Abstract

Although vaccinations are vitally important in the control and prevention of infectious diseases, there are many well documented cutaneous adverse reactions. Vaccinations are crucial to the late response to COVID-19. However, due to their recent availability, potential cutaneous reactions are still unknown. We present three cases with differing cutaneous reactions following COVID-19 vaccination. In the first, a 48 year-old-female developed a pruritic indurated erythematous plaque at the injection site 8 days after administration of her first Moderna dose. Within two weeks, she developed similar plaques on her legs. Histology revealed a mixed chronic and granulomatous infiltrate involving deep dermis and subcutaneous fat. No polarizable material or infectious agents were identified, and due to the timing of the eruption, granulomatous vaccine reaction is favored. A 66 year-old-male developed erythematous annular papules with scale 2 weeks after receiving the second Pfizer dose. Biopsy showed a superficial perivascular lymphocytic infiltrate with eosinophils extending into the interstitium with red blood cell extravasation. There was mild epidermal spongiosis, basal vacuolization and mounds of parakeratosis. These findings are consistent with a pityriasis rosea-like vaccine reaction. The final case is a 64 year-old-female who developed violaceous flat topped scaly papules on the extremities and trunk following administration of the first Moderna dose. Biopsy showed a band-like lymphoplasmacytic infiltrate extending into the epidermis with basal vacuolization and dyskeratosis. The epidermis was thinned with focal thickening of the granular layer and compact hyperkeratosis. This lichenoid interface dermatitis, temporally associated with vaccination, is consistent with vaccine related lichen planus. Although these findings are not exclusive to the COVID-19 vaccination, they highlight the diverse set of cutaneous manifestations that may arise following vaccination.

Financial Disclosure: No current or relevant financial relationships exist.