TABLE 1.

Mucocutaneous reaction after COVID‐19 vaccination reported in “Case reports” studies

Supplemental references a	First author	Case age	Case gender	Patients' mucocutaneous disease history	Patients' other comorbidity	Drug history at the time of vaccination	Vaccine dose	Any sign after vaccine	Description of mucocutaneous reactions	reactions onset	Skin or mucosal biopsy	Diagnosis	Resolution after (time)	Management of reactions
1. Injection site reactions, “Covid arm” (n = 12)
With BNT162b2
1	Gyldenløve, M.	33	F	NM	DM, obesity	NM	1	Neg	Asymptomatic rash at the injection site	12d	Perivascular, lymphocyte infiltration in the dermis	Reactions after incorrect subcutaneous administration	NM	Neg
2	Tammaro, Antonella	64	F	Neg	Neg	Neg	2	Neg	A nodule surrounded by an erythematous halo, extremely painful and pruritic	1d	NM	Localized reaction	4d	Topical Corticosteroid cream
2	Tammaro, Antonella	56	F	Neg	Neg	Neg	2	Neg	Small vesicular lesions surrounded by erythema	1d	NM	Localized reaction	7d	Topical Corticosteroid cream
2	Tammaro, Antonella	60	F	Neg	Neg	Neg	2	Neg	Severe xerosis and pruritus in the area injected, extensive erythematous pruritic and painful rash, on the shoulder and chest	7d	NM	Localized reaction	7d	Topical Corticosteroid cream
3	López‐Valle, A.	27	F	Neg	NM	NM	1 & 2	1st: fever, 2nd: fatigue after 24 h of injection	1st: pain at the injection site, erythematous–edematous firm plaque over the deltoid area, 2nd: pain and an erythematous–edematous plaque on the injection site	1st:7d / 2nd:6 h	NM	NM	1st: 2d	Paracetamol for 2nd dose symptoms (resolved after 2d)
4	Baeck, M.	38	F	BNT	NM	NM	1	Pain at the injection site had completely resolved within 2 days, numbness of the fingers	Only after 1st dose: erythema of the upper arm	6d	sparse, superficial, deep lymphohistiocytic infiltrates with CD3+ (including CD8+ and CD4+) T cells and some eosinophils and very rare CD20+ B cells	Delayed local reaction	5d	Spontaneous resolution
With mRNA‐1273
5	Sidlow, J. S.	67	F	NM	mild atopy	NM	1	NM	Only after 1stt: itchy 7‐cm erythematous red patch at the vaccine injection site of the upper portion of patient's left arm	7d	Spongiosis perivascular, interstitial infiltrate, mixed cell type with rare eosinophils, occasional neutrophils within the reticular dermis	Localized reaction	7d	Topical Corticosteroid use
5	Sidlow, J. S.	40	F	NM	atopic family history	NM	1 & 2	NM	1st: sharply demarcated warm urticarial oval patch, swelling and progressive erythema on the arm, 2nd: mild swelling at the injection site	8d	Spongiosis perivascular, interstitial infiltrate, mixed cell type with rare eosinophils, occasional neutrophils within the reticular dermis	Localized reaction	NM	Erythromycin for presumed erysipelas
5	Sidlow, J. S.	53	F	NM	mild atopic background	NM	1 & 2	2nd: weakness, diarrhea, patient could not raise her arm above 90° angle	1st: some mild sensitivity at the injection site and tenderness, 2nd: tender erythematous urticarial red ring on the injected arm	NM	Spongiosis perivascular, interstitial infiltrate, mixed cell type with rare eosinophils, occasional neutrophils	Localized reaction	3d	Neg
6	Lindgren, A. L.	60	F	NM	Neg	NM	1	Neg	Swollen, painful, extremely pruritic, erythematous plaque with minute papules in vaccination site	6d	NM	Hypersensitivity reaction	14 h	Clobetasol 0.05% cream twice
6	Lindgren, A. L.	44	F	NM	Neg	NM	1	fever, chills, headache, and myalgias	Erythema, pain, pruritus, induration and swelling at the vaccination site on patient's left arm	7d	NM	Hypersensitivity reaction	2d	Triamcinolone 0.1% cream
6	Lindgren, A. L.	33	F	NM	NM	NM	1	Neg	Redness, pain, itching, and swelling at the injection site	7d	NM	Hypersensitivity reaction	4d	1% Hydrocortisone cream
2. Non‐injection site reactions (n = 104)
2.1. Hypersensitivity reaction type 1 (n = 14)
2.1.1. Urticaria (n = 5)
With BNT162b2
7	Bianchi, L.	24	F	NM	Allergic rhinitis	NM	1	NM	Generalized acute urticaria	5 min	NM	urticaria	NM	Betamethasone Sodium Phosphate IV
7	Bianchi, L.	28	M	NM	Allergic rhinitis	NM	1	NM	Generalized acute urticaria	5 min	NM	urticaria	NM	Neg
8	Pitlick M.	24	F	NM	NM	NM	1	NM	Urticaria	3 h	NM	NM	4d	antihistamines
8	Pitlick M.	45	F	NM	Food allergy	NM	1	Throat tightness	Urticaria	8 h	NM	NM	NM	Neg
8	Pitlick M.	33	F	NM	Asthma, venom anaphylaxis	NM	1	Tachycardia	Urticaria	15 min	NM	NM	12 h	antihistamines
2.1.2. Flushing (n = 3)
With BNT162b2
7	Bianchi, L.	58	F	NM	Allergic rhinitis and asthma	NM	1	NM	Flushing of the face	30 min	NM	Flushing	NM	Neg
7	Bianchi, L.	44	F	NM	Allergic rhinitis	NM	1	NM	Flushing of the face	20 min	NM	Flushing	NM	Neg
8	Pitlick M.	36	F	NM	NM	NM	1	NM	Facial flushing	5 min	NM	NM	1 h	antihistamines
2.1.3. Angioedema(n = 3)
With BNT162b2
7	Bianchi, L.	31	F	NM	Allergic rhinitis	NM	1	NM	Angioedema (tongue, gums)	24 h	NM	Angioedema	NM	Neg
7	Bianchi, L.	54	F	atopic dermatitis,contact allergy	Allergic rhinitis	NM	1	NM	Angioedema (tongue, lips)	10 min	NM	Angioedema	NM	Neg
With mRNA‐1273
8	Pitlick M.	20	M	NM	Vaccine allergy	NM	1	NM	Angioedema	3 h	NM	NM	1d	Steroids, Antihistamines
2.1.4. Anaphylaxis(n = 3)
With BNT162b2
9	Daou, Christophe Abi Zeid	30	M	Allergies to Meperidine, Amocixillin‐Clavulonate Acid, pollen, and dust mites	NM	NM	1	Tachycardia, tachypnea, dysphagia, dyspnea, severe chills, dysphagia	Diffuse maculopapular rash + urticaria, diaphoresis, palate pruritis, rash, pruritus,diaphoresis, sudden onset of rash followed by urticaria, diaphoresis	a few minutes	NM	Biphasic anaphylaxis	1d	Diphenhydramine, Prednisone, Dexamethasone, Hydrocortisone Sodium Succinate, Epinephrine
10	Restivo, V.	30	F	Poly‐allergic subject, urticaria‐angioedema, immediate cutaneous reaction	NM	Prednisone, Chlorphenamine Maleate before vaccination	1	the feeling of a slurred mouth and hoarseness	erythematous spots on the face and neck	5 h	NM	Severe allergic reaction	NM	Dexamethasone, Chlorphenamine Maleate, 0.9% NaCl, Oxygen
With mRNA‐1273
8	Pitlick M.	22	F	NM	Allergic rhinitis	NM	1	wheezing, throat pruritus	Angioedema	20 min	NM	Level 1 Anaphylaxis	6 h	Antihistamines, Steroids
2.2. Generalized eruptions (n = 21)
With BNT162b2
11	Edriss, Manar	54	M	NM	NM	NM	1	Neg	Clustered erythematous papules and nodules on posterior upper left arm that extended to left elbow and forearm	5d	NM	erythematous papules and nodules	NM	Clobetasol BD
12	Ackerman, M.	55	M	NM	Neg	NM	1	injection‐site soreness, slight hepatic cytolysis (ASAT and GGT 2 N)	Localized pruritic erythematous eruption, later spread on the face, trunk, upper extremities and thighs, 30% of body surface area involved	3 h	slight lymphocytic perivascular infiltrate, compatible with non‐severe maculopapular toxidermia late biopsied	Persistent maculopapular exanthem	NM	one dose of Dermocorticoid Treatment, withholding of 2nd dose
13	Akinosoglou, K.	32	F	Neg	NM	NM	1 & 2	Neg	Itchy annular granulomatous rash over both elbows	2d	Cutaneous small cell vasculitis, possibly of leukocytoclastic origin	Annular rash	3d	Neg
14	Zafar, M.	84	M	NM	BPH	NM	2	Rise in D‐dimers and eosinophils	Widespread disseminated mildly itchy rash	11d	NM	Rash with eosinophilia	NM	Oral Antihistamines, Topical Steroids
15	Patruno, C.	42	F	Neg	NM	Neg	1	NM	Wheals (acute urticaria) on the trunk and limbs	7d	NM	Acute urticaria	7d	Antihistamine, Prednisone 25 mg
15	Patruno, C.	55	M	NM	Neg	Neg	1	NM	Multiple itchy erythematous papules, vesicles, and blisters	10d	spongiosis, epidermal exocytosis of lymphocytes, apoptotic keratinocytes, dermal edema	Erythema Multiforme‐like eruption	10d	Systemic Prednisone 25 mg/day
16	Lavery, M. J.	58	F	Erythema Multiforme (quiescent), recurrent episodes of herpes labialis	RA, Endometriosis, HTN, thyroid goiter	Abatacept, famciclovir	1 & 2	NM	A painful cutaneous eruption, erythematous concentric targetoid plaques on the palms of her hands and soles of the feet bilaterally	1st: 12 h,2nd:1d	NM	Erythema Multiforme‐like eruption	NM	Topical Clobetasol
17	Gambichler, T.	74	F	NM	Severe dementia syndrome	Pantoprazole	1	NM	Erythematous partly violaceous coalescing macules and papules with slightly indicated cocarde formation on the trunk and extremities	1d	epidermal atrophy, vacuolar interface dermatitis, lymphocytic infiltrates, dyskeratoses of basal keratinocytes	Rowell's syndrome	NM	NM
18	Ohsawa, R.	55	F	NM	Neg	NM	1	pain at the injection	d2: pruritic papules and erythematous lesions developed over the entire body except for the face d6: mild pruritic vesicopapular, erythematous macular and morbilliform eruption on the bilateral flanks and extremities	2d	perivascular lymphocytic infiltrates, basal cell vacuolization and intraepidermal vesicle with mild spongiotic change containing collections of Langerhans cells and degenerated acantholysis‐like keratinocytes,microthrombi in small vessels in the mid‐ and deep dermis,perivascular and intraepidermal lymphocytic infiltrates with CD8+ > CD4+ cells	Morbilliform rash	7d	2d: topical betamethasone dipropionate and oral antihistamine: ineffective, 6d: 15 mg of oral predonisolone, withholding 2nd dose of vaccine
19	Farinazzo, E.	37	F	NM	NM	NM	NM	NM	Morbilliform eruption	NM	NM	Morbilliform eruption	NM	NM
20	Weinstock‐Guttman, B.	31	F	history of allergic reaction to cefixime	history of MOGSD and biopsy‐confirmed smoldering myeloma with monoclonal gammopathy	IV RTX for the last 2 years, monthly doses of IVIG (1st vaccination 12 weeks after the RTX infusion)	1	local warmth	1st: multiple urticarial papules and plaques located on both lower extremities and gluteal area, primarily left side (unilateral side of the vaccination), local 2nd: lesions increased in size and became more evident Resolution: minimal hyperpigmentation residue	1st:7d, 2nd: 2d	NM	Late onset erythema	NM	oral corticosteroids tapered within 3 weeks (15 mg/10 mg/5 mg prednisone)
19	Farinazzo, E.	44	F	NM	NM	NM	2	NM	Purplish macule on the third finger of one hand	10d	NM	Fixed Drug Eruption	NM	NM
With mRNA‐1273
5	Sidlow, J. S.	45	M	NM	atopy and seasonal allergies	NM	1	Neg	Only after 1st: pruritic morbilliform rash with spread to the arms and abdomen	8d	spongiosis and a superficial and deep, perivascular and interstitial infiltrate, mixed cell type with numerously abundant eosinophils and occasional neutrophils within the reticular dermis	Generalized reaction	7d	Neg
5	Sidlow, J. S.	31	F	History of guttate psoriasis	NM	NM	1 & 2	2nd: low‐grade fever, generalized achiness, and malaise	Both doses: urticarial papular eruption on the contralateral aspect of the right arm	3d	spongiosis and a superficial and deep, perivascular and interstitial infiltrate, mixed cell type with eosinophils and occasional neutrophils within the reticular dermis	Generalized reaction	7d	Neg
5	Sidlow, J. S.	88	F	NM	multiple drug allergies	NM	1	1st: pins and needles sensation on the limbs and dysesthesia on the tongue	Only after 1st: generalized and progressing pruritus	3d	spongiosis and a superficial and deep, perivascular and interstitial infiltrate, mixed cell type with eosinophils and occasional neutrophils within the reticular dermis	Generalized reaction	NM	Benadryl (Johnson and Johnson) and Sarna (Stiefel) lotion
21	Kong, Joyce	66	M	NM	HTN, hyperlipidemia, DM, CKD, CAD, idiopathic hypothyroidism	Amlodipine, Aspirin, Brimonidine, Clopidogrel, Furosemide, Gabapentin, Insulin, Levothyroxine	2	fever, myalgias, malaise; After 5d: lower extremity muscle tenderness, stiffness with preserved strength	Painful blistering rash on torso, arms, legs, violaceous, poorly demarcated patches on trunk, arms, thighs, large flaccid bullae, erosion on buttocks, posterior shoulder, and scrotum	1d	epidermal necrosis, with detachment from the underlying dermis forming a subepidermal blister, a very sparse lymphocytic inflammatory infiltrate and a sparse perivascular dermatitis	Extensive Bullous Fixed Drug Eruption	5d	Ibuprofen, High‐dose Oral Prednisone, drainage of patient's bullae, Mupirocin Ointment with Vaseline
With Ad26.COV2.S
22	Lospinoso, K.	74	M	Known allergy to sulfa drugs and amoxicillin‐clavulanic acid, no prior vaccination‐related reactions	Panhypopituitarism, adrenal insufficiency, neurogenic bladder, obstructive sleep apnea	Prednisone (20 mg, daily)	1	ipsilateral arm discomfort, including the axilla, within 24 h of administration	Generalized distribution (50% of body) of erythematous plaques, numerous small, non‐follicular pustules, with sparing of the face, genitals, and mucosae; Significant acral swelling	3d	epidermal spongiosis with focal, dermal neutrophilic inflammation and occasional eosinophils, scattered subcorneal neutrophilic pustules	Spongiotic and pustular eruption	20d	Oral Prednisone (20 mg, daily), Topical Steroids
23	Song, E. J.	83	F	Neg	HTN, hypothyroidism, breast cancer	Palbociclib, Letrozole, Vitamin D	1	Neg	pruritic erythematous annular patches with central clearing on the breast, abdomen, and axilla; scattered petechiae on previous sites of involvement	2d	a mixed spongiotic and interface dermatitis with rare eosinophils and extravasated erythrocytes	Widespread annular eruption	14d	Fexofenadine 360 mg daily, Cetirizine 20 mg daily, Triamcinolone 0.1% cream BD
With ChAdOx1 nCoV‐ 19
24	Dash, S.	60	M	NM	DM, HTN	Teneligliptin, Metformin and Amlodipine	1	Fever, oral ulceration and skin rash	Multiple purpuric macules present all over the body with peri‐lesional erythema; lesions coalesced to form large sheets of necrosed skin over front and back of trunk, with bullae on few areas; Mucosal involvement: oral erosions, hemorrhagic crusting over the lips, eye congestion, erosions over the glans	3d	Orthokeratosis, epidermal atrophy, infiltration of lymphocytes, neutrophils spongiosis, scattered degenerated apoptotic keratinocytes, basal cell degeneration, interface dermatitis, perivascular and peri‐adnexal inflammatory cell infiltrate, extravasation of erythrocytes in dermis	Steven‐Johnson syndrome	7d	Oral Cyclosporine 300 mg
14	Zafar, M.	55	F	stable psoriasis and scleroderma	NM	NM	1	NM	new‐onset non‐itchy rashes, with progressive worsening over the past month on hands and back	2d	NM	Rash without eosinophilia	NM	oral antihistamines and topical steroid creams
25	Tammaro, A.	35	F	NM	Prior COVID‐19 +	NM	1	fever, nausea, and pain on the site of injection for 2d	extended erythematous rash on the legs with pruritus and warmth 2d later: vesicular lesions on top of that rash Resolution: vesicular lesions were substituted by white discolorations	6d	NM	Local nonspecific inflammatory reaction to vaccination	NM	ebastine 10 mg and 2 tablets of betamethasone 1 mg (tapered for 4d)
2.3. Chilblain‐like lesions (CBLL) (n = 9)
With BNT162b2
26	Lesort, C	82	F	psoriasis	NM	Methotrexate for more than 10 years	1	Neg	slightly painful macular violaceous and erythematous lesions of the fingers and toes, suggestive of CBLL	24 h	A partly necrotic epidermis, overlying a dense dermal lymphocytic infiltrate forming rather well‐circumscribed aggregates around blood vessels, eccrine sweat glands and occasionally nerves	CBLL	NM	NM
27	Piccolo, V.	41	F	Neg	Neg	Neg	2	NM	CBLL on the volar aspects of, the second and the third fingertip of right hand along with an acrocyanosis of the hands	Soon after	NM	CBLL	NM	NM
28	Pileri, A.	42	M	NM	NM	NM	1	NM	Nonpainful erythematous, purplish patches located on his distal phalanges and nail beds	12d	NM	CBLL	NM	NM
29	Davido, Benjamin	41	F	NM	Bipolar disorder	Valproate for more than 10 years	1	Sudden toe pain with walking impairment, otherwise asymptomatic	chilblain‐like skin changes on toes, itching at night; 10d after vaccination: non‐tender violaceous toes of the left foot, with no other dermatological lesion	4d	NM	CBLL	28d	NM
19	Farinazzo, E.	27	F	NM	NM	NM	1&2	NM	1st: Chilblain‐like rash on the first and third finger of one foot + urticarial rash 2nd: urticarial rash	1st: 4d,2nd:1d	NM	Chilblain‐like rash	NM	NM
With mRNA‐1273
30	Watad A.	48	F	NM	Neg	NM	1	NM	Painful chilblains like lesions on fingers; itchy urticarial‐type lesions (resembling urticarial multiforme)over volar aspect of both wrists and feet; evolving over thighs (asymptomatic) and extensor surfaces of both elbows; painful macular/nodular lesions over palmar surface of both hands	10d	NM	CBLL and Urticarial‐type lesions	7d	Hydrocortisone 0.5%, Naproxen 500 mg
31	Kha, C.	70	M	NM	Pityriasis lichenoides chronica, clinically stable	clobetasol 0.05% ointment	1 & 2	erythema, swelling, and pain with movement of the right PIP joints of the 4th and 5th digits for 10d	few scattered pruritic red edematous papules on an erythematous/violaceous background on palmar and lateral aspects of the fingers on right hand	1st: 2d, 2nd: 3d	dense and predominantly perivascular lymphocytic infiltrate (majority of CD31 T cells) within the superficial‐to‐deep reticular dermis, epidermis normal with no vacuolar changes at the epidermal‐dermal junction, notable papillary dermal edema, some slightly thickened vessels walls with trophism of lymphocytes within the superficial dermis	Chilblains	1st: 14d, 2nd: 7d	1st: Clobetasol 0.05% ointment applied twice daily 2nd: Topical Steroid therapy
WithCoronaVac
32	Selami Aykut Temiz	44	M	Neg, Prior COVID ‐	Neg	Neg	NM	Neg	Mildly pruritic, edematous violaceous plaques and nodules on the dorsal hands	7d	NM	Acral CBLL	21d	Topical corticosteroids, Antihistamines
32	Selami Aykut Temiz	53	M	Neg, Prior COVID ‐	Neg	Neg	NM	Neg	Erythematous‐to‐violaceous, patches on the marginal side of the fingers of both hands	7d	NM	Acral CBLL	21d	Topical corticosteroids, Antihistamines
2.4. Pityriasis rosea (n = 9)
With BNT162b2
33	Cyrenne, Benoit	20	F	Alopecia areata	NM	Neg	1 & 2	NM	1st: large, pruritic, red and scaly plaque at the inoculation site, small, red, scaly lesions on the trunk, 2nd: increased pruritus and an increasing number of lesions, multiple oval pink‐to‐tan‐colored thin plaques with peripheral scale on the trunk and proximal extremities	2d	Parakeratosis with minimal acanthosis and spongiosis of the epidermis, few scattered dyskeratotic keratinocytes in the lower epidermis, Melanin incontinence, perivascular lymphocytic infiltrate and rare scattered extravasated red blood cells in the papillary dermis	Pityriasis rosea‐like eruption	14d	Topical corticosteroid therapy
33	Cyrenne, Benoit	40	M	NM	NM	Neg	2	Neg	2nd: red and scaly plaque on lateral left axilla, widespread eruption of pruritic, symmetrically distributed, smaller plaques with peripheral scale on the trunk and proximal extremities	21d	NM	Pityriasis rosea	21d	Doxycycline and Bilastine
34	Busto‐Leis, J.M.	29	M	NM	NM	NM	2	NM	Herald patch, typical oval‐shaped macules, appeared along skin tension lines	1d	Mild spongiosis with foci of parakeratosis and a lymphohistiocytic infiltrate around superficial vessels	Pityriasis rosea	NM	NM
34	Busto‐Leis, J.M.	26	M	NM	NM	NM	2	NM	Herald patch, typical oval‐shaped macules appeared along skin tension lines	7d	Mild spongiosis with foci of parakeratosis and a lymphohistiocytic infiltrate around superficial vessels	Pityriasis rosea	NM	NM
35	Carballido Vazquez, A.M.	35	M	NM	NM	NM	1 & 2	NM	Extremely itchy exanthema, a single oval erythematous lesion on the thigh, papulo‐squamous rash on the trunk and proximal extremities	NM	NM	Pityriasis rosea like eruption	14d	Antihistamines, Topical Betamethasone
19	Farinazzo, E.	42	F	NM	NM	NM	2	NM	Pityriasis rosea‐like rash on the thighs and abdomen	4d	NM	Pityriasis rosea‐like rash	NM	NM
19	Farinazzo, E.	64	M	NM	NM	NM	1	NM	Pityriasis rosea‐like rash on the neck, upper limbs, and trunk	5d	NM	Pityriasis rosea‐like rash	NM	NM
36	Abdullah, Lina	40	M	NM	Neg	Neg	2	Neg	Rash, single larger erythematous patch with scale on the back, papules on the arms, thighs, chest, abdomen, and flanks in a Blaschkoid distribution	7d	Neg	Pityriasis rosea	21d	0.1% Triamcinolone cream
With CoronaVac
37	Akdas, E.	45	F	Neg	Neg	Neg	1 & 2	NM	Plaques, with a peripheral collarette scaling, herald patch on the right scapula and the right breast, salmon‐colored plaques over the trunk and proximal extremities, many of which had peripheral scales; distribution of plaques: along cleavage lines reminiscent of a Christmas tree pattern on the patient's body	1st& 2nd: 4d	Focal parakeratosis in mounds with exocytosis of lymphocytes, spongiosis in the epidermis and extravasated red blood cells in the dermis	Pityriasis rosea	1st:21d	1st: oral Antihistamine, Topical corticosteroid
2.5. Herpes zoster (n = 8)
With BNT162b2
38	Tessas, Ioannis	44	M	Mild varicella during a stressful period in childhood	Dyslipidemia and active smoking	NM	1	1st: neuropathic pain extending to the neck and the left hand, tiredness	Only after 1st: pain and redness, herpetiform vesicular and erythematous rash on the left upper back and lateral side and inner side of the left arm (C5–C6 dermatomes)	7d	NM	Ipsilateral Herpes zoster	NM	Oral Valaciclovir TDS for 14d
39	Burlando, Martina	42	M	NM	Neg	NM	1	NM	Unilateral small papulovesicular lesions, heralded by a burning sensation, on right hemithorax	2d	NM	Herpes zoster	NM	Acyclovir 800 mg five times a day for 7d
40	Nanova, Krassimira	33	F	Chickenpox in childhood	NM	NM	1	High‐grade fever	Widespread rash, Multiple vesicular lesions with an erythematous rim, observed on the trunk, scalp, and limbs	7d	NM	Herpes zoster	NM	NM
19	Farinazzo, E.	34	F	NM	NM	NM	1	NM	Herpes Zoster of the scalp	NM	NM	Herpes zoster	NM	NM
19	Farinazzo, E.	48	F	NM	NM	NM	1	NM	Herpes Zoster	NM	NM	Herpes zoster	NM	NM
With CoronaVac
41	Bostan, E.	78	M	NM	CHD, CVA, HTN, COPD, radical cystectomy, prostatectomy	Neg	NM	Neg	Erythematous, painful, pruritic, stinging crusted, hemorrhagic vesicles upon an erythematous base involving the left mammary region (an area corresponding to T3‐ T4 dermatomes on the chest and the back)	5d	NM	Herpes zoster	NM	Oral valacyclovir TDS for 7d
With BBV152
42	Arora, P.	60	M	NM	DM, HTN	NM	NM	Neg	Multiple grouped vesicles on an erythematous base, present over the knee, and anterior aspect of right thigh	4d	Intraepidermal spongiotic vesicle containing acantholytic cells with large vesicular nuclei neutrophils and dyskeratotic cells; Occasional multinucleate cell with ground‐glass chromatin and molded nuclei seen within the blister	Herpes zoster	14d	Oral Valacyclovir 1 g TDS for 7d, Topical Fusidic Acid BD
With ChAdOx1 nCoV‐ 19
43	Algaadi, S. A.	65	M	Chicken pox at childhood	CHD, HTN, DM	NM	1	NM	Painful grouped vesicles and ulcerations with a burning sensation on the right side of chest	6d	NM	Herpes zoster	NM	7d Acyclovir, Topical Fusidic Acid
2.6. Purpuric lesions (n = 16)
2.6.1. Immune thrombocytopenic purpura (ITP) (n = 14)
With BNT162b2
44	Ganzel, C.	53	M	NM	Morbid obesity, DM, HTN	Lercanidipin, Losartan, Doxazocin, Hydrochlorothiazide, Aspirin	NM	Epistaxis and low PLT count	Wet purpura on palate and petechial and purpuric rash on the trunk and limbs	14d	NM	ITP	NM	Dexamethasone 20 mg/d and IVIG, 1 g/kg,
45	Tarawneh, O.	22	M	NM	Neg	Neg	NM	Neg	Widespread petechiae and gum bleeding	3d	NM	ITP	3d	Dexamethasone, PLT transfusion, IVIG at 1 g/kg
46	Mazzatenta, C	44	F	NM	NM	NM	2	NM	Asymptomatic purpuric lesions on the right and left eyelid, circumscribed on the upper eyelid	23d	NM	Purpuric lesions on the eyelids	10d	Neg
46	Mazzatenta, C	63	M	NM	NM	NM	2	NM	Asymptomatic purpuric lesions on the right and left eyelid, circumscribed on the upper eyelid	14d	NM	Purpuric lesions on the eyelids	15d	Neg
46	Mazzatenta, C	67	F	NM	NM	NM	1	NM	Moderately itchy ecchymotic lesions on upper eyelids	10d	NM	Purpuric lesions on the eyelids	12d	Neg
47	de Bruijn, S.	38	F	NM	previously TTP‐ naïve	Neg	1 & 2	blurred vision in the left eye (central serous chorioretinopathy)	Bruises after 1st dose, increased bruising and petechiae, diffuse ecchymosis after 2nd dose	14d	NM	Immune‐ mediated TTP (iTTP)	NM	plasma exchange, methylprednisolone, Asprin, RTX, and caplacizumab
With mRNA‐1273
48	Toom, S.	36	F	Allergy to acetaminophen	ITP	Etonogestrel‐Ethinyl Estradiol	1	A mild headache 7d post vaccination	Diffuse petechiae of the extremities and trunk, easy bruising, oral ecchymosis	14d	NM	ITP	3d	Dexamethasone 40 mg IV daily for 4d, IVIG 1 mg/kg for 3d, monitoring
49	Julian, J. A.	72	F	Seasonal contact dermatitis	Gout, DM	Allopurinol, Sitagliptin	NM	NM	Diffuse petechiae across arms, legs, and abdomen and hemorrhagic bullae of the gingival mucosa	1d	NM	ITP	NM	Dexamethasone, IVIG, aminocaproic acid, RTX, PLT transfusions
50	Helms, J. M.	74	M	NM	HTN, gout, hyperlipidemia and nonischemic cardiomyopathy	NM	1	acute epistaxis	diffuse cutaneous purpura	Few hours	NM	Severe, Refractory Immune Thrombocytopenia	NM	High dose Dexamethasone, IVIG, PLT transfusions, RTX, Eltrombopag, plasma exchange, high dose Methylprednisolone, Romiplostim, Cefazolin
With ChAdOx1 nCoV‐ 19
51	Candelli, M	28	M	NM	Neg	Neg	1	fatigue and headache for 10 days and fever for 2 days	oral bleeding and the appearance of petechiae over the trunk, arms, and legs for 3d purpura over the trunk, all four limbs, and bleeding lesions within the oral cavity	19d	NM	ITP	NM	dexamethasone (40 mg/day)
52	Ryan, E.	35	F	NM	migraine	Neg	1	general myalgia and extreme fatigue,headache (different from her known migraine headaches	onset of bruising and petechiae	10d	Marrow aspirate revealed some reactivefeatures with no evidence of an underlying infiltrative disorder	VITT	NM	preemptively anticoagulated with apixaban
53	Thaler, J.	62	F	NM	substituted hypothyroidism of unresolved genesis since age 20	NM	1	flu‐ like symptoms including aching joints, moderate headache, and moderate dizziness, self‐ medicated with 1 g paracetamol, fever: 400 mg aspirin twice	unusually large hematoma after slight biting of lip, gum bleedings, an atraumatic hematoma at the right ankle, small hematomas and petechiae of the limbs	8d	NM	VIPIT	NM	low dose fibrinogen concentrate (1 g for 2d), danaparoid‐ sodium 750 IE IV bolus + 1500 IE SC, followed by 1500 IESC every 8 h). high dose IVIG (1 g/kg),prednisolone (0.75 mg/kg)(2d)
With Ad26.COV2.S
54	Costello, A.	40	F	NM	migraines, obesity	NM	1	sudden headache (intermittent, worsening with sinus pressure, prescribed amoxicillin/clavulanate, methocarbamol, and methylprednisolone), body aches, fever, chills, bilateral lower‐extremity pain without edema, intermittent vertigo	swollen red cheeks, petechiae on her right cheek and bilateral breasts and spontaneous bruising in extremities	10‐12d	NM	vaccine‐induced thrombotic thrombocytopenia	NM	Bivalirudin, Prednisone, (1 mg/kg/day), IVIG (1 g/kg/day), discharged on Rivaroxaban and a Prednisone taper
With CoronaVac
55	Cebeci, F.	82	F	NM	seronegative RA, HTN	Hydroxychloroquine 3 years, Olmesartan 2 years Prednisolone 5 mg 6 months (discontinued 3 weeks vaccination)	1	weakness, burning in the legs	1st: diffuse petechial rash on both lower extremities 2nd: uneventful	1d	NM	petechial rash as a vaccine‐ induced hypersensitivity reaction	7d	Prednisolone restarted 1 week after complete remission of the rash
2.6.2. Vasculitis associated purpura (n = 2)
With BNT162b2
30	Watad A.	53	M	NM	Neg	NM	1	Mild abdominal pain, arthralgia	Palpable purpura	3d	Leukocytoclastic cutaneous vasculitis (IgA and C3 deposits in the vessel walls)	Henoch‐Schonlein purpura	NM	Dexamethasone 10 mg, Prednisone 60 mg thereafter
With BBV152
56	Kharkar, V.	31	F	Neg	Neg	Neg	2	NM	painful palpable purpura on legs, predominantly on the left leg, Dermoscopy: irregularly arranged red blotches, with an orange–red background	4d	Perivascular infiltrate comprised of eosinophils and lymphocytes with a few neutrophils, along with erythrocyte extravasation, perivascular fibrin and perivascular edema	Cutaneous small vessel vasculitis (cSVV)	10d	Wait‐and‐watch policy
2.7.Inflammatory flare‐ups (n = 27)
2.7.1. Autoimmune inflammatory rheumatic diseases (n = 13)
2.7.1.1. Psoriasis (n = 3)
With BNT162b2
57	Cohen, Stephanie R	46	F	Psoriasis (2 years in remission)	Psoriatic arthritis, IBS, leukocytoclastic vasculitis (biopsy‐proven)	Prednisone	1 & 2	Neg	1st: mild exacerbation of palpable purpuric papules on the bilateral lower legs, 2nd: exacerbated again with significant exquisitely tender palpable purpuric papules distributed bilaterally on the lower legs, feet, upper extremities, lower back, and abdomen	1st& 2nd: 2d	Perivascular mixed inflammatory infiltrate with numerous neutrophils, lymphocytes, occasional eosinophils, leukocytoclasia and erythrocyte extravasation, no fibrinoid necrosis of vessels	Small vessel vasculitis such as IgA vasculitis (Leukocytoclastic vasculitis flare)	NM	Topical steroids and a Prednisone taper
With mRNA‐1273
30	Watad A.	36	F	Psoriasis since childhood (mild)	NM	NM	1	Dactylitis, stiffness and tightness, finger joint pain	Painful erythematous macules over palmar surfaceof several fingers on both hands, painful chilblains like lesions (CBLL) on fingers	10d	NM	NM	NM	Ibuprofen 800 mg
With CoronaVac
58	Onsun, Nahide	72	M	Plaque psoriasis	Prerenal acute injury, HTN	Indapamide	1	Fever	Diffuse erythema, desquamation, and coalescing pustules over the entire body	4d	Compatible with generalized pustular psoriasis	Generalized pustular psoriasis	NM	Acitretin (25 mg/d), IV infliximab 5 mg/kg
2.7.1.2. Lichen planus or lichenoid reactions (n = 2)
With BNT162b2
59	Hiltun, I.	56	F	Lichen planus lesions 7 years prior (successfully treated with topical therapy)	NM	Neg	2	NM	Polygonal, well‐delimited, erythematous papules in the ankles, periumbilical area, flexural wrist and forearms and mammary and axillary folds, Dermoscopy: slight desquamation and Wickham's striae, no mucosal or nail involvement	2d	Typical findings of lichen planus with epidermal hyperplasia forming a characteristic saw‐tooth appearance with wedge‐shaped hypergranulosis, vacuolar degeneration of basal layer and dense lymphocytic infiltrate in the superficial dermis	Lichen planus	NM	High‐potency Topical corticosteroids
39	Burlando, Martina	47	M	Previously diagnosed with lichen planus located on both forearms	Neg	NM	1	NM	Sudden worsening of the preexisting papules, which spread to both arms and trunk	1d	Refused by patient	Lichenoid reactions	NM	Topical corticotherapy BD for 10d
2.7.1.3. Behçet's (n = 4)
With BNT162b2
30	Watad A.	21	M	Behcet's disease for 3 years	NM	Colchicine	1	NM	Oral aphthous ulcers	5d	NM	Behcet's disease flare	NM	20 mg Prednisone for 7d
30	Watad A.	55	M	Behcet's disease for 20 years	Chronic lymphocytic leukemia	Apremilast	2	Synovitis of small joints	Oral aphthous ulcers(on the tongue)	7d	NM	Behcet's disease flare	NM	Colchicine 0.5 mg BD, 5 mg Prednisone
30	Watad A.	20	M	Behcet's disease for 2 years	NM	Colchicine	1	NM	Oral aphthous ulcers	3d	NM	Behcet's disease flare	NM	Colchicine 2 mg daily
30	Watad A.	34	M	Behcet's disease for 10 years	Neg	Colchicine, Humira	1	NM	Pustular skin lesions	5d	NM	Behcet's disease flare	NM	NSAIDs, increase of Colchicine dose
2.7.1.4. Systemic lupus erythematosus (SLE) (n = 2)
With BNT162b2
30	Watad A.	78	F	Laboratory SLE	NM	NM	1	Fever and arthritis	Erythematous rash (generalized acute cutaneous lupus), purpura, oral aphthous ulcers	2d	Biopsy from purpura: leukocytoclastic vasculitis	Leukocytoclastic vasculitis	NM	Hydroxychloroquine
With ChAdOx1 nCoV‐ 19
30	Watad A.	50	F	SLEwith arthritis, mucosal ulcers and hemolysis	NM	NM	1	Severe hemolysis and arthralgia	Oral and nasal ulceration	14d	NM	SLE flare	NM	Prednisolone 60 mg daily, RTX
2.7.1.5. Other AIIRDs (n = 2)
With BNT162b2
30	Watad A.	62	F	Dermatomyositis	NM	Methotrexate, Plaquenil	1	NM	Skin rash similar to the dermatomyositis rash	7d	NM	Dermatomyositis flare	7d	Local Steroid cream
30	Watad A.	42	F	NM	Transient synovitis	NM	1	Migratory arthritis of small joints	Painless hemorrhagic rash on toes, erythema on small joints	4d	NM	Florid clinical arthritis of the PIP joints	7d	Prednisolone 10 mg, daily
2.7.3. Ulcerative colitis (UC) (n = 1)
With BNT162b2
30	Watad A.	28	M	NM	UC for 10 years, HES for 5 years, (well controlled)	Vedolizumab, Cyclosporin	1	Hemorrhagic diarrhea	Vesicular skin rash, oral aphthosis	4d	NM	Flare of HES and UC	NM	1 gr of Sulomedrol daily for 3d, Prednisone 60 mg/day
2.7.4. BCG scar local skin inflammation (n = 2)
With BNT162b2
60	Lopatynsky‐Reyes, E. Z.	31	F	NM	Neg	NM	1	headaches, chills, myalgias, pain at injection site, lymphadenopathies	Only after 2nd: inflammation area of 1.5 cm on the BCG scar site with erythema, induration, but painless to palpation (5 cm from the COVID vaccine injection site)	2nd: 2d	NM	BCG Scar Local Skin Inflammation	4d	2nd: three doses of Oral Paracetamol
With mRNA‐1273
60	Lopatynsky‐Reyes, E. Z.	28	F	NM	NM	NM	1 & 2	1st: pain, redness at the injection site, myalgias, arthralgias, malaise, 2nd: headache, nausea, myalgias, arthralgias, and malaise	1st: redness at injection site, 2nd erythematous reaction followed by pain, induration, and mild edema at BCG scar site (3 cm below COVID vaccine injection site)	2nd: 36 h	NM	BCG Scar Local Skin Inflammation	2d	2nd: four doses of Oral Paracetamol
2.7.5. Radiation recall phenomenon (n = 3)
With BNT162b2
61	Soyfer, V.	68	M	NM	Metastatic soft tissues sarcoma in the posterior chest wall and 1 lesion in the right lung	Preoperative radiation therapy, resection in the posterior chest wall	2	NM	pain, burning sensation, redness, and mild skin exfoliation in the area of the posterior chest wall electron field (the electron port shape closely resembles the erythematic area)	5d	NM	Radiation Recall Phenomenon	a few days	Topical steroids and painkillers
61	Soyfer, V.	64	M	NM	Metastatic solitary fibrous tumor	Radiation of lumbar vertebrae after spinal cord surgery	2	NM	Only after 2nd dose (14d after RT): skin redness and itching sensation, sparing the skin covering the lumbar spine	6d	NM	Radiation Recall Phenomenon	7d	Neg
With CoronaVac
62	Afacan, E	60	F	Melanoma	NM	Dabrafenib/Trametinib combination therapy	1	Sudden onset painful lesion on the medial side of the right leg	Well demarcated, erythematous, indurated plaque confined to an area of previous irradiation	5d	Epidermal intercellular edema, lymphocyte exocytosis, and rare necrotic keratinocytes as well as increased dermal collagenization and fibrosis	Radiation Recall Phenomenon	NM	NM
2.7.6. Inflammatory reaction to hyaluronic acid (HA) soft tissue fillers (n = 2)
With BNT162b2
63	Michon, A.	39	F	NM	Neg	Neg	1	flu‐ like illness symptoms (fatigue, headache, myalgias, and anorexia), which resolved within 4d	tender, erythematous swelling at the left tear trough area (areas previously treated with filler)	2d	NM	Delayed inflammatory reaction to HA fillers	5d	Spontaneous resolution
63	Michon, A.	61	F	NM	intermittent benign vertigo	Neg	1	Flu‐like illness symptoms	intermittent facial swelling mostly on cheeks and undereye (areas previously treated with filler), lasting for almost 1d per episode, and once for 72 h	1d	NM	Delayed inflammatory reaction to HA fillers	2d after hyaloronidase	75 units of hyaluronidase at a concentration of 150 units/mL
2.7.7. No Flare‐up in Autoimmune Disorders (n = 6)
With BNT162b2
64	Iannone, Michela	48	F	HS for 6 years (vaccination was after 90D of treatment with a single HS flare), anti–TNF‐ α‐induced lupus syndrome	Concomitant endometriosis	Surgical drains, systemic Clindamycin/Rifampicin, Ixekizumab SC 160 mg	1 & 2	NM	No adverse events and no HS flares	NM	NM	NM	NM	Routine continuation of Ixekizumab
65	Pacifico, A	48	M	Psoriasis, with flares of both PsO and PsA during asymptomatic COVID‐19 infection, spontaneous resolution 10 days after COVID‐19 remission	Psoriatic arthritis	Apremilast, achieving stable remission, maintained for 8 months	1 & 2	NM	No psoriasis flares with either dose	NM	NM	NM	NM	NM
65	Pacifico, A	36	F	Plaque psoriasis, concurrent pustular palmoplantar psoriasis area	NM	Apremilast and narrowband UVB for 3 years	NM	Neg	No psoriasis flares with either dose	NM	NM	NM	NM	NM
66	Rama, T. A.	37	F	Adult‐onset monomorphic maculopapular cutaneous mastocytosis lesions with generalized pruritus, flare up of lesions, and osteopenia	severe mast cells mediator‐related symptoms including abdominal colicky pain, bloating and diarrhea	Antihistamines, Montelukast	1	Neg	No mastocytosis flare	NM	NM	NM	NM	NM
66	Rama, T. A.	47	F	monomorphic maculopapular cutaneous mastocytosis, anaphylaxis with multiple drugs, pruritus	MC mediator‐related symptoms including migraines, gastroesophageal reflux, and osteopenia	Antihistamines, montelukast	1	Myalgia	No mastocytosis flare	1d	NM	NM	NM	NM
With ChAdOx1 nCoV‐19
65	Pacifico, A	76	M	Psoriasis for 4 years: stable residual Psoriasis area severity index (PASI) of 3	NM	Apremilast for 4 years	1	1st: fever (38.5°C) and myalgia for 3 days	No psoriasis flares with either dose	NM	NM	NM	NM	NM

Abbreviations: 1st, after the first dose; 2nd, after the second dose; AIIRD, autoimmune inflammatory rheumatic diseases; ASAT, aspartate aminotransferase; BD, twice a day; BPH, benign prostatic hypertrophy; CAD, coronary artery disease; CBLL, chilblain‐like lesions; CHD, coronary heart disease; CKD, chronic kidney disease; CVA, cerebrovascular accident; d, days; GGT 2N, gamma‐glutamyl transferase twice normal upper limit; HA, hyaluronic acid; HES, hypereosinophilic syndrome; HS, hidradenitis suppurativa; HTN, hypertension; IBS, irritable bowel syndrome; ITP, immune thrombocytopenic purpura; IVIG, intravenous immunoglobulin; MC, mast cell; MOGSD, myelin oligodendrocyte glycoprotein spectrum disorder; Neg, negative; NM, not mentioned; PIP, proximal interphalangeal; PLT, platelet; PO, by mouth; PsA, psoriatic arthritis; PsO, plaque psoriasis; RT, radiation therapy; RTX, rituximab; SC, subcutaneously; SLE, systemic lupus erythematosus; SLE, systemic lupus erythematosus; TDS, three times a day; UVB, ultraviolet B.

^a Supporting information Table S1.