COVID vaccine‐induced pustular psoriasis in patients with previous plaque type psoriasis

Abstract

We read with great interest the paper by Sotiriou et al1 recently published on the Journal of European Academy of Dermatology and Venereology. The authors report the exacerbation of psoriasis in 14 patients following COVID vaccine. All the patients reported showed a widespread papulo-squamous eruption, then labelled as psoriasis (13 plaque-type and 1 guttate). In nine cases, it was referred a previous mild psoriasis. The mean time from vaccine was about 10 days. We would like to take the opportunity to signal two further patients who developed pustular palmo-plantar psoriasis after ©Biontech Pfizer vaccine. Both patients, respectively 57-year-old man (Fig. 1) and 63-year-old woman (Fig. 2), were previously affected by moderate form of plaque-type psoriasis and no history of antecedent pustular-type variant of psoriasis. In both patients, the latency from vaccine to psoriasis outbreak was about 1 month. Both patients were given oral acitretin. Differently from what reported by Sotiriou et al,1 whose patients mostly showed the same type of psoriasis both before and after the vaccine, with the latter just being a stimulus for exacerbation or worsening of the same type of psoriasis, the singularity of our cases is that the patients developed after vaccine a different and notoriously more severe type of psoriasis. Analogously to what reported by Sotiriou et al,1 who described a previous history of psoriasis in the majority of patients, our two cases reported a long history of mild psoriasis in the past 30 years earlier, just treated with topical medications. As concerning the latency between the vaccine and the appearance of psoriasis, it was quite longer in our patients (1 month vs. 10 days). No acceptable reason can be given to this difference, even if it could be argued that a palmo-plantar pustular psoriasis may perhaps take longer to develop as the histological changes are more complex and deeper than plaque psoriasis. Cutaneous manifestations of COVID-19 have been largely described.2-4 COVID vaccine-induced skin reactions have been reported as well.5-7 Anyway, no previous cases of palmo-plantar pustular psoriasis after COVID vaccine have been reported in the plenty of papers published about cutaneous reactions to vaccination against SARS-CoV-2. On the other hand, three cases of generalized pustular psoriasis (GPP) have been published.8-10 Two of three patients with GPP had a previous history of mild psoriasis and time to reaction after vaccine ranged from to 4 days to 3 weeks. Each case was triggered by a different type of COVID vaccine, namely ©Biontech Pfizer, ©AstraZeneca and ©Sinovac. For this reason, we thought that it could be worth noting that vaccine could potentially induce palmo-plantar psoriasis and not just exacerbate a plaque psoriasis. As the prevalence of psoriasis is very high in general population and immunization through COVID is planned to be planetary, we should expect an increase of the aforementioned cases. Patients in this manuscript have given written informed consent to the publication of their case details. None declared. None. Data sharing not applicable – no new data generated.

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