Abstract

To date, over 60% of the world’s population has received at least one dose of coronavirus disease 2019 (COVID-19) vaccination with over 12 billion doses administered globally. Commonly reported adverse effects of COVID-19 vaccination include fever, headache, myalgia, and injection site reactions. The spectrum of documented cutaneous reactions following COVID-19 vaccination is broad; however, pityriasis rubra pilaris (PRP) or PRP-like eruption secondary to COVID-19 vaccine is exceedingly rare, with only 10 cases previously reported to date in the English literature. Herein, we describe an additional case of COVID-19 vaccine-associated PRP in a 50-year-old female woman with a history of metastatic breast carcinoma who developed a widespread cutaneous eruption characteristic of PRP, including palmoplantar keratoderma, 10 days following her third dose of the Moderna COVID-19 vaccine. Punch biopsy specimen showed mild epidermal hyperplasia with overlying hyperkeratosis with alternating ortho- and parakeratosis and focal follicular plugging, supporting the diagnosis of PRP. The patient’s cutaneous reaction improved within weeks of initiating oral acitretin 20 mg daily and topical steroids, with resolution achieved after 3 months of continued therapy. To the best of our knowledge, this is the third reported case of Moderna COVID-19 vaccine-associated PRP and collectively the eleventh following the administration of all mRNA COVID-19 vaccines currently available, including Pfizer–BioNTech and AstraZeneca.

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