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Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases - 07/06/21

Doi : 10.1016/j.jaad.2021.03.092 
Devon E. McMahon, BA a, Erin Amerson, MD b, Misha Rosenbach, MD c, Jules B. Lipoff, MD c, Danna Moustafa, BS a, Anisha Tyagi, BA a, Seemal R. Desai, MD d, e, Lars E. French, MD f, g, Henry W. Lim, MD h, Bruce H. Thiers, MD i, George J. Hruza, MD, MBA j, Kimberly G. Blumenthal, MD, MSc k, Lindy P. Fox, MD b, Esther E. Freeman, MD, PhD a, l,
a Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
b Department of Dermatology, University of California San Francisco, San Francisco, California 
c Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 
d The University of Texas Southwestern Medical Center, Dallas, Texas 
e Innovative Dermatology, Plano, Texas 
f Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany 
g Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida 
h Department of Dermatology, Henry Ford Health System, Detroit, Michigan 
i Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina 
j Department of Dermatology, St. Louis University, St. Louis, Missouri 
k Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts 
l Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts 

Correspondence and reprint requests to: Esther Freeman, MD, PhD, Department of Dermatology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital55 Fruit StBostonMA02114

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Abstract

Background

Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized.

Objective

To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines.

Methods

A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination.

Results

From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions.

Limitations

Registry analysis does not measure incidence. Morphologic misclassification is possible.

Conclusions

We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.

El texto completo de este artículo está disponible en PDF.

Key words : COVID-19, dermatology, Moderna, mRNA, Pfizer, public health, registry, SARS-CoV-2, vaccine, vaccine reaction, delayed hypersensitivity, delayed inflammatory reaction, zoster, shingles, delayed large local reaction, pityriasis rosea, local injection site reaction, erythromelalgia, urticaria, morbilliform, pernio, chilblains, vesicular, erythema multiforme, filler, vasculitis

Abbreviations used : IQR, mRNA


Esquema


 Funding sources: COVID-19 registry support provided to Massachusetts General Hospital by the International League of Dermatological Societies for administration and maintenance and by the American Academy of Dermatology for in-kind administrative support.
 IRB approval status: Exempt. The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) Institutional Review Board and was determined to not meet the definition of human subject research.


© 2021  American Academy of Dermatology, Inc.. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 85 - N° 1

P. 46-55 - juillet 2021 Regresar al número
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