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. 2025 Mar 8;17(3):e80257.
doi: 10.7759/cureus.80257. eCollection 2025 Mar.

Cutaneous Adverse Events Following COVID-19 Vaccination in Japan: A Questionnaire Survey

Yuto Yamamura  1 , Chisa Nakashima  1 , Nana Kagawa  1 , Yumi Aoyama  2 , Akihisa Yamamoto  3 , Hisao Kawahira  4 , Yumiko Kubota  5 , Saeko Nakajima  6 , Takeshi Nakahara  7 , Yoko Fuyuno  7 , Daisuke Tsuruta  8 , Ayaki Matsumoto  8 , Risa Matsuo  9 , Riichiro Abe  10 , Akihiko Yuki  11 , Hayato Takahashi  12 , Chiaki Takahashi  12 , Shin'Ichi Imafuku  13 , Emi Sato  13 , Susumu Fujiwara  14 , Masahito Yasuda  15 , Yayoi Tada  16 , Kotaro Hayashi  16 , Norito Katoh  17 , Daisuke Watanabe  18 , Atsushi Otsuka  1
Affiliations

Cutaneous Adverse Events Following COVID-19 Vaccination in Japan: A Questionnaire Survey

Yuto Yamamura et al. Cureus. .

Abstract

We conducted a nationwide survey in Japan to clarify the clinical spectrum of these events. An initial questionnaire was sent to 126 dermatology facilities, and responses were obtained from 66 (52.4%). Among these responding facilities, the most commonly identified cutaneous adverse events after COVID-19 vaccination were urticaria (49 (74.2%)), delayed local reactions (37 (56.1%)), erythema multiforme (31 (47.0%)), and alopecia (30 (45.5%)). In the detailed survey, the primary adverse events were EM (19 (20.9%)), bullous pemphigoid (7 (7.7%)), and alopecia (6 (6.6%)). The mean latency from vaccination to onset was 13.1 days, and the mean duration of symptoms was 74.2 days. Although this study cannot establish a direct causal relationship between vaccination and adverse events, it highlights the need for dermatologists to recognize potential cutaneous reactions and provide appropriate care.

Keywords: alopecia; bullous pemphigoid; covid-19 vaccine; cutaneous adverse events; erythema multiforme; psoriasis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Ethics Committee of Aichi Medical University Hospital issued approval 2022-233. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This research was funded by MHLW Research on Emerging and Re-emerging Infectious Diseases and Immunization, under Program Grant Number JPMH21HA2011 and JPMH23HA2011. Financial relationships: Norito Katoh declare(s) personal fees from Pfizer. Norito Katoh has received honoraria as a speaker/consultant for Pfizer. . Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Cutaneous adverse events to COVID-19 vaccines in the initial questionnaire survey
Out of the 66 facilities surveyed, the most commonly reported dermatological adverse events were urticaria (49 (74.2%)), delayed local reactions (37 (56.1%)), EM (31 (47.0%)), and alopecia (30 (45.5%)). Disseminated maculopapular rash (23 (34.8%)), herpes zoster (23 (34.8%)), exacerbation of atopic dermatitis (20 (22.0%)), and exacerbation of psoriasis (17 (25.8%)) were also frequently reported.
Figure 2
Figure 2. Cutaneous adverse events to COVID-19 vaccines in the detailed survey
(a) A total of 91 cases of cutaneous adverse events were observed at 15 facilities in the detailed survey. The main cutaneous adverse events were EM in 19 (20.9%) cases, bullous pemphigoid in 7 (7.7%) cases, alopecia in 6 (6.6%) cases, disseminated maculopapular rash in 5 (5.5%) cases, delayed local reactions in 5 (5.5%) cases, herpes zoster in 4 (4.4%) cases, and exacerbation of psoriasis in 4 (4.4%) cases. (b) Number of vaccine doses received prior to the onset of adverse events in 91 cases: one dose in 35 (38.5%) cases, two doses in 21 (23.1%) cases, three doses in 21 (23.1%) cases, four doses in 5 (5.5%) cases, five doses in 8 (8.8%) cases, and unknown in 1 (1.1%) case. (c) Booster vaccination status after the development of adverse events in 91 cases: received in 22 (24.2%) cases, not received in 44 (48.4%) cases, and unknown in 25 (27.5%) cases. (d) Treatments for cutaneous adverse events in 91 cases: topical corticosteroids in 63 (69.2%) cases, oral antihistamines in 45 (49.5%) cases, oral corticosteroids in 46 (50.5%) cases, oral cyclosporine in 1 (1.1%) case, steroid pulse therapy in 3 (3.3%) cases, high-dose intravenous immunoglobulin therapy in 1 (1.1%) case, anti-IL-4/13 receptor antibody administration in 1 (1.1%) case, topical JAK inhibitor in 1 (1.1%) case, phototherapy in 8 (8.8%) cases, other treatments in 6 (6.6%) cases, and no treatment in 12 (13.2%) cases.
Figure 3
Figure 3. Characteristics of common cutaneous adverse events in the detailed survey
(a) Number of vaccine doses received prior to the onset of adverse events in cases of EM, (c) BP, and (e) alopecia. (b) Booster vaccination status after the development of cutaneous adverse events in cases of EM, (d) BP, and (f) alopecia. A total of 19 cases of EM, 7 cases of BP, and 6 cases of alopecia were observed in the detailed survey.
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