cristina Galván‐Casas, Mónica Roncero Riesco, David Revilla Nebreda, Amador Solá Truyols, Priscila Giavedoni, Mar Llamas‐Velasco, Carlos González‐Cruz, Xavier Cubiró, Ricardo Ruíz‐Villaverde, S. Gómez‐Armayones, M. P. Gil Mateo, David Pesqué, Orianna Marcantonio, Diego Fernández‐Nieto, J. Romaní, N. Iglesias-Pena, Lucía Carnero González, Jesús Tercedor‐Sánchez, G. Carretero, T. Masat-Ticó, Pedro Rodríguez‐Jiménez, Ana M. Giménez‐Arnau, M. Utrera-Busquets, Elena Vargas Laguna, Alvaro G. Menendez, E. San Juan Lasser, Maribel Iglesias‐Sancho, L. Alonso-Naranjo, Ingrid Hiltun, E. Cutillas Marco, Isabel Polimón Olabarrieta, Silvia Marinero Escobedo, Xavier García-Navarro, M.J. Calderón Gutiérrez, Gloria Baeza‐Hernández, L. Bou Camps, Tomás Toledo‐Pastrana, Antonio Guilabert
Abstract
BACKGROUND: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. OBJECTIVE: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. METHODS: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.