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. 2022 Jan;186(1):142-152.
doi: 10.1111/bjd.20639. Epub 2021 Sep 21.

Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases

A Català  1 , C Muñoz-Santos  2 , C Galván-Casas  3 , M Roncero Riesco  4 , D Revilla Nebreda  4 , A Solá-Truyols  5 , P Giavedoni  1 , M Llamas-Velasco  6 , C González-Cruz  7 , X Cubiró  8 , R Ruíz-Villaverde  9 , S Gómez-Armayones  1 , M P Gil Mateo  10 , D Pesqué  11 , O Marcantonio  11 , D Fernández-Nieto  12 , J Romaní  13 , N Iglesias Pena  14 , L Carnero Gonzalez  15 , J Tercedor-Sanchez  16 , G Carretero  17 , T Masat-Ticó  18 , P Rodríguez-Jiménez  6 , A M Gimenez-Arnau  11 , M Utrera-Busquets  19 , E Vargas Laguna  20 , A G Angulo Menéndez  21 , E San Juan Lasser  22 , M Iglesias-Sancho  23 , L Alonso Naranjo  24 , I Hiltun  25 , E Cutillas Marco  26 , I Polimon Olabarrieta  3 , S Marinero Escobedo  3 , X García-Navarro  27 , M J Calderón Gutiérrez  28 , G Baeza-Hernández  29 , L Bou Camps  30 , T Toledo-Pastrana  31 , A Guilabert  2
Affiliations

Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases

A Català et al. Br J Dermatol. 2022 Jan.

Abstract

Background: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized.

Objective: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination.

Methods: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification.

Results: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment.

Conclusions: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.

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Figures

Figure 1
Figure 1
Study flowchart of the inclusion and exclusion of reported reactions. SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; HSV, herpes simplex virus; VZV, varicella zoster virus.
Figure 2
Figure 2
Summary of the main features of the six reaction patterns.
See this image and copyright information in PMC

Comment in

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