Abstract

The novel mRNA vaccinations against COVID-19 have been associated with cutaneous manifestations including injection site erythema, urticaria, and delayed reactions. Most cutaneous reactions are localized to the injected arm and occur within 14 days of the patient receiving the first or second dose of mRNA vaccine. We report a series of three patients (2F, 1M) who developed a transient papular eruption two to four weeks after receiving their second COVID-19 mRNA vaccine. These patients range in age from 65 to 77 years old, received two doses of either the Pfizer or Moderna mRNA COVID-19 vaccine, and had no prior history of Grover’s disease. The patients presented with pruritic, erythematous papules on their trunk. Two patients were initially treated with benzoyl peroxide wash, but as their symptoms did not improve after two weeks, punch biopsies were obtained. The third used H1 antagonists and a topical corticosteroid, following biopsy. Histopathologic examination revealed multiple foci of acantholysis associated with mild dyskeratosis with an associated dermal infiltrate that was either superficial and lymphohistiocytic, or in one case occurring in the deeper dermis with an admixture of eosinophils and rare neutrophils. Following the biopsy results, two patients were treated with topical corticosteroids while the third was prescribed antibiotics. All patients’ symptoms resolved within six weeks of their onset and have not recurred. Acantholysis with dyskeratosis has been reported not only in Darier and Grover disease, but in response to bacterial and viral infections, immunotherapies, and hepatitis B immunization. These are the first reported cases of an acantholytic dermatosis arising from mRNA COVID-19 vaccinations. We propose that the mRNA vaccination produces an immune response simulating a viral infection, referred to as Vaccine-Associated Transient Acantholysis (VATA). As more of the population is vaccinated, additional cases of VATA will likely be observed.

Financial Disclosure: No current or relevant financial relationships exist.