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Pityriasis lichenoides et varioliformis acuta following COVID‐19 mRNA vaccination

2022; Wiley; Volume: 36; Issue: 5 Linguagem: Inglês

10.1111/jdv.17912

1468-3083

Jenni Palmén, Mervi Lepistö, Lauri Talve, Niina Hieta,

Skin Diseases and Diabetes

Journal of the European Academy of Dermatology and VenereologyEarly View Letter to the EditorFree Access Pityriasis lichenoides et varioliformis acuta following COVID-19 mRNA vaccination J. Palmén, J. Palmén Departments of Dermatology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorM. Lepistö, M. Lepistö Departments of Pathology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorL. Talve, L. Talve Departments of Pathology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorN. Hieta, Corresponding Author N. Hieta niina.hieta@utu.fi orcid.org/0000-0001-6449-3076 Departments of Dermatology, Turku University Hospital and University of Turku, Turku, Finland *Correspondence: N. Hieta. E-mail: niina.hieta@utu.fiSearch for more papers by this author J. Palmén, J. Palmén Departments of Dermatology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorM. Lepistö, M. Lepistö Departments of Pathology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorL. Talve, L. Talve Departments of Pathology, Turku University Hospital and University of Turku, Turku, FinlandSearch for more papers by this authorN. Hieta, Corresponding Author N. Hieta niina.hieta@utu.fi orcid.org/0000-0001-6449-3076 Departments of Dermatology, Turku University Hospital and University of Turku, Turku, Finland *Correspondence: N. Hieta. E-mail: niina.hieta@utu.fiSearch for more papers by this author First published: 11 January 2022 https://doi.org/10.1111/jdv.17912Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Editor Pityriasis lichenoides (PL) is an uncommon acquired dermatosis of unclear origin, which can occur in several forms, including pityriasis lichenoides chronica (PLC) and pityriasis lichenoides et varioliformis acuta (PLEVA).1 PLEVA typically presents with generalized papules that undergo necrosis and varioliform scarring. There is no current consensus regarding PL treatment.2 In under two years, several efficient vaccines against COVID-19 have been developed, tested and clinically used. The messenger RNA (mRNA) vaccines against COVID-19 are associated with cutaneous side effects, most commonly including delayed large local reactions, local injection site reactions, urticarial eruptions and morbilliform eruptions.3 Here, we describe the case of an 81-year-old man with hypertension and arthrosis. He was taking telmisartan/hydrochlorothiazide 80/12.5 mg once daily, and pain and sleeping medications as needed. Nine days after receiving his first dose of COVID-19 mRNA vaccine (BioNTech/Pfizer BNT162b2), the patient developed a pruritic rash on his upper back, shoulders and posterior neck. During the following 6 weeks, the rash transformed into ulcerating oval lesions. These lesions progressed to crusting over and eventually scarring, with new lesions appearing periodically. The patient’s general practitioners initially prescribed treatment with antibiotics and short courses of oral prednisolone, and then referred the patient to the dermatology clinic. Ulcerations were observed on the upper part of the back, neck and proximal arms (Fig. 1). Biopsies from the lesions on the back and upper arm revealed ulceration, without a specific aetiology. Immunofluorescence staining revealed that the biopsies were negative for immunoglobulins A, G and M, and complement 3 (C3). Laboratory analyses revealed normal complete blood count and liver and kidney function, and negative results for antibodies against blistering skin diseases, nuclear antibodies and ANCA antibodies. Urine and serological analyses were negative for HIV, HBV, HCV and Treponema pallidum. Total IgE was elevated (956 kU/L, reference value <110 kU/L), probably related to the atopic eczema. The patient’s history revealed no prior or current infections or new medications. Whole-body CT and orthopantomography were performed to further exclude possible infections and malignancies. Figure 1Open in figure viewerPowerPoint (a). Erosions and ulcerations on the patient’s neck and upper back. Only the upper back, back of the neck and arms were affected. (b) The lesions were oval, ranging from 2 to 15 mm in size. Blue circles mark the locations of punch biopsies for histological and immunofluorescence samples. (c) Superficial scars on the patient’s upper back in remission. (d) A punch biopsy from the right scapular area, showing a non-specific shallow erosion with inflammation. Haematoxylin–eosin, original magnification 40×. The patient was treated with prednisolone, starting with 30 mg/day, and high-potency topical corticosteroids. Five months from the onset of symptoms, spontaneous remission was achieved and treatments were discontinued. The ulcerations had healed, leaving scars. Two months later, no new lesions have appeared. We recommended that the patient receive a second vaccination against COVID-19, but he has declined it. The aetiology of pityriasis lichenoides is unknown. It has been suggested to be an inflammatory response to extrinsic antigens, such as infectious agents, drugs and vaccines.4 The literature describes only 11 cases of vaccine-induced PL.5 The patients were mainly young, 1.08–37 years of age, with almost twofold male dominance. The time from vaccination to symptoms ranged from 1 to 10 days.5 COVID-19 infection has reportedly caused PLEVA-like symptoms in 10 paediatric patients.6 Additionally, one publication describes a case of PLC immediately following COVID-19 infection in a 42-year-old female patient.7 There have been two reported cases of PLEVA following COVID-19 vaccination. Interestingly, the first patient was also an elderly (70-year-old) male.8 He started exhibiting symptoms of PLEVA at 5 days after his second vaccination with BioNTech/Pfizer BNT162b2. This patient had acute lymphocytic leukaemia in complete remission. PLEVA remission was achieved within 10 weeks of topical treatment. The second patient was a 31-year-old otherwise healthy woman, who had bilateral inguinal lymphadenopathy and PLEVA-like skin symptoms.9 Histologic and immunohistochemical samples showed a lymphomatoid drug reaction. Her symptoms tapered within 2 months with oral prednisolone. In summary, here, we report the third case of PLEVA following administration of a COVID-19 mRNA vaccine, which shows several similarities to another published case. Vaccination against COVID-19 is strongly recommended despite reported skin reactions. Acknowledgement The patient in this manuscript has given written informed consent to the publication of his case details. Conflicts of interest The authors do not have any conflicts of interest to declare. Funding source None. Open Research Data availability statement Data sharing is not applicable, and no new data were generated. 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