key: cord-0782145-vrfcu5am
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.
title: Clinical and Pathologic Correlation of Cutaneous COVID-19 Vaccine Reactions including V-REPP: A Registry Based Study
date: 2021-09-10
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2021.09.002
sha: 4a4b1a481c189488f1b288b8e58df6b54e612066
doc_id: 782145
cord_uid: vrfcu5am

Background Cutaneous reactions after COVID-19 vaccination have been commonly reported. However, histopathologic features and clinical correlations have not been well characterized. Methods From an international registry, we evaluated all reports of COVID-19 associated vaccination reactions for history of skin biopsy. When histopathology reports were available, we categorized them by reaction patterns. Results Of 803 vaccine reactions reported, 58 cases (7%) 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 (n=2), erythromelalgia (n=1), and other (n=5). Limitation Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. Conclusion Clinical and histopathologic correlation allowed for categorization of cutaneous COVID-19 vaccine reactions. We propose defining a subset of vaccine-related eruption of papules and plaques (V-REPP), as well as 12 other patterns, following COVID-19 vaccination.

The most common morphologies reported were local injection site reactions, delayed large local 117 reactions, urticaria, morbilliform, zoster, and papulosquamous eruptions (Supplemental Table 1 ). Cases 118 were reported by dermatologists (46%), other physicians (22%), mid-level providers (9.2%), nurses 119 (9.1%), and other healthcare providers (13%).

Of the 803 cases, 78 providers (9.7%) indicated that a skin biopsy was performed. Records listed 121 as pending (n=15) or incomplete (n=5) were not included, leaving 58 complete biopsy reports (7%) for 122 review (Table 1) . For these 58 cases, patients had a median age of 61 years (IQR 44-77) and were 62% 123 female, 75% white, and 95% from the United States. The majority of cases with skin biopsy reports 

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We would like to acknowledge the following individuals for providing clinical and histology photographs 245 and/or clinical discussion of cases: Jayne Bird, Shannon Foster, Elizabeth Goodwin, Tia Janicki, Anu