Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study

J Am Acad Dermatol. 2022 Jan;86(1):113-121. doi: 10.1016/j.jaad.2021.09.002. Epub 2021 Sep 10.

Abstract

Background: Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized.

Methods: We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns.

Results: Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym "V-REPP" (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5).

Limitations: Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence.

Conclusion: Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.

Keywords: AZD1222; Ad26.COV2.S; BNT162b2; COVID-19; Johnson & Johnson Janssen; Moderna; Oxford-AstraZeneca; Pfizer-BioNTech; SARS-CoV-2; Stevens-Johnson syndrome; bullous pemphigoid; chilblains; delayed large local; dermal hypersensitivity reaction; dermatology; dermatopathology; erythema multiforme; erythromelalgia; lichen planus; mRNA-1273; morbilliform; papular; papulosquamous; pathology; pernio; pityriasis rosea; psoriasis; registry; urticaria; vaccine; zoster.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19 Vaccines / adverse effects*
  • COVID-19* / prevention & control
  • Exanthema* / chemically induced
  • Humans
  • Registries
  • Skin Diseases / chemically induced*

Substances

  • COVID-19 Vaccines