Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study

Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an internati...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2022-01, Vol.86 (1), p.113-121
Main Authors: McMahon, Devon E., Kovarik, Carrie L., Damsky, William, Rosenbach, Misha, Lipoff, Jules B., Tyagi, Anisha, Chamberlin, Grace, Fathy, Ramie, Nazarian, Rosalynn M., Desai, Seemal R., Lim, Henry W., Thiers, Bruce H., Hruza, George J., French, Lars E., Blumenthal, Kimberly, Fox, Lindy P., Freeman, Esther E.
Format: Article
Language:English
Subjects:
Ad26.COV2.S
AZD1222
BNT162b2
bullous pemphigoid
chilblains
COVID-19
COVID-19 - prevention & control
COVID-19 Vaccines - adverse effects
delayed large local
dermal hypersensitivity reaction
dermatology
dermatopathology
erythema multiforme
erythromelalgia
Exanthema - chemically induced
Humans
Johnson & Johnson Janssen
lichen planus
Moderna
morbilliform
mRNA-1273
Original
Oxford-AstraZeneca
papular
papulosquamous
pathology
pernio
Pfizer-BioNTech
pityriasis rosea
psoriasis
Registries
registry
SARS-CoV-2
Skin Diseases - chemically induced
Stevens-Johnson syndrome
urticaria
vaccine
zoster
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Summary:Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym “V-REPP” (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2021.09.002