A systematic review on mucocutaneous presentations after COVID-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders

Abstract

With dermatologic side effects being fairly prevalent following vaccination against COVID-19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent, in order to provide a thorough body of information about these post-COVID-19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID-19 vaccine administration were retrieved using the following keywords: COVID-19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life-threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non-significant, self-limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare-ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra-indications.

Keywords: AstraZeneca; AstraZeneca/Oxford; Bharat; COVID-19 vaccine; Comirnaty; Janssen; Johnson & Johnson; Moderna; Pernio; Petechia; Pfizer; Pfizer-BioNTech; SARS-Cov-2; Sinopharm; Sinovac; Sputnik; Vaccine Adverse Event Reporting System; acute; adverse effect; adverse event; adverse event following immunization; allergy; angioedema; atopic dermatitis; collagen vascular disease; cutaneous; cyanosis; delayed; delayed-type hypersensitivity; dermatology; ecchymosis; edema; erythema multiforme; exanthematous rash; herpes; hidradenitis suppurativa; inflammatory bowel disease; injection site reaction; late; local site reaction; maculopapular rash; mastocytosis; morbilliform rash; mucocutaneous; mucosal; pemphigoid; pemphigus; pityriasis rosea; pruritus; psoriasis; purpura; remote site reaction; rheumatic disorders; side effect; urticaria; vaccine; zoster.

FIGURE 1

PRISMA flow diagram of the study