Background: Several population-based studies have reported an increased risk of serious skin conditions following COVID-19 vaccinations, but their population samples were not representative. Accurately estimating these risks is important for understanding vaccine hesitancy and improving clinical practice.
Objectives: To compare the incidence rates (IRs) of bullous pemphigoid (BP), herpes zoster (HZ) and urticaria before and after the UK's COVID-19 vaccination programme started.
Methods: We conducted a population-based cohort study using electronic healthcare records from the Clinical Practice Research Datalink (1 January 2019-31 May 2023). We estimated monthly IRs (cases/100 000 person-years) for BP, HZ and urticaria. Using interrupted time series analysis, we compared changes in the IR slopes before and after the vaccine programme started (intervention). Sensitivity analyses were adjusted for COVID-19 lockdowns and total general practitioner (GP) appointments.
Results: In total, 16 156 639 adults (aged ≥ 18 years) registered at a general practice between 1 January 2019 and 31 May 2023 (BP, n = 3506; HZ, n = 129 668; urticaria, n = 63 320). The BP IR (cases/100 000 person-years) did not change postintervention vs. the preintervention period. We did not detect pre- and postintervention slopes. Sensitivity analysis results were similar. Preintervention, there was a downward slope for the HZ IR [-4.44, 95% confidence interval (CI) -5.54 to -3.35; P < 0.005]. The HZ IR increased postintervention vs. the preintervention period (5.15, 95% CI 3.43-6.88; P < 0.005). Despite the increase in the HZ IR, we found no evidence of a postintervention slope. Sensitivity analysis results were similar. Preintervention, there was a downward slope for the urticaria IR (-3.42, 95% CI -4.13 to -2.70; P < 0.005). The urticaria IR increased postintervention vs. the preintervention period (4.40, 95% CI 3.27-5.53; P < 0.005), resulting in an upward slope (0.98, 95% CI 0.43-1.52; P < 0.005). However, after accounting for lockdowns or GP appointments, the upward postintervention slope was no longer apparent.
Conclusions: While the BP IR did not change following the COVID-19 vaccine programme in the UK, we detected increased IRs for HZ and urticaria. However, these increases were modest, and, for many, the benefits of vaccination will probably outweigh the potential risks. Future research should use individual patient-level studies (e.g. self-controlled case series) to determine whether the increases in HZ and urticaria IRs are driven by COVID-19 vaccines.
Following the start of COVID-19 immunization programmes worldwide, serious skin reactions were reported after getting the COVID-19 vaccines. These included bullous pemphigoid (‘BP’ for short), shingles and hives. BP is a rare autoimmune skin disease that mainly affects older people. About 8 in 100,000 people a year in the UK develop BP. The cause of BP is unknown. Symptoms often start with very itchy skin and a rash. Over time, these develop into painful blisters and open sores. Shingles typically results in a painful rash over the chest and abdomen. The condition is most common in people older than 80 years of age. About 1,100 in 100,000 people a year in the UK develop shingles. Hives presents as a rash with raised bumps. Around 8% to 10% of the UK’s population will get hives at least once in their lives, mostly between the ages of 20 and 40 years old. Previous studies found links between COVID-19 vaccines and BP, shingles and hives. However, the people included in the studies were not representative of the UK’s population. Accurate estimates of the risks of developing these diseases with a sample representative of the UK are important. More accurate information will help healthcare professionals and inform those who are hesitant about vaccines. In this study, we used information gathered by more than 2,000 general practices in the UK to compare changes in how often BP, shingles and hives were seen before and after the COVID-19 vaccination programme. We found that the number of cases of BP did not change after the vaccination programme. Cases of shingles and hives increased. However, the increases were not large. The benefits of vaccination will probably outweigh the potential risk of developing hives and shingles for many people. Future research should explore whether the increases in BP, shingles and hives that we found are driven by the COVID-19 vaccines or other reasons.
© The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists.