Generalized erythrodermic psoriasis triggered by vaccination against severe acute respiratory syndrome Coronavirus 2

Abstract

Generalized erythrodermic psoriasis (GEP) is a rare and potentially life-threatening variant of psoriasis. Possible triggers that have been identified to date include poorly controlled psoriasis, medications, abrupt discontinuation of anti-psoriatic treatment, and underlying systemic illnesses. However, vaccines have rarely been reported to exacerbate GEP. Herein, we report two unique cases with GEP exacerbated following a dose of the BNT162b2 mRNA vaccine for COVID-19 (as their second dose, the first being the mRNA-1273 vaccine). Based on our observations and a literature review, vaccination was considered the most likely trigger of GEP due to the close temporal relationship between the second vaccination and the onset of GEP.

Keywords: BNT162b2 vaccine; COVID-19; SARS-CoV-2 vaccination; generalized erythrodermic psoriasis; mRNA-1273 vaccine.

FIGURE 1

(A–C) Generalized erythroderma and exudative desquamation on the head, trunk, and extremities in combination with lower extremity edema; (D, E) Nail changes, including nail pitting and oil spots, are observed in the nails of both hands and feet (patient 1). (F, G) Generalized erythroderma affected more than 90% body surface area (patient 2)