New-onset psoriasis and psoriasis flares are potential cutaneous adverse events after COVID-19 vaccination, according to study findings published in the American Journal of Clinical Dermatology.
Researchers conducted a systematic review to evaluate the demographic and clinical factors and outcomes associated with psoriasis after COVID-19 vaccination. They searched the PubMed, Embase, Cochrane Library, and Web of Science databases for relevant studies from inception to April 25, 2022.
Eligible studies reported at least 1 patient who had new-onset psoriasis or a psoriasis flare following 1 or more doses of any COVID-19 vaccine.
A total of 7 studies assessed new-onset psoriasis, 32 studies reported psoriasis flares, and 4 studies reported new-onset psoriasis and psoriasis flares in the analysis. The new-onset group included 35 patients with an age range of 23 to 79 years. A majority of the participants presented with plaque psoriasis (17 patients), followed by guttate psoriasis (10 patients). The flare group included 279 patients, with an age range of 20 to 84 years, who mostly had plaque-type psoriasis.
In the new-onset group, 14% of participants received the BioNTech/Pfizer vaccine, 6% received the Moderna vaccine, and 6% received the AstraZeneca vaccine, respectively, although the vaccine type was not reported for a majority of patients. Vaccine dose was reported for 8 patients, with 4 new-onset psoriasis cases occurring after patients received the second vaccine dose and 4 cases occurring after the first dose. Onset times ranged from 2 to 21 days after vaccination.
In the flare group, most patients received mRNA vaccines (28%), with the BioNTech/Pfizer vaccine (20%) reported more frequently than the Moderna vaccine (7%), followed by the AstraZeneca vaccine (7%) and the Sinovac vaccine (1%). Flares most frequently occurred after the second vaccine dose (23%), followed by the first dose (7%), both the first and second doses (2%), and the third dose (1%). Onset times ranged from 1 day to 90 days.
Patients in the new-onset group were most commonly treated with topical agents, including topical corticosteroids, calcipotriol, or emollients. Most participants had improvement or resolution after treatment, with the time to improvement or resolution ranging from 7 days to 2 months.
In the flare group, patients received a variety of therapies to control their underlying psoriasis, including topical treatments. Most participants achieved improvement and resolution, with treatment times ranging from 3 days to 2 months.
Among several limitations, some of the studies were observational studies or included data from retrospective database collection that lacked detailed information. In addition, severity assessments were only reported in a limited number of studies. Furthermore, few studies reported whether patients continued to receive vaccine doses when psoriasis developed after the first dose, and reactions to later vaccines were rarely reported.
“Psoriatic patients may require regular follow-up before and after COVID-19 vaccination,” stated the study authors. “More investigations remain necessary to elucidate the association between COVID-19 vaccines and psoriasis and the underlying mechanisms that drive the development of psoriasis following vaccination.”
Wu P-C, Huang I-H, Wang C-W, Tsai C-C, Chung W-H, Chen C-B. New onset and exacerbations of psoriasis following COVID‑19 vaccines: a systematic review. Am J Clin Dermatol. Published online September 1, 2022. doi:10.1007/s40257-022-00721-z