Local injection site reactions (LIR) are the most commonly occurring cutaneous manifestations after COVID-19 vaccination and most of the reactions occur after the first dose, investigators reported in a study published in the Journal of the European Academy of Dermatology and Venereology.

The prospective study analyzed anonymous questionnaires from dermatologists in 8 hospitals in France and standardized forms from vaccination centers from January 2021 to August 2021.

Any patient reaction that occurred within 1 month after the most recent COVID-19 vaccination was considered as potentially related.


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A total of 152 patients (mean age, 52.4 years; 112 women) were included. Data were obtained for 70 patients from dermatologists and 82 patients from vaccination centers. Participants received either the mRNA BNT162b2 vaccine (BioNTech, Pfizer) (77.6%), the inactivated ChAdOx1 vaccine (AstraZeneca) (17.8%), or the mRNA-1273 vaccine (Moderna) (44.6%). Also, 15 patients (9.9%) were diagnosed previously with COVID-19 without a cutaneous manifestation.

Most cutaneous reactions (94.1%) occurred after the first dose, and no recurrence was observed after the second dose. LIR were the most commonly occurring cutaneous manifestations (57.2%). Other reactions included herpes zoster (7.9 %), urticaria without anaphylaxis (7.9%), eczematiform eruptions (5.9%), exanthema (3.9%), and fixed urticaria without argument for hypocomplementemic urticarial vasculitis (3.3%), among others.

The median delay from vaccination to cutaneous reaction was 2 days (interquartile range, 1-6 days). Of the cohort, 6.6% of patients had a flare-up of a well-controlled pre-existent skin disease (5 auto-immune bullous diseases, 4 chronic spontaneous urticaria, and 1 rosacea).

Among the 70 patients followed by a dermatologist (median age, 59 years; 69% women), 87% had a reaction after their first vaccine dose. Of this group of 70 participants, 32.9% had a medical history of allergy (11 respiratory allergy, 16 other drug allergy, and 3 food allergy).

One-half of this group (n = 35) were receiving treatment, including antihistamines (14.3%), corticosteroids (8.6%), immunosuppressive drugs (5.7%), or checkpoint inhibitors (1.4%). Also, 7.1% of the patients preferred to switch vaccine types owing to moderate manifestations such as cutaneous vasculitis or bullous diseases, and no recurrences were observed.

“Our case series supported the reassuring data concerning these cutaneous manifestations,” the study authors commented. “Despite these skin reactions, the benefit of vaccination remains high especially for immunosuppressed patients.”

Reference

Massip E, Marcant P, Font G, et al. Cutaneous manifestations following COVID-19 vaccination: a multicentric descriptive cohort. J Eur Acad Dermatol Venereol. Published online December 20, 2021. doi:10.1111/jdv.17883