key: cord-0815198-pi5ibse4
authors: Choi, Ellie; Liew, Choon Fong; Oon, Hazel H.
title: Cutaneous adverse effects and contraindications to COVID‐19 vaccination; four cases and an illustrative review from an Asian country
date: 2021-09-20
journal: Dermatol Ther
DOI: 10.1111/dth.15123
sha: e587b45b4f6b4fd66fc66dba50b16d48f8d6f05e
doc_id: 815198
cord_uid: pi5ibse4

nan

Cutaneous adverse effects and contraindications to COVID-19 vaccination; four cases and an illustrative review from an Asian country Dear Editor, With global mass vaccination programs, it is important for dermatologists to be familiar with the management of cutaneous adverse events (cAEs) and contraindications for vaccination. In this article, we report four patients with cAEs arising after COVID-19 vaccination, assess the conformity in management with existing guidelines, and discuss issues surrounding vaccination. Consent for use of photographs was obtained.

The first patient is a 33-year-old male who developed an itchy papulosquamous eruption over the trunk and upper limbs 3 days after the first dose of the Pfizer-BioNTech vaccine ( Figure 1A ,B).

The second case is a 38-year-old female who developed urticaria and dermographism 17 days after the first dose of the Pfizer-BioNTech vaccine ( Figure 1C ). The urticaria improved over 2 weeks.

She had a remote history of acute urticaria that was quiescent.

The third case was a health care worker in her 20s who developed urticaria a few days after the first dose of Pfizer-BioNTech vaccine and persistent upon review 6 weeks later. She had a remote history of chronic spontaneous urticaria that had been quiescent for the past few years up till the vaccination.

The last patient was a 31 female who developed itch and erythema at the injection 1 day after the Pfizer-BioNTech vaccine ( Figure 1D ). Table 1 ). With other reactions, the decision should consider the severity of the initial reaction and risk of acquiring severe COVID-19 infection.

The first patient was diagnosed with pityriasis rosea triggered by recent vaccination. While not an immediate allergic reaction or contraindication, the decision was made to defer the second dose, weighing also into account his low risk of COVID-19 acquisition.

The next two patients were diagnosed with urticaria triggered by vaccination, as opposed to a type 1 drug hypersensitivity reaction and thus were allowed to proceed with the second dose. The first was treated with antihistamines and completed the second dose without worsening in her hives.

Both local injection site reactions and delayed large local reactions are not contraindications to receiving the second dose, 1, 2 although recurrence of the reaction may occur in 50% (typically of same severity or milder). 3 The last patient with injection site local reaction appropriately proceeded with the second dose of vaccine, triggering a similar but milder reaction ( Figure 1E ). 

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