Table 1.
The demographic data of the patients and the clinical course of the cutaneous reactions
| Case age /sex | Cutaneous manifestation | Distribution | The clinical course of the lesions during the vaccination process | Medical history | PCR proven COVID‐19 infection |
|---|---|---|---|---|---|
| 45/F |
Erythematous dusky macules and papules and targetoid lesions Erythematous patch |
Symmetric, trunk, upper and lower limbs Upper palate |
Onset 3 days after the first dose, improved but recurred 1 day after the second dose with increased severity | Skin rashes with NSAID | No |
| 45/F |
Two oval thin plaques with a peripheral collarette scaling reminiscent of a herald patch Multiple scaly erythematous plaques |
Right breast and scapula Symmetric, along skin cleavage lines on trunk and upper limbs |
Onset 4 days after the first dose, gradually partially resolved but reactivated again 4 days after the second dose. | Unremarkable | Yes |
| 29/F | Linear weals | Along the shape of the scratching and rubbing areas | Onset 4 h after the first dose. She refused second dose. | Penicillin and metal allergy, polymorphic light eruption | No |
| 32/F |
Weals Angioedema |
Trunk, upper and lower limbs Both eyes(periorbital) |
Onset 12 weeks after the first dose. Persisted with worsening after the second dose. | Hashimoto thyroiditis | Yes |
| 48/F |
Weals Angioedema |
Trunk, upper and lower limbs Both eyes(periorbital) and lips |
Onset 4 h after the first dose. Persisted with worsening after the second dose. | Asthma, allergic rhinoconjunctivitis, latex and metal allergy, Hashimoto thyroiditis | No |
| 26/F | Weals | Ears and upper limbs | Onset 2 h after the second dose, improved within a week. | Unremarkable | No |
| Histopathology | Diagnosis | Treatment |
Follow‐up period/ current situation |
|---|---|---|---|
| Parakeratosis, spongiosis, lymphocytic exocytosis, parabasal layer vacuolar changes, apoptotic keratinocytes in the dermis and moderate mononuclear inflammation in the dermis | Erythema multiforme major | Oral antihistamine, systemic and topical corticosteroid |
8 weeks/ resolution |
| Focal parakeratosis with exocytosis of lymphocytes, spongiosis in the epidermis, and extravasated red blood cells in the dermis | Pityriasis rosea | Topical corticosteroid |
8 weeks/ resolution |
| None | Symptomatic dermographism | Oral antihistamine | 12 weeks/ improvement |
| None | Chronic spontaneous urticaria | Oral antihistamine and systemic corticosteroid |
9 weeks/ resolution |
| None | Chronic spontaneous urticaria | Oral antihistamine and omalizumab 300 mg/4 weeks |
12 weeks/ improvement |
| None | Acute urticaria | None |
1 week/ resolution |
F, Female.