key: cord-1015469-di1k6p1k
authors: McMahon, Devon E.; Amerson, Erin; Rosenbach, Misha; Lipoff, Jules B.; Moustafa, Danna; Tyagi, Anisha; Desai, Seemal R.; French, Lars E.; Lim, Henry W.; Thiers, Bruce H.; Hruza, George J.; Blumenthal, Kimberly; Fox, Lindy P.; Freeman, Esther E.
title: Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases
date: 2021-04-07
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2021.03.092
sha: b33a827044c127ed007aaff97e92cdd526d71f70
doc_id: 1015469
cord_uid: di1k6p1k

Background Cutaneous reactions after mRNA-based COVID-19 vaccines have been reported but are not well characterized. Objective To evaluate morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results From December 2020-February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first dose reactions experienced second dose recurrence. Limitations Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusion We report a spectrum of cutaneous reactions after COVID-19 mRNA vaccines. Most patients with first dose reactions did not develop a second dose reaction, and no patients in the registry developed serious adverse events after the first or second dose. These data provide reassurance to patients and providers.

The vaccine registry collected dates for both doses, morphology of cutaneous reaction(s), timing and 

Of 414 records, information about both vaccine doses was available for 180 (43% of cases). Of these, 

We additionally observed reactions to Moderna and Pfizer vaccines that had been noted after SARS-

CoV-2 infection itself, including pernio/chilblains (e.g., "COVID toes"), erythromelalgia, and pityriasis-rosea-like 213 exanthems. 3, 8, 9 That these exanthems mimic dermatologic manifestations of COVID-19 potentially suggests that a) the host immune response to the virus is being replicated by the vaccine and b) some components of these 9 effects. 10, 11 Erythromelalgia and pityriasis rosea have been noted in response to other vaccines such as those for 217 influenza and hepatitis B, although uncommonly. 13 (4.9) 9 (8.8) 2 (5.9) 3 (7.5) Diarrhea 9 (3.4) 4 (3.9) 1 (2.9) 0 Other ¶ 10 (3.7) 10 (10) 4 (12) 1 (2.5) 

8%) after first dose and in 68 participants (0.2%) after second dose

Moderna's trial also described vesicular, References: 278 13. Confino I, Passwell JH , Padeh S. Erythromelalgia following influenza vaccine in a child

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