Skip to main content
NCBI home page
Wiley - PMC COVID-19 Collection logoLink to Wiley - PMC COVID-19 Collection
letter
. 2022 Jun 13;35(8):e15602. doi: 10.1111/dth.15602

Reply to “the significance of investigating clinical, histopathologic and virological features in pityriasis rosea and pityriasis rosea‐like eruptions following COVID‐19 vaccinations” by Ciccarese G. et al.

Fabrizio Martora 1,✉, Vincenzo Picone 1, Teresa Battista 1, Gabriella Fabbrocini 1, Claudio Marasca 1
PMCID: PMC9347714  PMID: 35622446

Dear Editor,

We have read with great interest the correspondence entitled “The significance of investigating clinical, histopathologic and virological features in pityriasis rosea and pityriasis rosea‐like eruptions following COVID‐19 vaccinations” written by Ciccarese G. et al. regarding our article about Pityriasis rosea after Moderna mRNA‐1273 vaccine. 1

We agree with the comments made by colleagues, particularly that serology for HHV‐6 and HHV‐7 may be useful in order to distinguish among between Pityriasis Rosea (PR) and Pityriasis Rosea like eruption (PR‐Like).

In addition, it has been recently showed that the onset time of PR‐Like after vaccination is on average 7 days, 2 in our case series only one patient may be considered a PR‐like while the other two patients presented the manifestations after 7 days getting more likely to a classic PR. Moreover, the morphology of the lesions with erythematous macules finely scaling, the classic distribution with involvement of the trunk and limbs (face spared) with lesions symmetrically localized on long axes along the cleavage lines led to a classic PR. Finally, another significant issue was the mean period of manifestations: PR in our case series lasted about 40 days. All these features just mentioned allowed us to lean toward a PR rather than a PR‐like. 3

Although serology may be helpful for diagnostic and epidemiological purposes, it was not performed in our case, since worldwide the diagnosis of PR is based on clinical and physical examination findings. 4

We recently pointed out on PR linked to COVID‐19 vaccination that may persist for more than 6–8 weeks and may be resistant to conventional therapies. 5 Regarding therapy management systemic antiviral therapy 6 may be useful in relapsing or persistent forms even if the only symptomatic therapy may be enough to manage the most cases.

After almost a year‐and‐a‐half from the start of vaccination, there are now several studies 7 and case reports highlighting the various reactions that may occur after vaccination, in addition to PR, such as urticarial reactions, delayed local reactions, herpes zoster, 8 , 9 covid arm, 10 onset of de novo psoriasis 11 or lichen planus 12 or worsening of hidradenitis suppurativa 13 , 14 , 15 , 16 and atopic dermatitis. 17 , 18 , 19

In conclusion, we agree with the authors that these post‐vaccination reactions should not discourage the completion of the entire scheduled vaccination cycle.

CONFLICT OF INTEREST

None of the contributing authors has any conflict of interest, including specific financial interests or relationships and affiliation relevant to the subject matter or discussed materials in the manuscript. All authors equally contributed to the work.

INFORMED CONSENT

Patient gave her informed consent for publication of her case.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

  • 1. Martora F, Fabbrocini G, Marasca C. Pityriasis rosea after Moderna mRNA‐1273 vaccine: a case series. Dermatol Ther. 2022;35(2):e15225. doi: 10.1111/dth.15225 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Català A, Muñoz‐Santos C, Galván‐Casas C, et al. Cutaneous reactions after SARS‐CoV‐2 vaccination: a cross‐sectional Spanish nationwide study of 405 cases. Br J Dermatol. 2022;186(1):142‐152. doi: 10.1111/bjd.20639 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Drago F, Ciccarese G, Parodi A. Pityriasis rosea and pityriasis rosea‐like eruptions: how to distinguish them? JAAD Case Rep. 2018;4(8):800‐801. doi: 10.1016/j.jdcr.2018.04.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Villalon‐Gomez JM. Pityriasis Rosea: diagnosis and treatment. Am Fam Physician. 2018;97(1):38‐44. [PubMed] [Google Scholar]
  • 5. Martora F, Picone V, Fornaro L, Fabbrocini G, Marasca C. Can COVID‐19 cause atypical forms of pityriasis rosea refractory to conventional therapies? J Med Virol. 2022;94(4):1292‐1293. doi: 10.1002/jmv.27535 [DOI] [PubMed] [Google Scholar]
  • 6. Drago F, Vecchio F, Rebora A. Use of high‐dose acyclovir in pityriasis rosea. J Am Acad Dermatol. 2006;54(1):82‐85. doi: 10.1016/j.jaad.2005.06.042 [DOI] [PubMed] [Google Scholar]
  • 7. McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID‐19 vaccination: a registry‐based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46‐55. doi: 10.1016/j.jaad.2021.03.092 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Martora F, Fabbrocini G, Picone V. A case of herpes zoster ophthalmicus after third dose of Comirnaty (BNT162b2 mRNA) vaccine [published online ahead of print, 2022 Feb 27]. Dermatol Ther. 2022;35:e15411. doi: 10.1111/dth.15411 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Vastarella M, Picone V, Martora F, Fabbrocini G. Herpes zoster after ChAdOx1 nCoV‐19 vaccine: a case series. J Eur Acad Dermatol Venereol. 2021;35(12):e845‐e846. doi: 10.1111/jdv.17576 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Picone V, Martora F, Fabbrocini G, Marano L. "Covid arm": abnormal side effect after Moderna COVID‐19 vaccine. Dermatol Ther. 2022;35(1):e15197. doi: 10.1111/dth.15197 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Megna M, Potestio L, Gallo L, Caiazzo G, Ruggiero A, Fabbrocini G. Reply to “Psoriasis exacerbation after COVID‐19 vaccination: report of 14 cases from a single centre” by Sotiriou E Fabbrocini et al. J Eur Acad Dermatol Venereol. 2022;36(1):e11‐e13. doi: 10.1111/jdv.17665 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Picone V, Fabbrocini G, Martora L, Martora F. A case of new‐onset lichen planus after COVID‐19 vaccination. Dermatol Ther (Heidelb). 2022;12(3):801‐805. doi: 10.1007/s13555-022-00689-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. Marasca C, Ruggiero A, Megna M, Annunziata MC, Fabbrocini G. Biologics for patients affected by hidradenitis suppurativa in the COVID‐19 era: data from a referral center of Southern Italy. J Dermatolog Treat. 2022;33(1):592. doi: 10.1080/09546634.2020.1769828 [DOI] [PubMed] [Google Scholar]
  • 14. May COVID‐19 outbreaks lead to a worsening of skin chronic inflammatory conditions?. DOI: 10.1016/j.mehy.2020.109853 [DOI] [PMC free article] [PubMed]
  • 15. Teledermatology and chronic skin diseases: Real life experience in a Southern Italian Dermatologic Centre. DOI: 10.1111/dth.13839 [DOI] [PubMed]
  • 16. Martora F, Picone V, Fabbrocini G, Marasca C. Hidradenitis suppurativa flares following COVID‐19 vaccination: a case series. JAAD Case Rep. 2022;23:42‐45. doi: 10.1016/j.jdcr.2022.03.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Napolitano M, Patruno C, Ruggiero A, Nocerino M, Fabbrocini G. Safety of dupilumab in atopic patients during COVID‐19 outbreak. J Dermatolog Treat. 2022;33(1):600‐601. doi: 10.1080/09546634.2020.1771257 [DOI] [PubMed] [Google Scholar]
  • 18. Annunziata MC, Patrì A, Ruggiero A, et al. Cutaneous involvement during COVID‐19 pandemic: an emerging sign of infection. J Eur Acad Dermatol Venereol. 2020;34(11):e680‐e682. doi: 10.1111/jdv.16769 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Martora F, Fabbrocini G, Nappa P, Megna M. Impact of the COVID‐19 pandemic on hospital admissions of patients with rare diseases: an experience of a Southern Italy referral center [published online ahead of print, 2022 May 10]. Int J Dermatol. 2022;3(6). doi: 10.1111/ijd.16236 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Articles from Dermatologic Therapy are provided here courtesy of Wiley

RESOURCES