Exacerbations of chronic dermatoses may be associated with COVID-19 vaccination, according to data from a study published in the Journal of the European Academy of Dermatology and Venereology.
Researchers conducted a systematic review of articles on chronic dermatoses exacerbation after COVID-19 vaccination that were published in PubMed (Medline database), EMBASE, and the Cochrane Database of Systematic Reviews.
A total of 40 studies with 114 patients were included. The mean age of participants with flares was 55.85 years (range, 19-88), and 52 participants were women.
The investigators identified more than 15 different chronic dermatoses with exacerbations, with most involving psoriasis flares (n=49; including 28 cases of plaque psoriasis, 1 with psoriasis vulgaris, 2 with guttate, 2 with inverse, 2 with pustular, and 10 cases of uncategorized psoriasis). Exacerbation of psoriasis was in a pustular form in several cases.
A total of 31 reports of blistering diseases also were reported—11 cases of atopic dermatitis, 5 cases each of hidradenitis suppurativa and Haily-Haily disease, 3 cases of lichen planus, 2 cases each of alopecia areata and subacute cutaneous lupus erythematosus, and 1 case each of vitiligo, pyoderma gangrenosum, vasculitis, lichen planopilaris, erythema multiforme, Darier disease, and lepra.
The patients received various therapies during vaccination, including 31 who received biologic treatments, 13 who received topical treatments, and 14 who received different systemic treatments. Also, 57 reports of exacerbations resulted from the first dose of vaccine, 47 from the second dose, 4 after the first, second, and third dose, and 2 after the first and second doses.
The COVID-19 vaccine may induce a hyperstimulated state of the immune system or cause a de novo immune-mediated reaction that triggers the pre-existing abnormal pathways, noted the researchers.
Vaccination was associated with robust production of neutralizing antibodies against the wildtype SARS-CoV-2 and the B.1.351 strain, and significant increases in the antigen-specific polyfunctional CD4 and CD8 T cells occurred after the second dose. Booster vaccination stimulated an enhanced innate immune response compared with primary vaccination.
“Our findings indicated that it is advisable to allow patients with chronic dermatological diseases to get vaccinated while dermatologists should be aware of the possible exacerbations of dermatoses associated with the reported vaccines,” the investigators advised.
Fisher S, Dodiuk-Gad RP, Ziv M, et al. Chronic dermatoses exacerbation after COVID-19 vaccination—a systematic review. J Eur Acad Dermatol Venereol. Published online November 17, 2022. doi:10.1111/jdv.18760