key: cord-0706676-lc1tehxy
authors: Mohta, Alpana; Arora, Aakanksha; Srinivasa, Rekha; Mehta, Rajesh Dutt
title: Recurrent herpes zoster after COVID‐19 vaccination in patients with chronic urticaria being treated with cyclosporine—A report of 3 cases
date: 2021-09-12
journal: J Cosmet Dermatol
DOI: 10.1111/jocd.14437
sha: 966529ebfb02b8e1ab9cecb290b2d26c421cd683
doc_id: 706676
cord_uid: lc1tehxy

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To the editor, 1 had also received autologous serum therapy with little to no improvement, Therefore, these cases were being treated with cyclosporine as an established immunomodulator with a good disease control and a good reduction in urticaria severity score.

The duration of consumption of cyclosporine in our cases prior to onset of RHZ ranged from 5 to 8 weeks. In all 3 cases the symptoms of herpes zoster were mild to moderate, with complete resolution of HZ within a month.

The recurrence rates of HZ have been reported to range between 0.2% to 12.5%. 6 The observation of recurrent herpes zoster made by us is contrasting with the commonly reported literature which stated HZ recurrence to be more common in elderly patients. Other renal failure, metabolic syndrome, thyroid and pulmonary dysfunctions have also been attributed to high recurrence rates. 6 To our knowledge, this is the first case series of recurrent VZV following COVID-19 vaccination. Although we acknowledge that it is not feasible to establish a direct correlation between the vaccination and recurrence of HZ, there was a strong clinical suspicion of iatrogenic immunosuppression due to cyclosporine in our cases which could be a major contributory factor. However, in order to establish this theory further, larger case studies conducted over longer periods of time is the call of the hour, as the virus and vaccines evolve. 

A formal ethical approval was taken. Written informed consent was taken from all the patients for using their data and clinical images.

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Recurrent herpes zoster after COVID-19 vaccination in patients with chronic urticaria being treated with cyclosporine-A report of 3 cases