Table 1.
Reported cases of severe cutaneous adverse reactions due to COVID‐19 vaccine administration.
| Patient | Sex | Age, years | Allergy | Vaccine platform | Dose | Timing of onset | Lag period after vaccination, days, days | Clinical phenotype | Supporting investigations | Outcome | Second dose administration |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | M | 74 | Sulfa drugs, amoxicillin–clavulanic acid |
Viral vector vaccine (Janssen, Ad26.COV2.S) |
First | 3 days | 10 | AGEP |
Blood test: leucocytosis with neutrophilia and eosinophilia, normal creatinine level and liver enzymes Histology: epidermal spongiosis with subcorneal neutrophilic pustules and dermal neutrophilic inflammation with eosinophils. DIF: negative |
Improved with oral prednisolone 20 mg/day and topical steroid | NA |
| 2 | F | 43 | NA |
Viral vector vaccine (Oxford‐AstraZeneca, ChAdOx1) |
First | 3 days | NA | AGEP | Blood test: leucocytosis with eosinophilia. Histology: lichenoid interface dermatitis, intracorneal pustules, lymphocytic infiltrate with numerous eosinophils | Resolution with topical corticosteroid within 30 days | Platform changed to mRNA vaccine (Pfizer/BioNTech, BNT162b2); no recurrence of reaction |
| 3 | F | 32 | No |
Viral vector vaccine (Oxford‐AstraZeneca, ChAdOx1) |
First | 3 weeks | NA | AGEP | Blood test: leucocytosis with neutrophilia | Resolution with short course systemic corticosteroid within 2 weeks | Not mentioned |
| 4 | M | 38 | NA |
mRNA vaccine (Pfizer/BioNTech, BNT162b2) |
Second | 5 days | NA | AGEP |
Blood test: marked neutrophilia Histology: supportive of the diagnosis of AGEP |
Resolution with topical mometasone cream | NA |
| 5 | M | 60 | NA |
Viral vector vaccine (Oxford‐AstraZeneca, ChAdOx1) |
First | 3 days | 7 | SJS | Histology: moderate intraepidermal infiltration of lymphocytes and neutrophils with moderate spongiosis, scattered degenerated apoptotic keratinocytes, patchy areas of basal cell degeneration and interface dermatitis, perivascular and periadnexal inflammatory cell infiltrate along with extravasation of erythrocytes in dermis | Complete resolution with oral ciclosporin 300 mg/day after 7 days | Platform changed; no data on outcome |
| 6 | F | Middle‐aged | No |
mRNA vaccine (Pfizer/BioNTech, BNT162b2) |
Second | 5 days | NA | SJS | NA | Treated with oral prednisolone 30 mg/day; outcome unknown | NA |
| 7 | F | 49 | NA |
mRNA vaccine (Pfizer/BioNTech, BNT162b2) |
First | 7 days | NA | TEN | Histology: full‐thickness epidermal necrosis along with dermal–epidermal separation and necrotic keratinocytes | Treatment with 2 doses of etanercept 50 mg/mL (on Days 1 and 3); complete resolution in 22 days | Not mentioned |
| 8 | M | 66 | No |
mRNA vaccine (Moderna, mRNA‐1273) |
Second | 24 h | 5 | GBFDE |
Blood test: anti‐BP180 negative (8), anti‐BP230 negative (< 2) Histology: full‐thickness epidermal necrosis and a very sparse lymphocytic inflammatory infiltrate |
Improved with high‐dose oral prednisone | NA |
|
9 (our case) |
M | 74 | Penicillin (swollen lips) |
Viral vector vaccine (Oxford‐AstraZeneca, ChAdOx1) |
First | 25 h | 2 | GBFDE |
Histology: subepidermal separation with superficial and deep perivascular mixed inflammatory cells infiltration composing lymphohistiocytes and numerous eosinophils, melanophages were seen in the upper dermis IFN‐γ ELISpot assay: negative for polysorbate 80 |
Resolution with residual hyperpigmentation with topical desoximetasone within 2 weeks | Platform changed; no data on outcome |
AGEP, acute generalized exanthematous pustulosis; BP, bullous pemphigoid; DIF, direct immunofluorescence; GBFDE, generalized bullous fixed drug eruption; IFN, interferon; NA, not applicable; SJS, Stevens–Johnson syndrome; TEN, toxic epidermal necrolysis.