key: cord-1051391-at5pcnrq authors: Lee, Cynthia; Cotter, David; Basa, Jasmine; Greenberg, H.L. title: 20 Post‐COVID‐19 vaccine‐related shingles cases seen at the Las Vegas Dermatology clinic and sent to us via social media date: 2021-05-31 journal: J Cosmet Dermatol DOI: 10.1111/jocd.14210 sha: 33d31fe8607f62b5e57f0f4c03523c4e4ff54b06 doc_id: 1051391 cord_uid: at5pcnrq On March 11th 2020, the World Health Organization declared COVID-19 a global pandemic. COVID-19 is a novel coronavirus with high infectivity and severe morbidity and mortality, especially for those over 70 years old and also for those with comorbid medical conditions such as lung disease and obesity.1 The entire world has been gripped with fear and practiced social distancing, masking, and quarantine of exposed or infected individuals in an effort to curtail the spread of the disease. To the Editor, On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. COVID-19 is a novel coronavirus with high infectivity and severe morbidity and mortality, especially for those over 70 years old and also for those with comorbid medical conditions such as lung disease and obesity. 1 The entire world has been gripped with fear and practiced social distancing, masking, and quarantine of exposed or infected individuals in an effort to curtail the spread of the disease. 2, 3 The new virus is characterized primarily by respiratory-related disease, but also may involve multiple organ systems; COVID-19 has caught the medical community by surprise due to its myriad of clinical manifestations. Additionally, COVID-19 has been associated with various cutaneous manifestations; associated cutaneous skin eruptions from natural infection are described as diffuse erythematous eruptions, widespread urticaria, and chickenpox-like vesicles. 4, 5 Two vaccines were approved for use by the FDA on December 11 th (Pfizer) and December 18 th (Moderna) of 2020 to prevent COVID-19 infection and change the tide against this deadly pandemic. 6, 7 At the time of our observation, two vaccines were authorized in the United States to prevent COVID-19: Moderna (94.5% effective) and Pfizer (95% effective). 8, 9 Two doses of the aforementioned vaccines are required to reach optimal effectiveness. Side effects may emerge after the first and/or second dose, with common side effects including injection site pain and flu-like symptoms. 10 Recently, a third vaccine by J&J has been approved for use, requiring only one dose; to our knowledge, there are no reported cases of shingles reaction to the J&J COVID-19 approved vaccine. 11 In clinical trials, it was noted that the Moderna vaccine was associated with swelling in the area of facial filler injections in some patients. 7 A suggested pathophysiologic mechanism involving angiotensin-signaling pathways has been posited as the etiology of filler-associated swelling; in fact, these patients have been successfully treated with angiotensin inhibitors. 12 The initial Pfizer vaccine application mentioned no reported adverse facial filler reactions with vaccination. A 65-year-old man with a history of shingles 35 years prior to presentation and long-standing hypertension was consulted for painful, erythematous, and clustered skin eruptions. Symptoms first began after his 2 nd dose of the Pfizer COVID-19 vaccine, with pruritus 14 days post-vaccination, followed by increasing chest and back pain 3 days post-pruritus. The patient was diagnosed with HZ, later confirmed via VZV PCR, and was treated with a course of Valacyclovir for the virus, oral Gabapentin, and topical Lidocaine 4% for pain. He was the 4 th patient seen in our clinic for HZ related to COVID-19 vaccination. Several other individuals contacted us via social media to share their experience, contributing to our list of Post-COVID-19 vaccine HZ eruptions ( Table 1) . HZ is attributed to reactivation of VZV. Primary infection with VZV results in chickenpox; once resolved, VZV establishes lifelong dormancy in multiple sensory ganglia and may re-emerge due to risk factors including increasing age, immunocompromised condition, and/or stress. 16 Cases of shingles have also been seen in patients vaccinated to VZV. 17 This article does not contain any studies with human or animal subjects performed by any of the authors. The authors are in compliance with the ethical standards of this journal. There is no conflict of interest of all authors. Medical images used in this publication were granted by the patient after informed consent. Weekly updates by select demographic and geographic characteristics Suspension of Entry as Immigrants and Nonimmigrants of Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus and Other Appropriate Measures To Address This Risk Executive Office of the President. Declaring a National Emergency Concerning the Novel Coronavirus Disease The Daily Journal of the United States Government Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatology Venereol Food and Drug Administration Moderna COVID-19 Vaccine. Food and Drug Administration Covid-19: Moderna vaccine is nearly 95% effective, trial involving high risk and elderly people shows Covid-19: Pfizer vaccine efficacy was 52% after first dose and 95% after second dose, paper shows Public needs to prep for vaccine side effects Janssen COVID-19 Vaccine. Food and Drug Administration COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment Shingles 1 day post Covid19 Vaccination Las Vegas doctor wants more vaccine research after treating two shingles patients Herpes zoster following inactivated COVID-19 vaccine: A coexistence or coincidence? Clinical practice: Herpes zoster Severe herpes zoster following varicella vaccination in immunocompetent young children Kaposi′s varicelliform eruption: A case series Kaposi varicelliform eruption (eczema herpeticum) Herpes zoster (shingles) complicating the course of COVID19 infection COVID-19 and herpes zoster co-infection presenting with trigeminal neuropathy Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis Manipulation of the innate immune response by varicella zoster virus New study launches into COVID-19 vaccine responses in patients with impaired immune systems mRNA vaccines-a new era in vaccinology Biden vows enough vaccine 'for Every Adult in America' by End of May. The New York Times